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THE

JAMAICA GAZETTESUPPLEMENT

PROCLAMATIONS, RULES AND REGULATIONS117

Vol. CXXIII

No. 36

WEDNESDAY, APRIL 12, 2000 No. 28

THE ENDANGERED SPECIES (PROTECTION, CONSERVATION ANDREGULATION OF TRADE) ACT,2000

THE ENDANGERED SPECIES (PROTECTION, CONSERVATION AND REGULATION OF TRADE)

REGULATIONS, 2000

In exercise of the power conferred upon the Minister by section 53 of the Engandered Species(Protection, Conservation and Regulation of Trade) Act, 2000 and ofevery other power hereuntoenabling, the following Regulations are hereby made:-

1. These Regulations may be cited as the Endangered Species (Protection, Conservationand Regulation of Trade) Regulations, 2000.

Applications for Permits and Certificates

2. An application for the issue ofa permit to import, export or re-export plant specimenspursuant to the Act shall be made in the form specified as Form I in the First Schedule andaccompanied by the relevant fee specified in Regulation 4.

118 PROCLAMATIONS, RULES AND REGULAnONS [APRIL 12, 2000

3. An application for the issue ofa pennit to import, export or re-export animal specimenspursuant to the Act shall be made in the form specified as Form 2 in the First Schedule andaccompanied by the relevant fee specified in regulation 4.

4. An application under regulation 2 or 3 shall be accompanied by application fees asfollows-

(a) $1,000 in relation to an import or re-export permit; and

(b) $2,000 in relation to an export pennit.

5.-(1) A pennit to export a specimen ofa species granted by the Management Authorityshall not be transferable and shall be valid for such period as is specified therein, being aperiod not exceeding three months.

(2) An applicant shall be required to apply for an export pennit in respect of eachconsignment.

6. An application for an introduction from the sea certificate pursuant to section 23 or27 of the Act shall be made in the form specified as Form 3 in the First Schedule hereto andshall be accompanied by a fee of five hundred dollars.

7. An application for the issue ofa certificate under section 5 (2) (b) ofthe Act (hereinafterreferred to as a Pre-Convention certificate) in relation to specimens acquired before therelevant provisions of the Convention applied to them shall be made in the form specifiedas Form 4 in the First Schedule hereto and shall be accompanied by a fee of one thousanddollars.

8. An application for the issue of a Certificate of Origin shall be in the form set out asForm 5 in the First Schedule hereto and shall be accompanied by a fee of five hundreddollars.

9.-(1) A pennit shall be in the fonn set out as Form 1 in Part I ofthe Second Schedule.

(2) A certificate shall be in the form set out as Form 2 or 3, in Part II of the SecondSchedule.

10. Where a specimen-

(a) forms part of a travelling live exhibition; and

(b) is covered by a Pre-Convention certificate,

any certificate issued under these Regulations in respect of such specimen, shall specifythat the animal or plant specimen referred to therein belongs to a named travelling animalor plant exhibition.

11.-(1) Every person who imports, exports or re-exports any specimen specified in theFirst, Second, Third or Fourth Schedule of the Act shall, prior to the clearance or despatchof the specimen, present the appropriate permit or certificate, as the case may be, forprocessing to the Commissioner of Customs at the point of entry or departure.

APRIL 12,2000] PROCLAMA nONS, RULES AND REGULAnONS 119

(2) The Commissioner ofCustoms shall forward a copy of every permit or certificatereferred to under paragraph (1) to the Management Authority.

12. It shall be a condition ofevery export permit and re-export permit that the specimento which it relates shall be shipped in accordance with the provisions of the InternationalAir Transport Association Live Animals Regulations.

13. Where the validity of a permit or certificate has expired, such permit or certificateshall be null and void.

14. Every copy of a permit or certificate issued by the Management Authority shall beclearly marked as copied and, except to the extent endorsed thereon, no such copy shall beused in place of the original.

15. Where a specimen is being imported into Jamaica, the Management Authority shallcancel and retain the export permit or re-export permit issued in the State from which thespecimen is exported or re-exported and any corresponding import permit presented inrespect ofthe import of the specimen.

16. Every Register shall contain-

(a) the name of the person to whom the permit or certificate is granted;

(b) the type ofpermit or certificate;

(c) the date on which the permit or certificate is granted and renewed;

(d) the date of expiration of the permit or certificate;

(e) the date and reason for revocation and suspension of the permit or certificate andin respect of suspension the period thereof;

(f) the specimen or class of specimen of flora and fauna in respect of which thepermit or certificate is given;

(g) the number of the permit or certificate;

(h) any remarks relating thereto.

