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

Format of Health Certificate for Domestic or Wild Animal
Government of Nepal
Ministry of Agriculture
Department of Livestock Services
Animal Quarantine Check Post
Health Certificate for Domestic or Wild Animals
Exporting Country: ……………………
Ministry :…………………………………….
Department:……………………………………
District:……….……………………….
1. Identification of the animal/s:
Ear mark Breed Sex Age

2. Origin of the animal/s:
Name and address of exporter: ……….………………………………………………………………
Place of origin of the animal/s:…. ……….
3. Destination of the animal/s:
Name and address of consignee:……….
Nature and identification of means of transport: ………………………………………………………..
4. Sanitary Information:
The undersigned Official Veterinarian certifies that the animal/s described above and examined on
this day:
a) shows/show no clinical sign of disease;
* satisfies/satisfy the following requirements (if applicable)*
Official stamp:
Issued at ..………………………. on ……………………………
Name and address of Quarantine Officer …………………………………………………………
Signature: …………………………………………………………….
* These conditions are agreed conditions between the Veterinary Services of the importing and
exporting countries.