Commission Implementing Regulation (EU) 2017/717Show full title

[F1 ANNEX IV U.K. MODEL FORMS FOR ZOOTECHNICAL CERTIFICATES FOR ENTRY INTO THE UNION OF HYBRID BREEDING PIGS AND THEIR GERMINAL PRODUCTS

Textual Amendments

F1 Substituted by Commission Implementing Regulation (EU) 2020/602 of 15 April 2020 amending Implementing Regulation (EU) 2017/717 as regards the model forms of zootechnical certificates for breeding animals and their germinal products (Text with EEA relevance).

SECTION A U.K. Zootechnical certificate for entry into the Union of hybrid breeding pigs

Footnotes:
a A single zootechnical certificate may be issued for a group of hybrid breeding pigs provided that those hybrid breeding pigs have the same age and the same genetic dam and sire and that individual information is provided in points 4, 5, 6.2, 12 and, as appropriate, 13 of this zootechnical certificate.
b Keep empty if not applicable.
c Delete where not applicable.
d In accordance with the legislation on the identification and registration of animals of the country of dispatch.
e This may be required in accordance with Article 22(2) of Regulation (EU) 2016/1012 for hybrid breeding pigs used for the collection of semen for artificial insemination or for the collection of oocytes and embryos by breeding operations maintaining the breeding register where the animal is to be registered.
f If necessary attach additional sheets of paper.
g Add individual identification number if different from breeding book number.
h If the results of performance testing or genetic evaluation can be accessed on a website, a direct reference to that website may be provided instead.
i Required in the case of pregnant females. Information may be indicated in a separate document.
j Applicable only for purebred breeding pigs of different breeds or lines registered in a breeding register for hybrid breeding pigs.
l That individual shall be a representative of the breeding body, including official service of the country of dispatch, which is listed in accordance with Article 34 of Regulation (EU) 2016/1012, who is authorised to sign the zootechnical certificate.
Notes:
• The zootechnical certificate shall be issued in at least one of the official languages of the country of dispatch.
• The colour of the signature must be different from that of the printing.
• The zootechnical certificate may be issued in portrait or landscape orientation.
• The footnotes and notes of this zootechnical certificate may not be printed, provided a reference to a directly accessible multilingual source of information is included in the title.
Zootechnical certificate, in accordance with Regulation (EU) 2016/1012, for entry into the Union of hybrid breeding pigs ( Sus scrofa ), including purebred breeding pigs of breeds and lines registered in breeding registers maintained by breeding bodies a All EU official languages of the zootechnical certificates, including footnotes and notes, are available in EUR-Lex		(a logo of the issuing breeding body may be included)
		Certificate number b
1. Name of issuing breeding body (provide contact details and, where available, a reference to the website)
2. Name of breeding register	3. Name of breed c /line c /cross c of hybrid breeding pig
4. Sex of animal
5. Breeding register number of animal
6. Identification of animal d 6.1. System 6.2. Individual identification number 6.3. Name b	7. Identity verification b e f 7.1. Method 7.2. Result
8. Date (use format dd.mm.yyyy or ISO 8601) and country of birth of animal
9. Name, address and email address b of breeder
10. Name, address and email address b of owner
11. The pedigree of the hybrid breeding pig f
11.1. Sire Breeding register or breeding book number Individual identification number d g Breed c /line c /cross c Name b	11.1.1. Paternal Grandsire Breeding register or breeding book number Individual identification number d g Breed c /line c /cross c Name b
	11.1.2. Paternal Granddam Breeding register or breeding book number Individual identification number d g Breed c /line c /cross c Name b
11.2. Dam Breeding register or breeding book number Individual identification number d g Breed c /line c /cross c Name b	11.2.1. Maternal Grandsire Breeding register or breeding book number Individual identification number d g Breed c /line c /cross c Name b
	11.2.2. Maternal Granddam Breeding register or breeding book number Individual identification number d g Breed c /line c /cross c Name b
12. Additional information b f h 12.1. Results of performance testing 12.2. Up-to-date results of the genetic evaluation carried out last on … (insert date in format dd.mm.yyyy or ISO 8601) 12.3. Genetic defects and genetic peculiarities of animal in relation to the breeding programme 12.4. Other relevant information on hybrid breeding pig 12.5. Other relevant information, including results of performance testing or genetic evaluation, on parents and grandparents, if not indicated in point 11
13. Insemination c /mating c b i 13.1. Date (insert date in format dd.mm.yyyy or ISO 8601, or indicate in the same date format mating period from …. to ….) 13.2. Identification of the fertilising male(s) 13.2.1. Breeding register or breeding book number(s) 13.2.2. Individual identification number(s) d 13.2.3. Name(s) b 13.2.4. System(s) of identity verification and result(s) e
14. Name of breed society c /competent authority c /breeding operation c maintaining the breeding book c /breeding register c in which the purebred breeding pig is intended to be entered c /registered c ( provide contact details and, where available, a reference to the website ) b j
15. Validation
15.1. Done at: …	15.2. on: …
(insert place of issue)	(insert date of issue)
15.3. Name and capacity of the signatory: …
(insert in capital letters name and capacity of the individual l signing that certificate)
15.4. Signature: …