17.-(1) Permits or certificates referred to in regulations 2,3,6,8 and 9 shall be issuedon payment of the following fees-

Permits

1.

2.

3.

Import permit

Export permit

Re-export permit

$3,000

$4,000

$3,000

120 PROCLAMA nONS, RULES AND REGULAnONS [APRIL 12,2000

Certificates

4. Introduction from thesea certificate $2,000

5. Pre-Conventioncertificate $1,000

6. Certificate of origin $2,000.

(2) A fee of fifty dollars is payable in respect of each copy or an entry in a registerkept pursuant to section 38 of the Act.

APRIL 12,2000] PROCLAMAnONS, RULES AND REGULAnONS 121

SFORMl

THE ENDANGERED SPECIES (PROTECTION,CONSERVATION AND REGULATION OF

TRADE) ACT, 2000

Applicurion Form furImportlExportlRe-export of Plant Specimens

Application No.

o 11-.1PORT Permit

o EXPORT Permit

o RE·EXPORT Certificate

Please Print or Type

Name of Applicant: --=_--=-,-----=,--- _

Address of Applicant:----------------------------

TRN No _

Telephone No. Fax No. _ E-Mail _

Name of ConsigneeIIWe hereby apply for CITES Permit(s)/Certificate(s) for------0-;--=-:--------

Address of Consignee

City/State ZipCode Country

Indicate the name of Broker if applicable. _

Purpose of transaction: Commercial 0 Botanical Gardens 0 Travethng Exhibitions 0 Scientific 0 Educ.monal 0

Personal 0 ~ BiomedicalResearch 0 Reintroduction or introduction into the wild 0 ArtilicialPropagation 0

Please describe the purpose in detail on additional sheets.

If the specimen(s) is living indicate provisions to house and care it in country of import, export or reexport.

Indicate the name of each specimen(s) in each shipment in the table below. If additional space is requiredplease attach additional sheets,

la<liuteifArtifiullypropa ... 1ed

(Ajor

Co••o. Sdc.UOeNuacNu_benof DeKriptiCNIor CollKtedSpeci_n(l) SpKimn f"""tlM C"u.lryof Country of Country or

N••e (GtDIII " .pula) Wikl(W) Oric i• E1110rl 1..1 DateR_lIMlrl

122 PROCLAMAnONS, RULES AND REGULA nONS

Please note the following, where applicable:-

[APRIL 12,2000

(1) This application form must be completed to commence processing. Where space is not providedattach additional sheets. Paragraphs that are not applicable to your application should be markedasN/A

(2) If species were collected from the wild indicate name of location and parish/State/Country

(3) A permit is required for each shipment of plants.

(4) Any Certificate oflast re-export should be attached to the application form.

(5) Any import of plants shall be subject to the grant of a Permit from the Plant Quarantine Division,Ministry of Agriculture. Any export or re-export permit shall be subject to the grant of aPhytosantinary certificate from the Plant Quarantine Division, Ministry of Agriculture.

(6) For the purpose of re-export attach copies of cancelled CITES Export Permits or Re-exportCertificate issued by the appropriate CITES office in the country from which the plant wasimported. If you were not the importer, provide copies of the importer's documents outlinedabove and the invoice or receipt that shows you purchased the plant from the original importer.

(7) For a Pre-Convention plant, an application will only need to be made for a Pre-ConventionCertificate.

(8) For CITES Appendix I species, attach a copy of the CITES Import Permit issued by theManagement Authority of the country to which your plan to export or re-export the wildlife (notrequired if specimen qualifies as Pre-Convention.)

(9) List the Jamaican port through which the export, re-export or import will occur.

(10) This application is only applicable to plant specimens for which there is no quota system.

APPLICANTS DECLARAnON

I hereby certify that I have read and am familiar with the Endangered Species (Protection.Conservation and Regulation of Trade) Act.

I hereby certify that the information contained in this application is true and complete to the best ofmy knowledge and belief. I understand that any misrepresentation contained in this form shall leadto the discontinuation of the processing of the application and the revocation or suspension of anypermit granted and also may lead to prosecution.

