| Date of Issue | |
| Certificate Number | |
| Exporter Name & Address | |
| Consignee Name & Address | |
| Place of Fumigation | |
| Date and Time of Fumigation | |
| Commodity Description | |
| Quantity | |
| Packing Details | |
| Container No./Seal No. | |
| Vessel/Flight No. | |
| Fumigant Used | |
| Dosage Applied | |
| Exposure Period | |
| Temperature During Fumigation | |
| Fumigation Completed On | |
| Ventilation Completed On |
This is to certify that the above mentioned commodity has been fumigated as per the standard recommendations and is free from infestation at the time of inspection.