(Health Certificate)
2552 ()
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GAP
1 (Health Certificate)
(Health Certificate) .. 2552 .. 2507 ( 2) .. 2542 ( 3) .. 2552 .. 2552 .. 2552
.. 2552
.. 2552
GAP (Good Agricultural Practice: GAP)
GMP (Good Manufacturing Practice: GMP) .. 2507 ( 2) .. 2542
( 3) .. 2552 .. 2553 .. 2552 ( 2) .. 2552
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4. ( .. 11-1) (.) (.) 0-2579-6133 0-2579-6134 1 (.1) 0-5311-4121-5 0-5311-4126-7 2 (.2) 0-5531-1407 0-5531-1407 3 (.3) 0-4320-3504 0-4320-3500-1 4 (.4) 0-4520-2198 0-4520-2198 5 (.5) 0-5640-5070, 0-5640-5072-4 0-5640-5071, 0-5640-5074 6 (.6) 0-3939-7076 0-3943-4536 7 (.7) 0-7725-9445-6 0-7725-9447 8 (.8)
8 0-7444-5905-6 0-7421-8928
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1.1.2 GAP GAP GMP 14
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2.1 2 (Name of plants) (Scientific name) (Weight) .. 11
2.2 Export details - (Manufacturer or Shipper) - (Consignee) - (Address) - (Shipment date) - (Lot no.) - (Registration no.)
2.3 Weight (Shipment) 2.4 Total Weight .. 11.1 2.5 ..11.1 2.6 (Signature of applicant)/
14 3. (Signature of authorized)
Export details
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1. ..11.1 Consignee, Address, Shipment Date Weight () .. 12 ../ .1-8
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3. 3 4. ..12 . . 0-2579-6134 .1-8
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Page 1 of 2
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Application for Health Certificate under the Plant Quarantine Act B.E. 2507 and Amended
.. To Director General of the Department of Agriculture Date Month Year
. Name and address of packer
Province Postal code Telephone Facsimile
. Packing house code Name and address of packing house
Province Postal code Telephone Facsimile
. Name and address of exporter
Province Postal code Telephone Facsimile Name and address of consignee See attachment Means of conveyance Date of exportation
. Wish to apply for Health Certificate of plants as follows:
Name of microorganisms or other harmful substances
Sample No.
Name of plants
(.) Weight (Kg)
() Value (Baht)
GAP/Organic Code of GAP/Organic farm
Signature of applicant
( )
.. Form P.Q. 11
Receipt No.
Date
Recipient
Page 2 of 2
. Herewith I have enclosed documentary evidence as follows:
A copy of the identification card or passport
()
A copy of the certificate of corporate registration and signatures authorized, issued within six months (In case of the applicant is a
corporation)
A copy of the identification card of person authorized sign for the corporate entity or passport
Application letter of authorized to submit the application for permit
Other
Documentary evidence is required only for the first time of exportation. Note Insert the check mark symbol into check block in front of the required text
.. Form P.Q. 11
Page 1 of 1
Attachment Sheet
Attached to Application Form for Health Certificate Health Certificate No. Date of issue Date of expiry Lab sample No. (.) Name of plants Scientific name Weight (Kg)
No. Export details Weight (kg)
1 Manufacturer or Shipper: Address:
Consignee: Address:
Shipment date: Lot no.: Registration no.:
2 Manufacturer or Shipper: Address:
Consignee: Address:
Shipment date: Lot no.: Registration no.:
3 Manufacturer or Shipper: Address:
Consignee: Address:
Shipment date: Lot no.: Registration no.:
4 Manufacturer or Shipper: Address:
Consignee: Address:
Shipment date: Lot no.: Registration no.:
5 Manufacturer or Shipper: Address:
Consignee: Address:
Shipment date: Lot no.: Registration no.:
6 Manufacturer or Shipper: Address:
Consignee: Address:
Shipment date: Lot no.: Registration no.:
7 Manufacturer or Shipper: Address:
Consignee: Address:
Shipment date: Lot no.: Registration no.:
8 Manufacturer or Shipper: Address:
Consignee: Address:
Shipment date: Lot no.: Registration no.:
9 Manufacturer or Shipper: Address:
Consignee: Address:
Shipment date: Lot no.: Registration no.:
10 Manufacturer or Shipper: Address:
Consignee: Address:
Shipment date: Lot no.: Registration no.:
Total weight (kg)
(This page only)
Signature of applicant Signature of authorized officer
( ) ( )
.. . Form P.Q. 11.1
Department of Agriculture
Ministry of Agriculture and Cooperatives, Bangkok, Thailand
Health Certificate
No.
1. GAP code of farm:
2. GMP code of packing house:
3. Laboratory number:
4. Laboratory sample number:
5. Shipment date:
6. Name and address of exporter:
7. Name and address of consignee:
8. Declared point of entry:
9. Declared means of conveyance:
10. Description of goods and weight:
Declaration
12. Date of issue:
11. Stamp of Organization:
13. Date of expiry:
14. Name and signature of authorized officer:
.. - Form P.Q. 11-1
Page 1 of 2
..
Application for Correction of Attachment Sheet of Health Certificate under the Plant Quarantine Act B.E. 2507 and Amended
.. To Director General