Signature of Applicant'- _

FOR OFFICIAL USE ONLY

Date Received _

Date

Registration Number of Artificial Propagation Facility _

Date:of NRCA Inspection _

Quantityof specimens _

Name ofOtlicer-------------

Application Fee Enclosed _

Appendix No, _


FORMZ


TRADE) ACT, 2000

Application Form forImport/Export/Re-Export of Animal Specimens

Application No. _

o IMPORT PERMIT

o EXI'01n PERMIT

o J<E-EXI'OJ{T CL:J<TIFICATE

Please print or type

Name of Applicant: _

Address of Applicant: _

TRN No _

Teiephone No. Fax No. _ E-Mail _

Name of ConsigneelfWe hereby apply for CITES Pennit(s)/Certificate(s) for: --:--:-_-::-::,---,--- _

Addressof Consignee

City/State Zip Code Country

Indicate the name of Broker if applicable---- _

Purpose of transaction Commercial 0 .zoosD Circus and Travelling Exhibitions 0 Scientific 0

Reintroduction or introduction into the wild 0

Huming TrophicsD Personal 0 Biomedical Research 0

Breeding in captivity 0

Educational 0


If the specimen(s) is living indicate provisions to house and care it in country of import, export or reexport.

Indicate the name of each specimen(s) in each shipment in the table below. If additional space is requiredplease attach additional sheets.

InlJic.leifCaprin Bred

Dacriplionol (C).

Co••on Sdtadfic Namt Nu.buor Sp«imca Ib.ret!in Dlle Cllunlry O,ulllryurCouutry ur Uatt

Sp«imCQI (III.rklor Caplivity ,r of Origin luiNamt (Genua It .pecie.) n"m~n.I&e1",. (R)or Ilirlh I(~-,·.p...-l

E_lwrl

iflivc) ColIKleufrllmIhcWild W

124 PROCLAMAnONS, RULES AND REGULA nONS

Please note the following, where applicable:-

[ApRIL 12,2000

(1) This application form must be completed to commence processing. Where 5pace is not providedattach additional sheets. Paragraphs that are not applicable to your application should be markedasN/A.

(2) If species were collected from the wild, indicate name of location and parish/state/country.

(3) A permit is required for each shipment of animals.

(4) Any Certificate oflast re-export should be attached to the application form.

(5) Any import of animals shall be subject to the grant of an Animal and Importation Permit from theVeterinary Division, Ministry of Agriculture. Any export permit or re-export certificate shall besubject to the grant of a Health Certificate from the Veterinary Division, Ministry of Agriculture.

(6) If the specimens are protected animalslbirds taken from the wild in Jamaica provide (a) exemptionfrom the Minister of Environment and (b) the purpose that the specimen was removed from thewild.

(7) If the specimens are required for the purpose of re-export, attach copies of cancelled CITESExport Permits or Re-export Certificate issued by the appropriate CITES office in the countryfrom which the animal was imported. If you were not the importer, provide copies of theimporter's documents above and the invoice or receipt that shows you purchased the animal fromthe original importer.

(8) For a Pre-Convention animal, an application will only need to be made to the ManagementAuthority for a Pre-Convention Certificate.

(9) For living wildlife, describe the type, size and construction of any shipping container andarrangement for caring for the animal(s) during transport.

(10) For CITES Appendix I species, attach a copy of the CITES Import Permit issued by theManagement Authority of the country to which you plan to export or re-export the wildlife (notrequired if specimen qualifies as Pre-Convention).

(II) List the Jamaican port through which the export, re-export or import will occur.

(12) This application is only applicable to animal species for which there is no quota system

APPLICANTS DECLARATION

I hereby certify that I have read and am familiar with the Endangered Species (Protection,Conservation and Regulation of Trade) Act.

I hereby certify that the information contained in this application is true and complete to the best ofmy knowledge and belief. I understand that any misrepresentation contained in this form shall leadto the discontinuation of the processing of the application and the revocation or suspension of anypermit granted and abo may lead to prosecution.