SECTION B U.K. Zootechnical certificate for entry into the Union of semen of hybrid breeding pigs

Footnotes:
a Keep empty if not applicable.
b In case Part A of the zootechnical certificate is kept empty or removed from the zootechnical certificate and a copy of the zootechnical certificate issued for the donor male hybrid breeding pig(s) is attached, a reference (certificate number) to that zootechnical certificate of the donor male hybrid breeding pig(s) must be provided.
c Part A of the zootechnical certificate may be kept empty or removed from the zootechnical certificate following the instructions in footnote 12.
d Delete where not applicable.
e In accordance with the legislation on the identification and registration of animals of the country of dispatch.
f This may be required in accordance with Article 22(2) of Regulation (EU) 2016/1012 for hybrid breeding pigs used for the collection of semen for artificial insemination by breeding operations maintaining the breeding register where the offspring of the donor animal is to be registered.
g If necessary attach additional sheets of paper.
h Add individual identification number if different from breeding book number.
i If the results of performance testing or genetic evaluation can be accessed on a website, a direct reference to that website may be provided instead.
j Only required if Part A of the zootechnical certificate is issued by the breeding body, including official service of the country of dispatch, which is listed in accordance with Article 34 of Regulation (EU) 2016/1012 and Part B of the zootechnical certificate is issued by a semen collection or storage centre acting on behalf of the breeding body in accordance with Article 33(1) of that Regulation.
l That individual shall be a representative of the breeding body, including official service of the country of dispatch, which is listed in accordance with Article 34 of Regulation (EU) 2016/1012, who is authorised to sign the zootechnical certificate.
k In case only Part B of the zootechnical certificate is issued by a semen collection or storage centre acting on behalf of the breeding body in accordance with Article 33(1) of Regulation (EU) 2016/1012 and Part A of the zootechnical certificate is kept empty or removed from the zootechnical certificate, point 1 of Part B must be completed and copies of the zootechnical certificates for the donor males, issued in accordance with the model laid down in Section A of Annex IV to Regulation (EU) 2017/717, must be attached.
m Optional.
n A straw or another package may contain semen collected from more than one hybrid breeding pig, provided information on all contributing donor male hybrid breeding pigs is provided in point 1.2. of Part B.
o Where applicable, information on sexed semen may be provided.
p For semen intended for performance testing or genetic evaluation of hybrid breeding pigs which have not undergone such testing or evaluation, in accordance with the quantity limits referred to in Article 24(1)(d) of Regulation (EU) 2016/1012.
q That individual shall be a representative of the breeding body, including official service of the country of dispatch, which is listed in accordance with Article 34 of Regulation (EU) 2016/1012, or of a semen collection or storage centre acting on behalf of the breeding body in accordance with Article 33(1) of that Regulation, who is authorised to sign the zootechnical certificate.
Notes:
• The zootechnical certificate shall be issued in at least one of the official languages of the country of dispatch.
• The colour of the signature must be different from that of the printing.
