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International Scheduled Animal Shipping Authorization Application

Form: CITES-A55-Vv-IP3
Important. Read this before completing this form:
The CITES (Convention on International Trade in Endangered Species of Wild Fauna and Flora) 1973 treaty requires all parties involved in
international cross-border shipping of Schedule I and Schedule II animals to seek and acquire prior authorization before any shipment or
transfer can take place.

 This form (IP3) MUST be completed by the SENDER of the animal(s) BEFORE the animals can be sent.
 Once completed this form must be sent to the RECEIVER of the animal who must submit it with the receiver declaration (IP2) form
and oversight (IP1) form to the UNEP authorized office in the country of the RECIEVER.
 A SEPARATE FORM IS REQUIRED FOR EACH ANIMAL
 All sections must be completed fully in BLACK ink.
 All photographs must be in color. Digital photographs are acceptable.

NOTE: Making a false declaration is a criminal offence in all CITES Party countries and can be punished by a fine, imprisonment or both.

1. SENDER INFORMATION

1.1 Name

1.2 Address

Country

Post/Zip Code

1.3 Telephone (Land) +

1.4 Telephone (Mobile) +

1.5 Email

1.6 CITES license held YES NO If “Yes” give number

1.7 Zookeeper license held YES NO If “Yes” give number

1.8 Have you shipped before YES NO Shipments made

1.9 Are you a charity YES NO Charity registration #

1.10 Are you a Sched 4 party YES NO Party #

1.11 CITES registered sender YES NO Sender reference #


CITES A55-Vv-IP3 Page 2

2. ANIMAL INFORMATION

2.1 Species

2.2 Taxonomic (latin) name

2.3 Animal’s name

2.4 Sex Male Female Hermaphrodite

2.5 Conservation status Extinct Extinct in the wild Critically Endangered

Endangered Vulnerable Threatened

Conservation Dependant Near Threatened Least Concern

2.6 Has this animal been poached from a wildlife reserve? Yes No

2.7 Does the animal have any communicable diseases? Yes No

2.8 Does the animal have any scars, marks or blemishes? Yes No

2.9 Has the animal been used for breeding? Yes No

2.10 If female, is the animal pregnant? Yes No

2.11 Has any human being has sexual intercourse with this animal? Yes No

2.12 If you have answered YES to any of the questions above give FULL details in the space below

2.13 Is the animal chipped? YES NO Microchip #


Chip registration authority

IF THE ANIMAL IS MICROCHIP IDENTIFIED PLEASE GO TO SECTION 3 OTHERWISE COMPLETE THE REST OF SECTION 2
WHICH CONTINUES ON PAGE 3
CITES A55-Vv-IP3 Page 3

2.14 Attach a photograph of the animal’s LEFT side in the space below.

2.15 Attach a photograph of the animal’s RIGHT side in the space below.
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2.16 Attach a photograph of the animal’s HEAD as seen from the FRONT

2.17 Attach a photograph of the animal’s genitals (NOTE: Male animals MUST be FULLY erect)
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2.18 Place the animals hoof / claw / paw prints in the spaces below

Left Fore Right Fore

Left Hind Right Hind

2.19 Detail any distinguishing features the animal has in the space below.
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3 DECLARATION

3.1 Have you ever been convicted of trafficking in CITES scheduled animals Yes No

3.2 Have you ever been convicted of trafficking in restricted animal products Yes No

3.3 Have you ever been convicted of cruelty to or misuse of any animal? Yes No

3.4 Have you ever had sexual relationships with any animal? Yes No

3.5 Have you ever been convicted or charged with a criminal offence? Yes No

3.6 If you have answered YES to any of the questions above give FULL details in the space below

I hereby swear under penalties of perjury that this information I have given on this form is the truth
and I have not sought to lie, dissemble or act in an ingenuous manner in completing it. I understand
that the giving of false information is a criminal act in all CITES party countries and I would be liable
to fines or a jail sentence if false or deliberately misleading information was given. I hereby declare
that the images and imprints shown on this form are those of the animal that is to be transported.

Signed

Date D D M M M Y Y Y Y

YOU SHOULD NOW SEND THE COMPLETED FORM TO THE RECEIVER OF THE ANIMAL