Signature of Applicant


Date: Received-----

RegistrationNumber of Captive breeding Facility _

Date: of NRCA Inspection-----

Quantity ofspecimcn-----

Name ofOfficer----- _

Applicationfee enclosed _

AppendixNo. _

Date _

APRIL 12,2000] PROCLAMAnONS, RULES AND REGULA nONS 125

Gi3FORM 3

THE ENDANGERED SPECIES (PROTECTION,CONSERVATION AND REGULATIONOF

TRADE) ACT. 2000

Application Form forIntroduction from the SC~I

Appfic.uion No _

o IMI'OII.TI'I:.II.MII

o EXPOKT PERMIT

o [U~-EXI'ORT CERTIFICATE

Pleaseprint or type

TRN No ~__

Telephone No. Fax No. _ E-Mail _

I1Wehereby apply for CITES Permit(s) for:

Name of Consignee



Indicate the name of Broker if applicable.--- _

Purpose of transaction Commercial 0 ZooiD Circus and Travelling Exhibitions 0 Scientific 0

Huntina TrophiesD Personal 0 BivmedicaJ Research 0 Educational 0

Reinuoduction or introduction into the wild 0 Breeding in captivity/Artificial Propagation 0

Indicate the date in which the specimens came into your possession. (See below)

Indicate the name of each specimen in each shipment in the table below. If additional space is requiredplease attach additional sheets.

Dac:riplio. hlllicaleir,r C.ptinDrflI

S, .....i,"..11 (('),(Itlubur It ... r..uill

Common Scienlinc N.me'IIm~n, C'pli"ityCK),

COlilltryor DillealdHKir "Milici.U)' ll.kor Cuuntry"t C"ulllry"rN....c. {GUIIII It. lpedu) n....l l,rn.'.a_I.. 1("'I lIirlh Oriain 1••1 l':_II'lrt

(_ ..illl_l) 1t....... I'urlCoJltctedr....I", Wild W

126 PROCLAMAnONS, RULES AND REGULAnONS

Please not the following where applicable:-

[APRIL 12,2000

(I) This application form must be completed to conunence processing. Where space is not providedattach additional sheets. Paragraphs that are not applicable to your application should be markedasN/A.

(2) If species were collected from the wild indicated name of location and parish/state/country.

(3) A permit is required for each shipment of animals/plants.

(4) Any Certificate oflast re-export should be attached to the application from.

(5) Any import of animals shall be subject to the grant of an Animal and Importation Permit from theVeterinary Division, Ministry of Agriculture and any plants a Permit from the Plant QuarantineDivision, Ministry of Agriculture. Any export or re-export permit shall be subject to the grant of aHealth Certificate from the Veterinary Division, Ministry of Agriculture and PhytosanitaryCertificate from Plant Quarantine, Ministry of Agriculture.

(5) If specimens are protected animals/bird taken from the wild in Jamaica provide (a) exemptionfrom the Minister of Environment and (b) the purpose that the specimen was removed from thewild.

(6) If the specimens arc for the purpose of rc-cxport, attach copies of cancelled CITES Export Permitsor Re-export Certificate issued by the appropriate CITES office in the country from which theanimal was imported. If you were not the importer, provide copies of the importer's documentsabove and the invoice or receipt that shows you purchased the animal from the original importer.

(7) For a Pre-Convention animal, an application will also need to be made to the ManagementAuthority for a Pre-Convention Certificate.


(9) For CITES Appendix I species, attach a copy of the CITES Import Permit issued by theManagement Authority of the country to which you plan to export or re-export the wildlife (notrequired if specimen qualifies as Pre-Convention).

(10) List the Jamaican port through which the export, or re-export and import will occur.

(11) This application is only applicable to animal species for which there is no quota system.



I hereby certify that tbe information contained in this application is true and complete to the best of myknowledge and belief. I understand that that any misrepresentation contained this form shall lead to thediscontinuation of tbe processing of the application and the revocation or suspension of any permit granteda"d also may lead to prosecudon.



Date Received ------

ReaiSlration Number of Captive bred Facility _

Date of NRC A Inspection _

Quantityofspcc:imcn _

Name ofOfticer _

AppliClition fee enclosed _

AppendiXnumber _

Date _


~FORM 4

THE ENDANGERED SPECIES (pROTECTION,CONSERVATION AND REGULATION OF

TRADE) ACT, 2000

Application Form for a Pre-Convention CertificateApplication Pursuant to Section 5 of the Endangered Species

(protection, Conservation and Regulation of Trade) Act

Application No. _

Pleaseprintor type

Name of Applicant: _

Address of Applicant,-· _

TRN No. _

Telephone No. ______ Fax No. _ E-Mail _

Name of SpecimenlIWe hereby apply for a CITES Pre-Convention Certificate(s) for "7,"_--;;-;;----, _



Indicate when you came into possession of the specimen(s). (See below)

Attach documents, signed statements or evidence that the specimen was obtained prior to the date CITESapplied to it.

