FSIS Form 9060-6

Application for Export Certificate

Application Type

12–21. Product Lines

Line 1
Line 2
Line 3
Line 4
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Taiwan Export Certificate (FSIS 9285-1)

Optional supplemental form. Only used for exports to Taiwan.

Signatures

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0583-0153. The time required to complete this information collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE
APPLICATION FOR EXPORT CERTIFICATE
APPLICATION TYPE
X 1. ORIGINAL
2. REPLACEMENT APPLICATION / REASON FOR REPLACEMENT
Lost Certificate
Importing Country Border Closure
Incorrect Certificate
Split Shipment
Importer/Exporter Changed
Consolidated Shipment
Certificate Missing Required Information
3. Certificate No.
4. Shipment Type
Commercial Sale
Personal Consumption
Ship's Store
U.S. Military
Samples
U.S. Embassy
Airlines
5. Date of Request (mm/dd/yyyy)
6. Country of Destination
7. Country of Final Destination
8. Consignor/Exporter (Applicant's name and address)
9. Consignee/Importer (name and address)
10. Export Est. No.
11. EXPORT MARK TO BE USED:
USDA EXPORT MARK
UNIQUE IDENTIFIER:
12. Description of Product
(including Product Code)		13. HACCP
Cat.		14. Species15. Maturity <30 mos16. Frozen/
Shelf-Stable		17. Net Weight of Lot18. No. of Pkgs19. Type of Pkgs20. Shipping/ID Marks21. Est. No. on Product
22. Total Net Weight
23. Total No. of Packages
24. Additional Statement
Under penalty of law, I certify that the products covered by this application for export meet the inspection requirements for the country of destination. I will provide documentation to FSIS program employees upon request.
25. Applicant Signature
26. Printed Name
27. Date
I certify that the product was examined in accordance with Agency policy.
28. Certifying Official's Signature and Title
29. Printed Name and Title
30. Date
FSIS FORM 9060-6 (02/13/2020)