Model Health Certificate
for imports of live bivalve molluscs intended for human consumption

Name SAMPLE

Address SAMPLE

Postal code SAMPLE

Tel No. SAMPLE

Name SAMPLE

Address SAMPLE

Postal code SAMPLE

Tel No. SAMPLE

Name SAMPLE

Approval number SAMPLE

Address SAMPLE

Airplane  SAMPLE
Ship  SAMPLE
Railway wagon  SAMPLE
Road vehicle  SAMPLE
Other  SAMPLE

Identification SAMPLE

Documentary references: SAMPLE

03 07 SAMPLE

I, the undersigned, declare that I am aware of the relevant provisions of Regulations (EC) No 178/2002, (EC) No 852/2004, (EC) No 853/2004 and (EC) No 854/2004 and certify that the live bivalve molluscs described above were produced in accordance with those requirements, in particular that they:

• — come from (an) establishment(s) implementing a program based on the HACCP principles in accordance with Regulation (EC) No 852/2004,
• — have been harvested, where necessary relayed and transported in accordance with Section VII, Chapters I and II of Annex III to Regulation (EC) No 853/2004,
• — were handled, where necessary purified, and packaged in compliance with Section VII, Chapters III and IV of Annex III to Regulation (EC) No 853/2004,
• — satisfy the health standards laid down in Section VII, Chapter V of Annex III to Regulation (EC) No 853/2004 and the criteria laid down in Regulation (EC) No 2073/2005 on microbiological criteria for foodstuffs,
• — have been packaged, stored and transported in compliance with Section VII, Chapters VI and VIII of Annex III to Regulation (EC) No 853/2004,
• — have been marked and labeled in accordance with Section I of Annex II and Section VII, Chapter VII of Annex III to Regulation (EC) No 853/2004,
• — in the case of pectinidae harvested outside classified production areas, comply with the specific requirements laid down in Section VII, Chapter IX of Annex III to Regulation (EC) No 853/2004

  and

• — have satisfactorily undergone the official controls laid down in Annex III to Regulation (EC) No 854/2004.

II.2. ⁽¹⁾ [Animal health attestation

I, the undersigned, declare that the live molluscs described above originate from a source (2) where there are no unresolved abnormal mortality in the mollusc population, and certify, in particular that:

• — ⁽¹⁾[⁽³⁾ if from species susceptible ⁽⁴⁾ to infections with Bonamia exitiosa, Mikrocytos roughleyi, Marteilia sydneyi, Mikrocytos mackini, Perkinsus marinus, P. olseni/atlanticus; Haplosporidium nelsoni, H. costale and/or Candidatus Xenohaliotis californiensis, they:
  • — ⁽¹⁾ [originate from a source ⁽²⁾ considered free from bonamiosis (Bonamia exitiosa and Mikrocytos roughleyi); marteiliosis (Marteilia sydneyi); mikrocytosis (Mikrocytos mackini); perkinsosis (Perkinsus marinus and P. olseni/atlanticus); haplosporidiosis (Haplosporidium nelsoni and H. costale) and Withering syndrome (Candidatus Xenohaliotis californiensis) in accordance with the relevant EU legislation or OIE Standard ⁽⁵⁾],
  • — ⁽¹⁾ [are dispatched as unprocessed or processed products]],
• — ⁽¹⁾[⁽⁶⁾ if from species susceptible ⁽³⁾ to infections with Marteilia refringens or Bonamia ostrea, they:
  • — ⁽¹⁾ [originate from a source ⁽²⁾ considered free from ⁽¹⁾ Marteilia refringens / ⁽¹⁾Bonamia ostrea in accordance with the relevant EU legislation or OIE Standard ⁽⁵⁾],
  • — ⁽¹⁾ [are dispatched as unprocessed or processed products]], ]

Part I:

• — Box reference I.8: Region of origin: indicate the production area.
• — Box reference I.11: Place of origin: name and address of the dispatch establishment.
• — Box reference I.15: Registration number (railway wagons or container and lorries), flight number (aircraft) or name (ship). Separate information is to be provided in the event of unloading and reloading.
• — Box reference I.23: Identification of container/seal number: only where applicable.
• — Box reference I.28: Manufacturing plant: includes dispatch centre, purification centre.

Part II:

— Part II.2 is not relevant for consignments intended for retail, provided they comply with the rules applying to packaging and labeling laid down in Regulation (EC) No 853/2004.

1. Delete as appropriate
2. Source may be a country, zone, or an individual farm.
3. This requirement applies to exports to all Member States. However, it is only relevant if the consignment comprises species susceptible to bonamiosis (Bonamia exitiosa and Mikrocytos roughleyi); marteiliosis (Marteilia sydneyi); mikrocytosis (Mikrocytos mackini); perkinsosis (Perkinsus marinus and P. olseni/atlanticus); haplosporidiosis (Haplosporidium nelsoni and H. costale) and Withering syndrome (Candidatus Xenohaliotis californiensis), whereby one or the two statements must be retained.
4. Known susceptible species:

   Disease (Infection with)	Susceptible host species
   Bonamia exitiosa	Tiostrea chilensis and Ostrea angasi
   Bonamia ostrea	Ostrea edulis
   Mikrocytos roughleyi	Saccostrea(commercialis) glomerata
   Marteilia sydneyi	Saccostrea (commercialis) glomerata
   Marteilia refringens	Ostrea edulis
   Mikrocytos mackini	Crassostrea gigas; C. virginica; Ostrea edulis; O. conchaphila
   Perkinsus marinus	Crassostrea virginica and C. gigas
   Perkinsus olseni/atlanticus	Haliotis ruber; H. cyclobates; H. scalaris; H. laevigata, Ruditapes philippinarum and R. decussates
   Haplosporidium nelsoni	Crassostrea virginica and C. gigas
   Haplosporidium costale	Crassostrea virginica
   Xenohaliotis californiensis	black abalone (Haliotis. cracherodii), red abalone (H. rufescens), pink abalone (H. corrugata), green abalone (H. fulgens) and white abalone (H. sorenseni)

5. Freedom according to the provisions laid down in Annex B or C to Directive 91/67/EEC, and Commission Decisions 2002/878/EEC. Freedom according to the current edition of the OIE Code and Manual is also recognized.
6. This part of the animal health certificate is only relevant if the consignment comprises species referred to as susceptible species to infections with Marteilia refringens and/or Bonamia ostrea. In order for the consignment to be authorized into a Member State or part thereof (boxes I.9 and I.10 of Part I of the certificate) declared free from Marteilia refringens and/or Bonamia ostrea, or undergoing a program for such freedom, one of the two statements must be retained. List of such Member States and zones are laid down in Commission Decisions 2002/300/EC and 1994/722/EEC.

—The color of the stamp and signature must be different to that of the other particulars in the certificate.

Name (in capitals): NAME OF INSPECTOR

Qualification and title: Qualification and Title of Inspector

Date: MM-DD-YYYY  Signature: Signature of Inspector