CircusandTravellinsExhibitions 0 Scientific,; 0Purpose of transaction» Com"",do1 0 Zoos 0

Huntln,Trophies 0 BiomedicalResearch 0 Educational 0

Reintroduction orintroduction intolhcwild 0 Breeding incaptivity or Artificially Propagated 0


Indicate the name of each specimen to be issued a Pre-Convention Certificate in the table. If additionalspace is required please attach additional sheets.

IndiCIII~ ifDnc:riplioa C.pIIVllUreo&

or (e.Sped_u Retired I.

Co...... Sdtadftc NalM(_Ituor Capllvlry(R),

CounlryorIII\lMbe", Ar1i1idaUy D.I~lIIr Coualryoflu'N.... c (Gens" Ip«lu) •••• if propal·Ift!(A) Uir111 ~IIKlrl Export nale

live) ..~:::~:~~


Please note the following where applicable>

[APRIL 12,2000

(I) This application form must be completed to commence processing. Where space is not providedattach additional sheets. Paragraphs that are not applicable to your application should be markedasN/A

(2) If species were collected from the wild indicate name oflocation and parish/state/country.

(3) A Certificate is required for each shipment of animals/plants.

(4) Attach certificate oflast re-export

(5) Any importation of animals/plants shall be subject to the grant of an Animal and ImportationPermit from the Veterinary Division and a permit from Plant Quarantine. Any Export or ReExport Permit shall be subject to the grant of a Health Certificate from the Veterinary Division anda Phytosanitary Certificate from Plant Quarantine.

(6) For protected animalslbirds taken from the wild in Jamaica provide CaJ exemption from theMinister of Environment and (b) purpose specimen was removed from the wild.


(8) List the Jamaican port through which the export, re-export and import will occur.


I hereby certify that I have read and am familiar with the Endangered Species (Protection,Comervation and Regulation of Trade) Act.

I hereby certify that the information contained in this application is true and complete to the best ofmy knowledge and belief. I understand that any mIsrepresentation contained in this form shall leadto the discontinuation of the processing of the application and the revocation or suspension of anypermit granted and also may lead to prosecution.


FOR OFnCIAL USE ONLY

DaleReceived _

Date _

Recistradon Number of Captive bred/Artificial propagationFacility _

Dale o(}<RCAlospcctioo _

Quantity of specimen (.) _

NameofOfficer _

Application fee enclosed _

AppendixNo. _


~FORMS


TRADE) ACT, 2000

Application Form for Certificate of Origin

Application No. _

RIC·EXPORT CERTIFICATE

o EXPORT PERMrl

oName of Applicant:..: _

Address of Applicant:----------------------------

TRNNo.

Name of ConsigneelfWe hereby apply for CITES Permit (s) to export/re-export to -:-;-__=_-,- _

Addressof Consignee

City/State lip Code Country

Indicate when you came into possession of the specimen(s) (see below)

Indicate the name of the broker if applicable _

Purposeof transaction Commercial0 Zoos 0 Circus and Travelling Exhibitions 0 Sl.:,ClIlilicD

Hunting Trophies 0 Personal fUiomcdical Research 0 Educational 0

Reintroduction or introductioninto the: wild0 Breeding in captivily/Artilicial Propagation 0

Please describe purpose in detail on additional sheets.

Indicate the name of each specimen for which certificate of origin is required.

Sdenlilic Name Inlliule irC.plin Hwl{C).

COlDlDoaNamc: (Genus" lpetitt) Number of lpec:imra Rurw in C.pli~ily (R). DaleArlirici.lly l,rllroK.IC',1(A)lIrC"Il~I..llrrull'lh.. W;hl IV


Please note the following: -

(I) An application for each species is required.

[APRIL 12,2000

(2) Attach export permit where the species is being imported from a Convention State whose lawsapply to this species.

APPLICANTS DEC LARA TION


I hereby certify that the information contained in this application is true and complete to the best ofmy knowledge and belief. I understand that any misrepresentation contained in this form shall leadto the discontinuation of the processing of the application and the revocation or suspension''of anypermit granted and also may lead to prosecution.