• The zootechnical certificate may be issued in portrait or landscape orientation.
• The footnotes and notes of this zootechnical certificate may not be printed, provided a reference to a directly accessible multilingual source of information is included in the title.
Zootechnical certificate, in accordance with Regulation (EU) 2016/1012, for entry into the Union of semen of hybrid breeding pigs ( Sus scrofa ), including purebred breeding pigs of breeds and lines registered in breeding registers maintained by breeding bodies All EU official languages of the zootechnical certificates, including footnotes and notes, are available in EUR-Lex				(a logo of the issuing breeding body or semen collection or storage centre may be included)
				Certificate number a
Name of issuing breeding body/semen collection or storage centre (provide contact details and, where available, a reference to the website)/ reference to zootechnical certificate of donor animal b
Part A. Information on the donor male hybrid breeding pig c
1. Name of issuing breeding body (provide contact details and, where available, a reference to the website)
2. Name of breeding register			3. Name of breed d /line d /cross d
4. Breeding register number of donor male
5. Identification of donor male e 5.1. System 5.2. Individual identification number 5.3. Name a			6. Identity verification a f g 6.1. Method 6.2. Result
7. Date (use format dd.mm.yyyy or ISO 8601) and country of birth of donor male
8. Name, address and email address a of breeder
9. Name, address and email address a of owner
10. The pedigree of donor male g
10.1. Sire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a			10.1.1. Paternal Grandsire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
			10.1.2. Paternal Granddam Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
10.2. Dam Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a			10.2.1. Maternal Grandsire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
			10.2.2. Maternal Granddam Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
11. Additional information a g i 11.1. Results of performance testing 11.2. Up-to-date results of the genetic evaluation carried out last on … (insert date in format dd.mm.yyyy or ISO 8601) 11.3. Genetic defects and genetic peculiarities of donor male in relation to the breeding programme 11.4. Other relevant information on donor male 11.5. Other relevant information, including results of performance testing or genetic evaluation, on parents and grandparents, if not indicated in point 10
12. Validation j
12.1. Done at: …			12.2. on: …
(insert place of issue)			(insert date of issue)
12.3. Name and capacity of the signatory: …
(insert in capital letters name and capacity of the individual l signing the certificate)
12.4. Signature: …
Part B. Information on semen k
1. Identification of donor male(s) e j 1.1. Individual identification number(s) 1.2. Reference(s) to zootechnical certificate(s) of donor male(s) a
2. Identification of semen
Colour of straws or other packages a m	Code on straws or other packages	Number of straws or other packages n	Place of collection	Date of collection (dd.mm.yyyy or ISO 8601)	Others a o
3. Semen collection or storage centre of dispatch 3.1. Name 3.2. Address 3.3. Approval number
4. Destination ( insert name and address)
5. Name and address of the breeding operation b , or the third party b designated by that breeding operation, responsible for carrying out testing a p
6. Validation
6.1. Done at: …			6.2. on: …
(insert place of issue)			(insert date of issue)
6.3. Name and capacity of the signatory: …
(insert in capital letters name and capacity of the individual q signing that certificate)
6.4. Signature: …

