Commission Implementing Regulation (EU) 2016/6Show full title

ANNEX III

Declaration for the import into the Union of …(Product and country of origin)

Batch identification Code …Declaration Number …

In accordance with Commission Implementing Regulation (EU) 2016/6 imposing special conditions governing the import of feed and food originating in or consigned from Japan following the accident at the Fukushima nuclear power station the

…

(authorised representative referred to in paragraphs 2 or 3 of Article 6 of Implementing Regulation (EU) 2016/6)

DECLARES that the ……(products referred to in Article 5(1) of Implementing Regulation (EU) 2016/6) of this consignment composed of: ……(description of consignment, product, number and type of packages, gross or net weight) embarked at …(embarkation place) on …(date of embarkation) by …(identification of transporter) going to …(place and country of destination) which comes from the establishment ……(name and address of establishment)

is compliant with the legislation in force in Japan as regards the maximum levels for the sum of caesium-134 and caesium-137.

DECLARES that the consignment concerns:

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mushrooms, fish and fishery products, rice, soybeans, (Japanese) persimmon, Japanese or giant butterbur (fuki), Aralia spp., bamboo shoot, bracken, Japanese royal fern, ostrich fern and koshiabura or a derived product thereof or a compound feed or food containing more than 50 % of those products, which have been harvested and/or processed before 11 March 2011;

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mushrooms, fish and fishery products, rice, soybeans, (Japanese) persimmon, Japanese or giant butterbur (fuki), Aralia spp., bamboo shoot, bracken, Japanese royal fern, ostrich fern and koshiabura or a derived product thereof or a compound feed or food containing more than 50 % of those products, which do not originate in and are not consigned from one of the prefectures listed in Annex II to Implementing Regulation (EU) 2016/6, for which the sampling and analysis of this product is required;

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mushrooms, fish and fishery products, rice, soybeans, (Japanese) persimmon, Japanese or giant butterbur (fuki), Aralia spp., bamboo shoot, bracken, Japanese royal fern, ostrich fern and koshiabura or a derived product thereof or a compound feed or food containing more than 50 % of those products, which are consigned from but do not originate in one of the prefectures listed in Annex II to Implementing Regulation (EU) 2016/6, for which the sampling and analysis of this product is required and have not been exposed to radioactivity during transiting;

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mushrooms, fish and fishery products, rice, soybeans, (Japanese) persimmon, Japanese or giant butterbur (fuki), Aralia spp., bamboo shoot, bracken, Japanese royal fern, ostrich fern and koshiabura or a derived product thereof or a compound feed or food containing more than 50 % of those products, which originate in one of the prefectures listed in Annex II to Implementing Regulation (EU) 2016/6, for which the sampling and analysis of this product is required, and have been sampled on …(date) and subjected to laboratory analysis on …(date) in the …(name of laboratory), to determine the level of the radionuclides, caesium-134 and caesium-137. The analytical report is attached;

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mushrooms, fish and fishery products, rice, soybeans, (Japanese) persimmon, Japanese or giant butterbur (fuki), Aralia spp., bamboo shoot, bracken, Japanese royal fern, ostrich fern and koshiabura of unknown origin or a derived product thereof or a compound feed or food containing more than 50 % of those products as (an) ingredient(s) of unknown origin, which have been sampled on …(date) and subjected to laboratory analysis on …(date) in the …(name of laboratory), to determine the level of the radionuclides, caesium-134 and caesium-137. The analytical report is attached.

Done at …on …

Stamp and signature of the authorised representative referred to in Article 6(2) or (3) of Implementing Regulation (EU) 2016/6