Name inspecting officer/badge no.: ____________________________

Mammals

Birds

Reptiles

Amphibians

Chlorocebus aethiops

Amazona amazonica

Chamaeleo senegalensis

Dendrobates pumilio

Macaca fascicularis

Eos borneo

Python sebae

Mantella aurantiaca

Saimiri sciureus

Psittacus erithacus

Testudo horsfieldii

Trochilidae spp.

Other species: ______________________________________________

(Re-)export permit no.: ____________________________

Date:

Country of (re-) export:

Country of import:

No. of bags per box:

Size of bag:

Quantity of specimens:

Air company:

No. of specimens per bag:

Injured and/or damaged:

Dead on arrival:

No. boxes:

No. of solid containers per box:

Size of container:

Condition of animals:

Good:

Average:

Poor:

No. of specimens per container:

Principal causes for injury or mortality (more than one answer possible):

Function of inspecting officer:

Improper ventilation

Improper temperature

Over-crowding

Unplanned delay of transport

Structural failure of shipping container

Improper packing within shipping container

Inappropriate health conditions at the time of departure

Time of transport process too long

Customs

Veterinary service

Scientific Authority

Other:

If applicable: Place and duration of transit (if known):

No. of days in quarantine:

No. of dead during quarantine:

Please return to CITES Secretariat: 15, chemin des Anémones, CH-1219 Châtelaine/Geneva, Switzerland • Tel.: (+4122) 917-8139/40 • Fax: (+4122) 797-3417