Please Complete This Form in BLOCK LETTERS

Application for a Zoosanitary Certificate to Export Dogs and Cats from St Helena
Please complete this form in BLOCK LETTERS
Failure to provide information as requested in this form may result in delays in processing and/or your application may be declined. / FOR ANRD USE:
Issued on: ______
Date received: ______
Application No.______

Exporter Details

Your Name / Contact person
Full Address
Work phone / Email / Fax

Importer Details (person different to exporter who might be importing dog into Ascension, UK or South Africa)

Name / Contact person
Full Address
Work phone / Email / Fax
Address to send zoosanitary certificate to if different from exporter
Name / Address

Application for Zoosanitary to Export Dogs and Cats from St Helena

Description of Animals(s)
Species* / Breed / Microchip number / Age (yrs/mths) / Sex (M/F)

* Must be members of the species Canis familiaris (domestic dog) and Felis catis (domestic cat).

Country of Origin / Date of Export
Exporter’s Declaration
I / We the undersigned hereby declare that the information provided above is accurate to the best of my / our knowledge.
Signature: Name: Date:
Signature: Name: Date:
I, the

Where to Send this Application When it is Completed

Post, e-mail, or fax
Head of Agriculture and Natural Resources / Fax: +00 290 42603
Agriculture and Natural Resources Division, Scotland / E-mail:
St Helena Island
STH 1ZZ

Notes:

(1)  This form contains 2 pages. Applicants should ensure that the sheets and any supporting documentation are stapled and clipped together when submitted. ANRD will not accept applications comprising incomplete forms.

(2)  The data collected in this form will be kept in confidence. They may however be disclosed to other third parties on the Island, if such disclosure is necessary to facilitate consideration of the related application, or is in the public interest.