SECTION C U.K. Zootechnical certificate for entry into the Union of oocytes of hybrid breeding pigs

Footnotes:
a Keep empty if not applicable.
b In case Part A of the zootechnical certificate is kept empty or removed from the zootechnical certificate and a copy of the zootechnical certificate issued for the donor female hybrid breeding pig is attached, a reference (certificate number) to that zootechnical certificate of the donor female hybrid breeding pig must be provided.
c Part A of the zootechnical certificate may be kept empty or removed from the zootechnical certificate following the instructions in footnote 12.
d Delete where not applicable.
e In accordance with the legislation on the identification and registration of animals of the country of dispatch.
f This may be required in accordance with Article 22(2) of Regulation (EU) 2016/1012 for hybrid breeding pigs used for the collection of oocytes by breeding operations maintaining the breeding register where the offspring of the donor animal is to be registered.
g If necessary attach additional sheets of paper.
h Add individual identification number if different from breeding book number.
i If the results of performance testing or genetic evaluation can be accessed on a website, a direct reference to that website may be provided instead.
j Only required if Part A of the zootechnical certificate is issued by the breeding body, including official service of the country of dispatch, which is listed in accordance with Article 34 of Regulation (EU) 2016/1012 and Part B of the zootechnical certificate is issued by an embryo production team acting on behalf of the breeding body in accordance with Article 33(1) of that Regulation.
l That individual shall be a representative of the breeding body, including official service of the country of dispatch, which is listed in accordance with Article 34 of Regulation (EU) 2016/1012, who is authorised to sign the zootechnical certificate.
k In case only Part B of the zootechnical certificate is issued by an embryo production team acting on behalf of the breeding body in accordance with Article 33(1) of Regulation (EU) 2016/1012 and Part A of the zootechnical certificate is kept empty or removed from the zootechnical certificate, point 1 of Part B must be completed and copies of the zootechnical certificates for the donor female, issued in accordance with the model laid down in Section A of Annex IV to Regulation (EU) 2017/717, must be attached.
m Optional.
n Where there is more than one oocyte in a straw or another package, a clear indication of the number of oocytes is required. A straw or another package shall contain only oocytes collected from one hybrid breeding pig.
o That individual shall be a representative of the breeding body, including official service of the country of dispatch, which is listed in accordance with Article 34 of Regulation (EU) 2016/1012, or of an embryo production team acting on behalf of the breeding body in accordance with Article 33(1) of that Regulation, who is authorised to sign the zootechnical certificate.
Notes:
• The zootechnical certificate shall be issued in at least one of the official languages of the country of dispatch.
• The colour of the signature must be different from that of the printing.
• The zootechnical certificate may be issued in portrait or landscape orientation.
• The footnotes and notes of this zootechnical certificate may not be printed, provided a reference to a directly accessible multilingual source of information is included in the title.
Zootechnical certificate, in accordance with Regulation (EU) 2016/1012, for entry into the Union of oocytes of hybrid breeding pigs ( Sus scrofa ), including purebred breeding pigs of breeds and lines registered in breeding registers maintained by breeding bodies All EU official languages of the zootechnical certificates, including footnotes and notes, are available in EUR-Lex					(a logo of the issuing breeding body or embryo production team may be included)
					Certificate number a
Name of issuing breeding body/embryo production team (provide contact details and, where available, a reference to the website)/ reference to zootechnical certificate of donor animal b
Part A. Information on the female donor hybrid breeding pig c
1. Name of issuing breeding body (provide contact details and, where available, a reference to the website)
2. Name of breeding register			3. Name of breed d /line d /cross d
4. Breeding register number of donor female
5. Identification of donor female e 5.1. System 5.2. Individual identification number 5.3. Name a			6. Identity verification a f g 6.1. Method 6.2. Result
7. Date (use format dd.mm.yyyy or ISO 8601) and country of birth of donor female
8. Name, address and email address a of breeder
9. Name, address and email address a of owner
10. The pedigree of donor female g
10.1. Sire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a			10.1.1. Paternal Grandsire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
			10.1.2. Paternal Granddam Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
10.2. Dam Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a			10.2.1. Maternal Grandsire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
			10.2.2. Maternal Granddam Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
11. Additional information a g i 11.1. Results of performance testing 11.2. Up-to-date results of the genetic evaluation carried out last on …. (insert date in format dd.mm.yyyy or ISO 8601) 11.3. Genetic defects and genetic peculiarities of donor female in relation to the breeding programme 11.4. Other relevant information on donor female 11.5. Other relevant information, including results of performance testing or genetic evaluation, on parents and grandparents, if not indicated in point 10
12. Validation j
12.1. Done at: …			12.2. on: …
(insert place of issue)			(insert date of issue)
12.3. Name and capacity of the signatory: …
(insert in capital letters name and capacity of the individual l signing the certificate)
12.4. Signature: …
Part B. Information on oocytes k
1. Identification of donor female e j 1.1. Individual identification number 1.2. Reference to zootechnical certificate of donor female a
2. Identification of oocytes
Colour of straws or other packages a m	Code on straws or other packages	Number of straws or other packages	Number of oocytes n	Place of collection	Date of collection (dd.mm.yyyy or ISO 8601)	Others a
3. Embryo production team of dispatch 3.1. Name 3.2. Address 3.3. Approval number
4. Destination ( insert name and address)
5. Validation
5.1. Done at: …			5.2. on: …
(insert place of issue)			( insert date of issue)
5.3. Name and capacity of the signatory: …
(insert in capital letters name and capacity of the individual o signing that certificate)
5.4. Signature: …

