动物健康证明书-（适用於从第三组国家地方出口猫狗到香港.PDFVIP

動物健康證明書 - (適用於從第三組國家／地方出口貓狗到香港) Animal Health Certificate-- For Dog Cat to be Exported to Hong Kong from Group III Countries / Places 甲部PART A ：*動物主人╱發貨人聲明 DECLARATION BY *OWNER / CONSIGNOR(此部分須由動物主人╱發貨人填寫To be completed by owner / consignor) 狗Dog╱貓Cat ： 品種Breed ： 性別Sex ： 年歲Age ： 顏色Colour ： 微型晶片鑑別編號 晶片閱讀機型Type of Microchip ：# AVID Microchip No ： #其它Others( ISO) 該動物在出口地居住的處所地址Address of premises where the animal has been residing ： 香港收貨人的姓名和地址 (此欄必須填寫)Name and address of consignee in Hong Kong (Mandatory Field) ： (註: 收貨人姓名須與特別許可證上持證人的姓名相符合) (Remark : The name of consignee must match with the one as stated in the Special Permit) 本人，即下開簽署人，為上述*動物之主人╱發貨人，現聲明上述資料皆屬正確無誤。 I, the undersigned, am the *owner/consignor of the above animal and declare that the above information is true and correct. 簽署Signature ： ____________________________ 姓名（正楷）Name in Block Letter ： ________________________ 日期Date : ______年yy________月mm______ 日dd 地址／電話／電子郵件Address/Telephone/E-mail ： 乙部PART B ：獸醫證明書VETERINARY CERTIFICATE (本證明書有效期由簽發日期起計14天內有效This certificate is valid for 14 days from the date of issue) 本人乃該動物出口國／地方*政府獸醫師／註冊執業獸醫 ，現證明下列各項： I, * a government veterinary officer / a registered veterinary surgeon licensed to practise in the country/place from where the animal is exported, certify the following: 請在適當空格內填上號 Please tick  in the appropriate boxes   是 不是 True False 本人認為上方甲部之*動物主人／發貨人所作之聲明乃屬正確，並已查核上述微型晶片鑑 (1) 別編號正確。I am satisfied as to the correctness of the declaration made by the *owner/consignor in Part A above. I have checked that the microchip number above is