Annex

I, ...................................................... (name),

being an official veterinarian of ............................................. (country) hereby certify that:

1. This certificate relates to a cryogenic shipper

manufactured by .............................................. (brand),

identified with ........................................ (make/model),

and ............................................ (unique serial number)

2. The shipper was treated on __ / __ / __ (date: dd/mm/yy) with one of the following:

2.1. Irradiation

[ ] Gamma irradiation at 50 kGy

OR

2.2. Disinfected following verification of effective physical cleaning, with exposure of all inner surfaces with one of the following:

[ ] A mixture of 30% chlorine bleach with 70% water for not less than 30 minutes

[ ] A solution of 2% available chlorine for not less than 1 minute

[ ] A 1% solution of Virkon, Viraban, Viral FX or FarmCare Viru-Gard for not less than 60 minutes (1 hour)

(The certificate must indicate the option that applies.)

3. A tamper evident seal was placed on the shipper.

The seal is identified with ...................................... (seal number), which was placed on the shipper immediately following treatment on __ / __ / __ (date: dd/mm/yy).