SECTION D U.K. Zootechnical certificate for entry into the Union of embryos of hybrid breeding pigs

Footnotes:
a Keep empty if not applicable.
b In case Part A or B of the zootechnical certificate is kept empty or removed from the zootechnical certificate and a copy of the zootechnical certificate issued for the donor female or male hybrid breeding pig(s), or for the semen of those male hybrid breeding pig(s) is attached, a reference (certificate number) to that zootechnical certificate of the donor female or male hybrid breeding pig(s), or of the semen of those male hybrid breeding pig(s) must be provided.
c Part A or B of the zootechnical certificate may be kept empty or removed from the zootechnical certificate following the instructions in footnote 12.
d Delete where not applicable.
e In accordance with the legislation on the identification and registration of animals of the country of dispatch.
f This may be required in accordance with Article 22(2) of Regulation (EU) 2016/1012 for hybrid breeding pigs used for the collection of embryos by breeding operations maintaining the breeding register where the offspring obtained from those embryos is to be registered.
g If necessary attach additional sheets of paper.
h Add individual identification number if different from breeding book number.
i If the results of performance testing or genetic evaluation can be accessed on a website, a direct reference to that website may be provided instead.
j Only required if Part A or B of the zootechnical certificate is issued by the breeding body, including official service of the country of dispatch, which is listed in accordance with Article 34 of Regulation (EU) 2016/1012 and Parts C and D of the zootechnical certificate are issued by an embryo collection or production team acting on behalf of the breeding body in accordance with Article 33(1) of that Regulation.
l That individual shall be a representative of the breeding body, including official service of the country of dispatch, which is listed in accordance with Article 34 of Regulation (EU) 2016/1012, who is authorised to sign the zootechnical certificate.
k In case only Part C and, where applicable, Part D of the zootechnical certificate are issued by an embryo collection or production team acting on behalf of the breeding body in accordance with Article 33(1) of Regulation (EU) 2016/1012, and Part(s) A and/or B of the zootechnical certificate is/are kept empty or removed from the zootechnical certificate, points 1 and 2 of Part C must be completed and copies of zootechnical certificates attached as follows: (a) for donor females, in accordance with the model laid down in Section A of Annex IV to Regulation (EU) 2017/717; (b) for the fertilising semen: (i) as described in point (a), with the necessary adaptations for donor males, or (ii) in accordance with the model laid down in Section B of Annex IV to Regulation (EU) 2017/717.
m Optional.
n Where there is more than one embryo in a straw or another package, a clear indication of the number of embryos is required.
o A straw or another package may contain embryos collected, or produced from oocytes collected, from a single female hybrid breeding pig fertilised with semen collected from more than one donor male hybrid breeding pig, provided information on all contributing donor male hybrid breeding pigs is provided in point 2.2. of Part C.
p Where applicable, information on sexed embryos or on the stage of development of the embryo may be provided.
q That individual shall be a representative of the breeding body, including official service of the country of dispatch, which is listed in accordance with Article 34 of Regulation (EU) 2016/1012, or of an embryo collection or production team acting on behalf of the breeding body in accordance with Article 33(1) of that Regulation, who is authorised to sign the zootechnical certificate.
Notes:
• The zootechnical certificate shall be issued in at least one of the official languages of the country of dispatch.
• The colour of the signature must be different from that of the printing.
• The zootechnical certificate may be issued in portrait or landscape orientation.
• The footnotes and notes of this zootechnical certificate may not be printed, provided a reference to a directly accessible multilingual source of information is included in the title.]
Zootechnical certificate, in accordance with Regulation (EU) 2016/1012, for entry into the Union of embryos of hybrid breeding pigs ( Sus scrofa ), including purebred breeding pigs of breeds and lines registered in breeding registers maintained by breeding bodies All EU official languages of the zootechnical certificates, including footnotes and notes, are available in EUR-Lex					(a logo of the issuing breeding body or embryo collection or production team may be included)
					Certificate number a
