(별지 제41호 서식)				(앞 면)
멸종위기에 처한 야생동식품종의 국제거래에 관한 협약 CONVENTION ON INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA	1. 허가(증명)번호 Original Permit / Certificate No. R.O.K
□ 수 출 EXPORT □ 재수출 RE-EXPORT □ 수 입 IMPORT □ 기 타 OTHER	2. 유효기간 Valid - until
3. 수탁자 (성명, 주소, 국명) Consignee (Name and address country)	4. 수허가자(성명, 주소, 국명) Permitee (Name and adress, Country)
3a. 목적지 (Country of destination)
5. 대한민국 관리당국 R.O.K MANAGEMENT AUTHORITY : 식품의약품안전청 의약품안전과 PHARMACEUTICAL SAFETY DIVISION, KOREA FOOD AND DRUG ADMINISTRATION
5a. 사용목적(뒷면참조) Object of the operation (See reverse)	6. 스템프번호 Security stamp No.
7./8. 학명 및 보통명 Scientific Name(genus and species) and Common Name of Animal or Plant	9. 표본이 포함된 상품명 (수량) Name of commodity including part or derivative of specimens (Quantity)	10. 부속서번호 및 출처(뒷면참조) Appendix No. and source (See reserve)	11. 표본의 수량 /또는 중량 Quantity, number of specimens and /or net weight (kg)	11a. 총수출쿼터량 Total exported Quota
A.
12. 원산지 Country of origine★	허가번호 Permit No.	일자 Date	12a. 최종재수출국 Country of last re-export	증명번호 Certificate No.	일자 Date	12b. 사용목적 및 취득일자 No. of operation★★ or date of acquisition★★★
B.
12. 원산지 Country of origine★	허가번호 Permit No.	일자 Date	12a. 최종재수출국 Country of last re-export	증명번호 Certificate No.	일자 Date	12b. 사용목적 및 취득일자 No. of operation★★ or date of acquisition★★★
★ 야생 또는 인공사육증식국가(재수출의 경우) Country in which the specimens were take from the wild, bred in captivity of artificially propagated (only in case of re-export)
★★ 상업목적으로 야생 또는 인공사육 증식한 부록 Ⅰ에 한함. Only for the specimens of AppendixⅠspecies bred in captivity of artificially propagated for commercial purposes
★★★ 협약이전의 표본 For pre-Convention specimens
13. 허가서(증명서) 발급기관 THE PERMIT IS ISSUED BY :
	Pharmaceutical safety division						Director
	장소 Place		일자 Date		서명 Signature		Official scal and title
14. EXPORT ENDORSEMENT 15. 선하증권/항공화물운송장번호 Bill of Landing / Airway-Bill Number
	See block 7	Quantity
A
		수출항 Port of export		일자 Date		서명 Signature		Official scal and title
B

(뒷 면)

앞면 5a란에 사용될 코드

The codes to be used for box no. 5a are as follows :

T  상업용 Commercial

Z  동물원용 Zoos

G  식물원용 Botanical gardens

Q  서커스 및 순회공연(전시)용 Circuses and travelling exhiitions

S  과학연구용  Scientific

H  수렵기념품 Hunting trophies

P  사적(私的)사용 Personal

M  생물학적연구용  Bio-medical reserch

E  교육용 Educational

N  야생용 Reintroduction or introduction into the wild

B  인공사육 증식용 Breeding in captivity or artificial propagation

앞면 10란에 사용될 코드

The codes to be used for box no. 10 are as follows :

W 야생의 것.  Specimens taken from the wild.

R 목장의 것.  Specimens originating from a ranching operation.

D 상업목적으로인공사육한 부록 Ⅰ 게재표본으로서 CITES규정 제7조제4항에 의거 수출한 것(부분품․완제품 포함).

Appendix Ⅰanimals bred in captivity for commercial purposes, or Appendix Ⅰplants artificially propagated for commercial purposes as well as parts and products thereof, exported under the provisions of Article Ⅶ, paragraph 4, of the Convention.

A 식물의 경우는 CITES규정 제7조제5항 및 제8차 당사국회의 결정서(Conf. 8.17)에 따라 인공재배한 것(상업목적으로 인공재재하지 않은 부록Ⅰ, 부록Ⅱ, 부록Ⅲ, 부분품․완제품 포함).

Plants that are artificially propagated in accordance with Resolution Conf. 8.17, as well as parts and products thereof, exported  under the provisions of Article Ⅶ, paragraph 5, of the Convention (specimens of species included in Appendix Ⅰ if they are not reproduced artificially for commercial purposes and specimens of species included in Appendices Ⅱ and Ⅲ).

C 동물의 경우는 CITES 규정 제7조제5항 및 제2차 당사국회의 결정서(Conf. 2.12)에 의거 인공사육한 것(상업목적으로 인공사육하지않은 부록 Ⅰ, 부록Ⅱ, 부록Ⅲ, 부분품․완제품 포함).

Animals bred in captivity in accordance with Resolution Conf. 2.12, as well as parts and products thereof, exported under the provisions of Article Ⅶ, paragraph 5, of the Convention (specimens of species included in Appendix Ⅰ if they are not bred in captivity for commercial purposes and specimens of species included in Appendices Ⅱ and Ⅲ).

F 사육증식된 것으로 제2차 당사국회의 결정서(Conf. 2.12)에서 정의한 인공사육증식의 범위내에 포함되지 않는 것(부분품․완제품포함).

F1-generation animals born in captivity, but which do not fulfil the definition of "bred in captivity" in ResolutionConf. 2.12, as well as and products thereof.

U 자료미상(정당한 사유 설명).  Source unknown(must be justified).

I 몰수 또는 압류된 것.  Confiscated or seized specimens.