Annex

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

1. being an official veterinarian of ............................................. (country) hereby certify that:
   
   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 one minute
   
   [ ] A 1% solution of Virkon, Viraban, Viral FX or FarmCare Viru-Gard for not less than 60 minutes (one 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).