Potvrzení příslušného orgánu veterinární správy o nákazové situaci v okrese
Veterinary certification for intrastate transport / Certificat sanitaire pour le transport indigéne
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| Datum | Nákazová situace | Doba platnosti, účel vydání | Jméno, podpis a razítko | Místo pro nalepení |
| | v okrese | a místo určení | veterinárního lékaře | kolku |
| | | | příslušného orgánu | |
| | | | veterinární správy | |
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| Datum | Místo | K tomuto průkazu koně je přiloženo samostatné | Razítko a podpis veterinárního lékaře |
| Date | Place | veterinární osvědčení číslo: | Name, signature and stamp of |
| | Lieu | To this passport is attached individual | veterinarian |
| | | veterinary certificate N° | Nom, signature et cachet du |
| | | Le document est accompagné par certificat | vétérinaire |
| | | sanitaire officiel N° | |
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