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

Format of Health Certificate for Semen of Animal
Government of Nepal
Ministry of Agriculture
Department of Livestock Services
Animal Quarantine Check Post
Health Certificate for Semen of Animals
Exporting Country: ………………………..
Ministry:……………………………………………….
Department …………………………………………..
District:…………..………………………………
1. Information concerning the donor animal
Species: …………………………………………………………
Breed: ………………………………………………………………
Name: ……………………………………………………………….
Date of birth: ……………………………………………….
Place of birth:……………………………………………..
Registered entry in the herd/stud book: …………………………………..
Date of approval of animal for AI purposes: ………………………………….
2. Information concerning the semen
Date of collection:…………………..
Quantity and packaging of exporting semen: ………………………………………………….
3. Origin of the semen M Name and address of AI centre or exporter: …………………………………..
4. Destination of the semen M Name and postal address of consignee:…………………………………
Nature and identification of means of transport: …………………………………………………
5. Sanitary Information:
The undersigned Official Veterinarian certifies that the donor animal M
a) shows no sign of disease on the day of collection;
b) satisfy/satisfies 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.