Health Certificate Template For Dog - Free Download
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Health Certificate Template For Dog
Health Certificate Template For Dog
(Form No.: VC-DC2-Jul13E_v1)
Animal Health Certificate
(for Dog & Cat to be Exported to Hong Kong from Group II Countries/Places only)
IMPORTANT : Please read the Notes overleaf before completing this form
PART A: DECLARATION BY *OWNER / CONSIGNOR (To be completed by owner / consignor)
Dog/Cat: Breed: Sex: Age: Year Month
Colour :
Microchip No:
Type of Microchip: #
AVID
#
Other ISO Compatible
Expected Date of Animal to be
Exported: (dd/mm/yy)
Address of premises where the animal has been continuously resident during the preceding 180
days or since birth :
Name and address of consignee in Hong Kong (Mandatory Field) :
(Remarks: The name of consignee must match with the one as stated in the Special Permit)
The above mentioned animal is 5 months old or older.
I, the undersigned, am the *owner/consignor of the above animal and declare that the above information is true and correct.
Signature :______________________ Name in Block Letter: _______________________ Date : ______/______/_______(dd/mm/yy)
Address/Telephone/E-mail:
PART B: VETERINARY CERTIFICATE (This certificate is valid for 14 days from the date of issue)
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: (Note: The animal can only be exempted from quarantine provided all the following terms are attested
as “true”)
Please tick in the appropriate boxes
True False
(a)
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 correct.
(b)
After due enquiry I am satisfied that the animal has been continuously residing in the country/place of export during
the preceding 180 days or since birth prior to departure from that country/place. The area within 10km of animal
premises has been free of reported cases of rabies in any animals (excluding bats) during the preceding 180 days
from the date of departure.
(c)
The animal has been vaccinated against rabies on ___________________ (date) that is less than one year and
more than 30 days prior to departure. In the case of primary vaccination the animal was at least 90 days old when
vaccinated.
A copy of the history of all rabies vaccination records must be attached to this certificate
(d)
The animal is free of any quarantine restrictions imposed by the government authority of the country/place of
export.
(e) The animal is free from clinical signs of infectious or contagious disease and is fit to travel to Hong Kong.
(f)
I have sighted the attached vaccination records/certificates and confirmed that the animal has been vaccinated
against the following canine/feline diseases on ___________________ (date) that is not less than 14 days and not
more than 1 year before coming into Hong Kong.
Dog-- Canine Distemper, Infectious Canine Hepatitis and Canine Parvovirus.
Cat -- Feline Panleucopaenia ( Infectious Enteritis ), Feline Respiratory Disease Complex ( Cat Flu ).
 A copy of the history of above mentioned vaccination records must be attached to this certificate 
(g) I certify that the animal is either not pregnant or less than 4 weeks pregnant if it is a female.
Signature :______________________ Name in Block Letter :____________________________Date :______/______/______(dd/mm/yy)
*Official Capacity : Seal or Stamp
Address/Telephone/Fax/E-mail :
PART C: OFFICIAL AUTHORITY (This part must be fully completed and stamped/sealed by a full time salaried
Government Veterinary Officer.)
I am a full time Government Veterinary Officer and I confirm that the above information is correct and the above mentioned veterinary
surgeon is registered and licensed to practise in the country/place from where the animal is exported.
Signature :______________________ Name in Block Letter :___________________________ Date :______/______/______(dd/mm/yy)
Official Capacity : Official Seal or Stamp
Address/Telephone/Fax/E-mail :
* Delete as appropriate
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source: afcd.gov.hk
Health Certificate Template For Dog
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