Order of the State Service on Food Safety and Consumer Protection of Ukraine validating Health certificate for food of non-animal origin

"3ATBEP )])KYIO" ,. fo:1ona Acp1Kas1101 c .,r1yiK611 YKpa'im11 llltl'a-ijb -0e.mc1.111ocTi xap1.1osn~ flPOAY,tahi ,:a 'HCT)' CIIO,KHBa'-tiB j B.I. Jlana for food of non-animal origin h' pAYt1a-t1mt0p1rp/l ,port in::;g~co:;:u~n: ::t::.:l\: 1 ;-~~h'::'.. p~a::Y:-'.11::a:::•i~":::1;.1;0:::p::•::e;--p 'l m :p o r1 1 n :.!!. c o un t r,:... 1 ";;-----:::::::7i 11 lliuopn,.1111"/Consognor 12 llo'leprrp,ucj>i"arn ~~a q .. ~ C': a:, E 0 ll•rn• Name \wern ,Addrcss llo"•P re. ,ecj,011) 'Tel No 1 ~ 0.1eJ)it-)n.a,1 ·con,1~,c..--c lla1B:o Name Ccn1ticatc rcf(rt.:ncc n11mher I , Ko\tnt1tu11111i1 01111111/ Compc1cn1 Authotll) I ., Ttptnopia..1btt11ii opt uu " o ,meTeun,~ 01M 111, Loe,,! ComP',::ltnt Authont) I 6 \Jicue no,0Me1111w (111111061111") Place of ongon (producer) llaJBo Name A:,,peca Address I I0\1Cll ~ ~IJSl.lttttUI Pe, Cl llllUillllltll 110 ,1ep / Appro,al Reghtrauon number = • 1---------------,---.----,,-----------:-:--,--l-:--:,-:-:-:----------:-:--=::--r-;--=--=---:--------;-:--;-"1 ~ c I 7 K11ai11n Ko:t ISO/ I 8 Periou no,011;,,t1111a Kolll I 9 Kp1T11a np11111a•1eo111a Ko., ISO I ' 10 Peliou Ko.-i/ :ii E noxo11;,,e111111/ ISO code Rc~oon of on1:111 Code Counll') of dcstmauon ISO code 111111111a•1e1111w Code li. ~ Country of ori@on I Re~10n of de,1111011011 ~ -~ I h.lt \11' l I l \ I I ~ e '111 \lime Bl 181.11111.+itllllW Place o-f-lo a d ... 111 g .. -+-,-, 2-.-.-,.- ,-.-B-i-11-,1-,a-11J-,-.-.. -.. w Date of Jcpanurc <'!'t:l 0 ~ 3 ~ '----·= '« I 13 ~, pa11c1101n• Means of trnnsf)Ort ~ ,;' .~i••" 0 Cy.1110 g ::: Airplane Ship ~ 0 C ~ .. lopo~uHi tl\ina,. '" Road ,ch,clc - .; ""Q .. I tell nocj>i"nuiw E t: ldcn11ficn11011 I ~ : #lo~) ,1e11 rn 111,ui not1Lia11us1 Docu111cn1ar, reference~ □ □ Ja.J11)tt111111i ORI OltU Raol"a~ .-agon l11m11ii Other I 16 llan\leu)oo1111• 1os1 11) ra 0111,c· Name of the producl and de<cnptoon I IS I e,,,,111 npu 1a 111oc1P L,p1rnllon date I 20 I 22 I ic1m1cj>i"a11i• 1<011 ren11epa/110>1e11 n.,0\1611 ldcn1,r1ca11on of contaoner seal number I 2'.\ .,;l,; rn l"lf0..1Cb~OrO CllO~UftltlltA / for human c0Mump11on 0 □ □ I 11 lhi.11mh 111uu~opn,om111h i11c11el\1li111111n II) Ilk, (Wt\HIO Huo,10)/ bury Border 111spcc11on poml (1fapphcablcJ I IS } MOBIi 16epira1111w Ta rpa11cno1n) eu111w (re,111epa r) 1111)/ Storage and transport cond111on, I temperature) I 17 1 lo,ttp napTii" ntio IJ:'lTtt ""flk") on111u1/ l.01 numbc, or date 1dcn11fication I 2-1 np11"1inrn No1cs I 19 Ba, a uen o o.1111111uil Un11 nc1 '"eight (in appropriate 11111h) 1 21 ~i. tbl\iCTb Tl Bit l J UAlo:0801' Number and •~pc of pac~a~~, I SI. 11ep;i;ao1111n incnek,op, wo 1111;i;4e ni.an11caoc11. u11,1 1acoi11•1)10, mo 011po61111i- npo11yKT}, 11i-11ii np1n11a•1e1111JI 1111 ei-cnopr 1 ) i-pal'1111, 11i.1. rnrno 11epeoipui 1 6oi-, h'o,111nc11111oro op, a11 ~ i-pal'1111 rn 111a,o.111TbCR ni.1 ilo, o 11a1.111,10,1 m o.10 1orp11,111111111 oi111ooi,11101 o lR>-0110/IRBOB:l npo ,ap•tOBi 11po,1y1n11, II >-0. 111 ue 11eo6Ai.1110 Bi,1611pa10TbCII lpHl>-11 npO,I) k"T) Ta 10<'. ti.l;t;) IOI l,CII B ) 110Bll088;t;Cllili h'o,111e1e111111"1 oprn110,1 ~ i-pa'i1111. 1a6opa1 opiY. I. the undcr.1gned state inspector hereby ccrtt r> 1hm the producer of 1hc product "hich ,s ,mended to be export b} I l..ramc has been undergoing mspcclllms b) Compc1c111 Authont) or Ukrnme and 1s being under tis supervision m terms of relevant food lcgisla11on and ,,hen ncccssal) samples are taken from the roducl\ and anal Led 111 lahoruto • authon,cd b the Com tent Authorit of U l..rmnc , lep;i;111111111t i11c11ek,op \late mspcc1or llpi11111111e (oc,111i-11,111 . 1i1epaM11) Name (111 cnp1tals) .la 1u ' Date: ne•1a1Ka I Stamp: h'oa. 1i<1>ii-nui11 rn 11ocn 111 ' Quahlica1,on and 1111c m .1n11c I Signature