輸出犬貓免疫注射證明書
VACCINATION CERTIFICATE

編號Ref. No.                     檢查日期Date    年(Y)    月(M)    日(D)
畜主姓名Owner's Name                                                    
身份證字號ID NO                                          Passport No.                                             
地址 Address                                                   
畜種Species          品種Breed           體種Body Weight          kg 
性別Sex          年齡Age    Years    Months生日Birthday   年(Y)  月(M)  日(D)
毛色與特徵Color&Characteristics                     
生產地Country of Orgin                    到達地 Destination                  
晶片號碼Micro chip no.                                                植入位置Implant position                 

狂犬病預防注射紀錄Rabies Vaccination Data：

血液寄生蟲檢測 Blood Test                   驅蟲日期Deworm Date                   
糞便寄生蟲檢查Fecal Exam.                   驅蟲日期Deworm Date                   
血液生化檢查Blood Chemistry&Cells Exam.及尿液檢查Urinalysis 如下頁附件： 

其他預防注射之種類及日期Kind & Date of Other Vaccination：

茲證明上列動物業經本獸醫師檢查，健康情形良好，無任何傳染病之徵狀。
This is to certify that the above described animal has been examined by the undersignedveterinary and has been found in good condition and free from Any evidence of infectious, or communicable disease.

獸醫師簽字                    
(Signature of Veterinarian)
獸醫院名稱：亞東動物醫院YeaDong Animal Hospital 
(Name of issuing Veterinary Hospital) 
獸醫院電話：886-2-22218515
(Telephone of issuing Veterinary Hospital)
獸醫院地址：台北縣中和市中正路639號
NO 639 CHUNG CHENG ROAD CHUNG HO CITY TAIPEI HSIEN TAIWAN ROC
(Address of issuing Veterinary Hospital)
獸醫師(登記)證書字號：台獸師字第1900號
獸醫師執業執照字號：北縣獸師執字第045號
獸醫診療機構開業執照字號：北府畜醫業字第053號