Signature ofApplicant'--- _


DateReceived _

Date of NRCA Inspection _

Quantityof specimens _

Nameofofficer _

Application fee enclosed _

AppendixNo. _

Date _


PARI I

TIlE ENDANGERED SPECIES (PROTECTION, CONSERVAnON ASDREGULATION OF TRADE) ACT, 2000

Permit for ExportlImportIRe-Export of Plant or Animal Specimensand Certificate for Introduction from the Sea

D EXPORT PERMITc

FO!lenventtou on

International Trade o IMPORT PERMIT

of EndaDeered Species of Wild o RE·EXPORT PERMIT II Ongmul Permit! Certificate No.Fauna and Flora JM

o OTHER CERTIFICATES _. ano unn

3. Importer (name & address, country) 4. Exporter (name & address, country)

3a. Country of import

5. Special conditions 6. Name, address. national seal/stamp of Jamaica Management Authority

F....I"".,;....... ItIi1,.miIOl..,;lIc-*it ... I)'~IIli4irllle......,.,..~liuna_f""""'IIIeGui<kJj_ it~ l.>Ii "'tAlAlC"

Sa. P'urpoIc: of the transactionISh

Security Number

718.SCIENTIFICNAME(&tml$ & species) 9, Description ofs >ccimen 10. Appendix No. II. Quantity (kg or [lao Total uportedlAND COMMON NAME OF ANIMAL OR PLANT including iderui ying marks 0 and source numbcr ofspccuucns Quota

numbers (age Is x iflive)

/& 9 10 11 11,

A 12. Country of origin -I Permit No. 1 D'I< 12, Country of last re-export I Certiflcate No.

IDale \ 12b. No ofoperations e or date

acqulsition·-·

7/& 9 10 11 Iia

B12. Country of criain -I Penni! N0l "'I< 12a. Country of last re-export I Certificate No Dale 112b,NOOfoperatiOn•• ordate

ac ui.~ition···

7/& 9 I. 11 Iia

C12. Country of Oriain·

1Permit N1' "'" 12a. Country of last re-export I Cernficatc No. I Dale I 12b. No or opcrJlion·· or dale

acquisition···

7/& 9. I. 11 11,

D 12. Country of oriain - Penni! No ",,, 12a. Country of last re-export Certificate No Date I 12b. No of operatlone'" or date

I I I I ;'l\;quisition···

c.o.m.y ia wtDda!be~ _1IJtal6om!be wild, bred in uptivityotartificil.lIypropq;a\lCd(only incase of_port).. 00Iy b lIpICimcu 01AppcDdiA. IIpeCia bred iDcaplivilyot artifieiallyforconmm;i.1 pWJl<l'C5...·pQl'....coe~~

13. THISPERMITIS ISSUEDBY:

PI"", ",,, Security stamp. signature and official seal

14. ExportlRc·Expon Endorsement

1bc Official who inlpCCcashipmen! upon exponauonJ re-expcrtatien mustenter the actlolalquantitiCf of apociCi re~ltported in this block.

~Port of Export ",,, Signature Otlicial Stamp and Title

~FORM 2

PART II

The Endangered Species (Protection, Conservation andRegulation of Trade) Act, 2000

Pre-Convention Certificate

WN

Certificate No. _

The Management Authority of Jamaica hereby certify that, under section 5 of the Endangered Species (Protection, Conservation andRegulation of Trade) Act, that: -

This Certificate is issued by:

Country of Origin

Common Name

Appendix No.

CountryAddress

Scientific Name(Genus and Species)

Dalc or Issue

Description (marks distinguishing features)

Authorized Officer

Has been issued a Pre-Convention Certificate for the following: -

Number of Specimens

Name of Importer/Exporter/Re-exporter

Name, address, country of Management Authority

Security Stamp and Official Seal -JVNooo

The Management Authority of Jamaica hereby certify that, under Section 3 of the Endangered Species (Protection, Conservation andRegulation of Trade) Act, a Certificate of Origin has been issued to:

-JVNooo.......Certificate No. _

Appendix No.

Country

Common Name

Address

Scientific Name(Genus and Species)

The Endangered Species (Protection, Conservation andRegulation of Trade) Act, 2000

Certificate of OriainE;jFORM 3

Number of Specimens

Name, address, Country of Management Authority

The Country oforigin is.s _

This Certificate is issued by:

Date of Issue

Authorized Officer

Description (marks or other distinguishing features).

Security Stamp and Official Seal

Name of ExporterlRe-exporter

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