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[]
[null,"別記様式第４号の１"]
[null,"Certificate for dogs, cats, foxes, raccoons, or skunks to be imported into Japan"]
[]
[null,"from THE RABIES-FREE DESIGNATED REGION"]
[]
[null,"Either type or write clearly in BLOCK letters in English. Do not use pencils or erasable ink to fill in.\nNo correction fluid shall be used. The original entry shall be struck through and remain legible. \nThe correction shall be written adjacent to the original and signed."]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Form AB"]
[]
[null,"Exporting country"]
[null,"Consignor",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Name ："]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Address ："]
[null,"Consignee",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Name ："]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Address ："]
[null,"IDENTIFICATION OF ANIMAL"]
[null,"Species",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Breed",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Name",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Sex"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"    Male      Female"]
[null,"Date of birth (yyyy/mm/dd) or Age  ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Color",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Use"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"    Pet        Other:"]
[null,"Microchip number",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Date of identification (yyyy/mm/dd)"]
[]
[null,"CLINICAL INSPECTION BY VETERINARIAN\n*Immediately before embarkation ( Inspection within 10 days is acceptable )"]
[]
[null,null," I,",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,", a veterinarian certify that;"]
[]
[null,null,null,"・　I have read the microchip implanted in the animal and confirmed the number."]
[null,null,null,"・　The animal has shown no clinical signs of rabies (and leptospirosis only for dog)."]
[]
[null,null," Address of veterinarian: "]
[]
[null,null," Date of  inspection (yyyy/mm/dd):",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Signature:"]
[]
[null,"CERTIFICATION BY OFFICIAL GOVERNMENT VETERINARIAN"]
[]
[null,null,"1. Residency (check the relevant box)"]
[]
[null,null,null,null,"The animal has been continuously resident in the exporting country for at least 180 days immediately before shipment to Japan, or since its birth."]
[]
[]
[null,null,null,null,"The animal has been continuously resident in the exporting country since being directly imported from Japan."]
[]
[null,null,null,null,"It is less than 180 days that the animal has been continuously resident in the exporting country before shipment to Japan. (Describe the history for 180 days before shipment to Japan.)"]
[]
[]
[null,null,null,null,"A country that the animal had been resident before entering the exporting country:"]
[]
[null,null,null,null,"Entry date (yyyy/mm/dd):"]
[]
[null,null,null,null,"Past history before the above (country and period, if applicable):"]
[]
[null,null,"2. There has been no case of rabies for at least two years prior to export in the exporting country."]
[]
[null,null,"3. The animal has been consigned in a cage and sealed. Seal Number:"]
[]
[null,null,null,"N.B.) If the animal is transshipped, the cage must be sealed or an ANNEX form is necessary."]
[]
[null,"ENDORSEMENT BY OFFICIAL GOVERNMENT VETERINARIAN"]
[]
[null,null," I,",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,", an official government veterinarian of exporting country certify"]
[]
[null,null,"that to the best of my knowledge and belief all the details mentioned above are true and correct."]
[]
[null,null," Name and address of office："]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"OFFICIAL GOVERNMENT STAMP"]
[null,null," Signature:"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," Date (yyyy/mm/dd):"]