Request Form for Testing Animals for Export

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Surname

First name

License No.

Contact Details

City

Street

House No.

Telephone

Moblie phone

Fax

Email Address

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Type identification

Israeli ID

Passport Num

Surname

First name

Israeli ID

Passport

Issuing country (passport)

Contact Details

City

Street

House No.

Postal Code

Telephone

Moblie phone

Fax

Email Address

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Animal Type

Other animal

Name

Breed

Birth Date (mm)

(yyyy)

Sex

Colour

Microchip No.

Additional identification

Animal’s place of residence

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Type of Test

Select one or more from the list

Test Delete test Sample Name of test Name of test Comment

Details of submitted material

Date of sampling

type choose Sample Comments

Vaccination history

Date of last Rabies vaccination

Vaccine Batch

Total Rabies vaccinations received

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I hereby certify that the submitted samples

* Are marked by 4 last digits of Microchip No.

* Were taken by me and are from the animal described above

Please print this form by clicking PRiNT. The form must be signed, stamped by the veterinarian and submitted with the sample and payment confirmation

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The statutory fee for the requested test may be paid by the following methods

Method of payment

ePayment

Check

Other

After sending and printing the form, you can proceed to the government server to complete your ePayment through this link Please submit payment confirmation with the sample and the signed submission form

Ordinance Veterinary Institute

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