(1)
Consignment Code Certificate Number
According to the provisions of Commission Implementing Regulation (EU) 2015/175 laying down special conditions applicable to the import of guar gum originating in or consigned from India due to contamination risks by pentachlorophenol and dioxins, the
(competent authority referred to in Article 5(2) of Regulation (EU) 2015/175)
CERTIFIES that the
(insert feed or food referred to in Article 1 of Regulation (EU) 2015/175)
of this consignment composed of:
(description of consignment, product, number and type of packages, gross or net weight)
embarked at (embarkation place)
by (identification of transporter)
going to (place and country of destination)
which comes from the establishment
(name and address of establishment)
have been produced, sorted, handled, processed, packaged and transported in line with good hygiene practices.
From this consignment, samples were taken in accordance with Commission Directive 2002/63/EC on (date), subjected to laboratory analysis on
(date) in the
(name of laboratory). The details of sampling, methods of analysis used and all results are attached.
This certificate is valid until
Done at on
Stamp and signature of authorised representative of competent authority referred to in Article 5(2)
Product and country of origin.