Name of issuing breeding body/embryo collection or production team (provide contact details and, where available, a reference to the website)/ reference to zootechnical certificate(s) of donor animal(s) b
Part A. Information on the female donor hybrid breeding pig c
1. Name of issuing breeding body (provide contact details and, where available, a reference to the website)
2. Name of breeding register			3. Name of breed d /line d /cross d
4. Breeding register number of donor female
5. Identification of donor female e 5.1. System 5.2. Individual identification number 5.3. Name a			6. Identity verification a f g 6.1. Method 6.2. Result
7. Date (use format dd.mm.yyyy or ISO 8601) and country of birth of donor female
8. Name, address and email address a of breeder
9. Name, address and email address a of owner
10. The pedigree of donor female g
10.1. Sire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a			10.1.1. Paternal Grandsire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
			10.1.2. Paternal Granddam Breeding register or breeding book number Breed d /line d /cross d Name a
10.2. Dam Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a			10.2.1. Maternal Grandsire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
			10.2.2. Maternal Granddam Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
11. Additional information a g i 11.1. Results of performance testing 11.2. Up-to-date results of the genetic evaluation carried out last on … (insert date in format dd.mm.yyyy or ISO 8601) 11.3. Genetic defects and genetic peculiarities of donor female in relation to the breeding programme 11.4. Other relevant information on donor female 11.5. Other relevant information, including results of performance testing or genetic evaluation, on parents and grandparents, if not indicated in point 10
12. Validation j
12.1. Done at: …			12.2. on: …
(insert place of issue)			(insert date of issue)
12.3. Name and capacity of the signatory: …
(insert in capital letters name and capacity of the individual l signing the certificate)
12.4. Signature: …
Part B. Information on the donor male hybrid breeding pig c
1. Name of issuing breeding body (provide contact details and, where available, a reference to the website)
2. Name of breeding register			3. Name of breed d /line d /cross d
4. Breeding register number of donor male
5. Identification of donor male e 5.1. System 5.2. Individual identification number 5.3. Name a			6. Identity verification a f g 6.1. Method 6.2. Result
7. Date (use format dd.mm.yyyy or ISO 8601) and country of birth of donor male
8. Name, address and email address a of breeder
9. Name, address and email address a of owner
10. The pedigree of donor male g
10.1. Sire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a			10.1.1. Paternal Grandsire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
			10.1.2. Paternal Granddam Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
10.2. Dam Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a			10.2.1. Maternal Grandsire Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
			10.2.2. Maternal Granddam Breeding register or breeding book number Individual identification number e h Breed d /line d /cross d Name a
11. Additional information a g i 11.1. Results of performance testing 11.2. Up-to-date results of the genetic evaluation carried out last on … (insert date in format dd.mm.yyyy or ISO 8601) 11.3. Genetic defects and genetic peculiarities of donor male in relation to the breeding programme 11.4. Other relevant information on donor male 11.5. Other relevant information, including results of performance testing or genetic evaluation, on parents and grandparents, if not indicated in point 10
12. Validation j
12.1. Done at: …			12.2. on: …
(insert place of issue)			(insert date of issue)
12.3. Name and capacity of the signatory: …
(insert in capital letters name and capacity of the individual l signing the certificate)
12.4. Signature: …
Part C. Information on embryos k
1. Identification of donor female e j 1.1. Individual identification number 1.2. Reference to zootechnical certificate of donor female a
2. Identification of donor male(s) e j 2.1. Individual identification number(s) 2.2. Reference(s) to zootechnical certificate(s) of 2.2.1. donor male(s) a d 2.2.2. semen a d
3. Identification of embryos
Colour of straws or other packages a m	Code on straws or other packages	Number of straws or other packages	Number of embryos n o	Place of collection or production	Date of collection or production (dd.mm.yyyy or ISO 8601)	Others a p
4. Embryo collection or production team of dispatch 4.1. Name 4.2. Address 4.3. Approval number
5. Destination ( insert name and address)
Part D. Information on surrogate recipient of embryo(s)
6. Individual identification number e of surrogate recipient a
7. Validation
7.1. Done at: …			7.2. on: …
(insert place of issue)			(insert date of issue)
7.3. Name and capacity of the signatory: …
(insert in capital letters name and capacity of the individual q signing that certificate)
7.4. Signature: …