飞机进 / 出口卫生检疫申请书

APPLICATION FORM FOR QUARANTINE INSPECTION ON

IMPORTATION / EXPORTATION OF AIRCRAFTS

中华人民共和国 浙 江 出入境检验检疫局

To the ZheJiang Bureau for Entry-exit inspection and Quarantine of the People’s Republic of China

本飞机申请实施进 / 出口卫生检疫，并根据检查结果发给进 / 出口检疫证。

I hereby apply for a quarantine inspection of importation/exportation on my aircraft and the issue of the
Pratique / Quarantine Certificate for the Departure of Aircrafts on the basis of the inspection results.

飞机型号
Type and registration marks of aircraft

国籍 总吨
Nationality Gross tons

飞机所有人
Owner of the aircraft

申请日期及时间
Date and time of application

机长签字
Captain Signature

-------------------------------------------------------------------------------------------------------------------------------------

日期
签 证 Date
Certificate issued 时间
Time

检验检疫人员签字
Signature of Quarantine Officer