ANNEX IVSupplementary provisions
ANNEX IV PASSPORT FOR BIRDS AND RODENTS IN A CIRCUS or ANIMAL ACT Text of image COVER EUROPEAN UNION [MEMBER STATE] ANIMAL PASSPORT: BIRDS AND RODENTS (CIRCUSES AND ANIMAL ACTS) Number Issued at on / / Competent authority Regional/local service of COVER Text of image 1. Owner 1.1. First name 1.2. Surname 1.3. Address 1.4. Post code 1.5. City 1.6. Country 1.7. Telephone number 1.8. GSM ( 1 ) 1.9. Fax ( 1 ) 1.10. E-mail ( 1 ) ( 1 ) Not mandatory. In the event of a change of ownership, this section shall be crossed out and the relevant addendum must be completed. 2. Description and identification of the animal 2.1. Species 2.2. Breed 2.3. Individual identification numbers (if practical) 3. Notes The identification must be verified before any new entry is made on this passport. Text of image 4. Vaccination history 4.1. Date 4.2. Vaccine 4.3. Stamp and signature (*) For pigeons: yearly vaccination against Newcastle disease. 5. Testing details (*) 5.1. Date 5.2. Test 5.3. Result 5.4. Stamp and signature (official vet) Text of image ADDENDUM 1 Date Stamp and signature of official veterinarian 1. Owner (to be completed only in the event of a change of ownership) 1.1. First name 1.2. Surname 1.3. Address 1.4. Post code 1.5. City 1.6. Country 1.7. Telephone number 1.8. GSM ( 1 ) 1.9. Fax ( 1 ) 1.10. E-mail ( 1 ) ( 1 ) Not mandatory. ADDENDUM 2 Date Stamp and signature of official veterinarian 1. Owner (to be completed only in the event of a change of ownership) 1.1. First name 1.2. Surname 1.3. Address 1.4. Post code 1.5. City 1.6. Country 1.7. Telephone number 1.8. GSM ( 1 ) 1.9. Fax ( 1 ) 1.10. E-mail ( 1 ) ( 1 ) Not mandatory. Sequences of the headings, numbering of pages and languages: 1. The sequence of the headings (including the numbers) of the model passport must be strictly followed. 2. Each page of the passport must be numbered at the bottom. The number of pages of the passport as issued must be indicated on page 1 in the following format: 1 out of [insert total number of pages]. 3. Headings must be given in the official language(s) of the Member State of issue and in English. 4. The size and the shape of the ‘boxes’ of the model passport are indicative and not binding.