Schedule-3
(Relating to Clause (a) of Sub-rule (2) of Rule 10)

Format of the Health Certificate for Dog and Cat
Government of Nepal
Ministry of Agriculture
Department of Livestock Services
Animal Quarantine Check Post
Health Certificate for Dogs and Cats

1. Owner’s name and address :………………………………………………….
2. Description:
Species of animal: ……………………………………………………..
Age or date of birth: ………………………
Sex: ………………………………………………………………………
Breed: ………………………………………………………………….
Colour: ………………………………………………………………..
Coat type and marking /distinguishing marks: …………………………………………
Identification number (tattoo or other permanent method of identification)] M
3. Additional information:
Country of origin:
Countries visited with pet over the past two years by the owner (give dates):
…………………………………………………………………………..
4. Vaccination:
I the undersigned declare herewith that I have vaccinated the animal described in Part 2 against
rabies as shown below. The animal was found to be healthy on the day of vaccination.
Date of vaccination Name of inactivated
virus vaccine
(Manufacturing laboratory)
1. Batch No.
2. Expiry date
Name (in block letters) and
signature of the veterinarian
1.
2.
3.

(PERIOD OF VALIDITY OF VACCINATION FOR
INTERNATIONAL MOVEMENT
Name (in block letters) and signature of the
official veterinarian
From To

5. Serological Testing:
I the undersigned declare herewith that I have taken a blood sample from the animal described
in Part 2 and have received the following result from the official diagnostic laboratory which
has carried out the neutralizing antibody titration test.
Date of
sampling
Name and address of the
official diagnostic laboratory
Result of the antibody
titration test (in IU/ml)
Name (in block letters) and
signature of the veterinarian

Period Of Validity Of Serological Testing For
International Movement
Name (in block letters) and signature of the
official veterinarian
From To
6. Clinical Examination:
I the undersigned declare herewith that I have examined on the date indicated below the animal
described in Part 2 and have found it to be clinically healthy.
Date of Vaccination Name (in block letters) and
signature of the veterinarian
Name (in block letters) and signature of
the official veterinarian