良好农业规范(GAP)认证申请书.doc

良好农业规范（GAP）认证申请书APPLICATION FORM FOR GOOD AGRICULURAL PRACTICE(GAP) CERTIFICATIONCQC/13GAP01.01 1.申请人信息/Applicant information:申请人名称/Name of Applicant：申请人地址、邮编/Address and Zip of Applicant：付款人名称/Name of drawee：付款人地址/Address of drawee：法人代表/Legal representative：联系人/Contact person：联系电话、传真/Telephone/Fax Number：E-MAIL(或网站/and/or website):2.申请内容/Applying Information：2.1 首次申请/First Application 复评申请/ ApplicationSubsequent （第 年） 转换机构/Chang CB2.2 申请认证级别/ Certification Grade of Application ChinaGAP-GLOBALGAP认证/ ChinaGAP-GLOBALGAP Certification (仅适用于种植类产品/Only for Crops)GLOBALGAP认证/ GLOBALGAP Certification (仅适用于种植类产品/Only for Crops) ChinaGAP一级认证/Grade 1 of ChinaGAP Certification ChinaGAP二级认证/Grade 2 of ChinaGAP Certification 如申请ChinaGAP一级认证现场检查没有通过，同意申请二级ChinaGAP认证/ Agree to Apply Second Class of GAP Certification, If Not Acquire First Class of GAP Certification.2.3申请选项/Option of Application 选项1-农业生产经营者/Option 1-Producer 选项2-农业生产经营者组织/Option 2-Producer Group 2.4申请模块/Applying for Modules：大田作物/Combinable Crops ： 果蔬/Fruit Vegetables 茶叶/Tea牛羊/Cattle Sheep 奶牛/Dairy 猪/Pigs 家禽/Poultry水产池塘养殖/Aquaculture Pond culture 水产网箱养殖/ Aquaculture Cage culture水产工厂化养殖/ Aquaculture Industrial culture 水产围拦养殖/ Aquaculture Net enclosure culture水产滩涂、吊养、底播养殖/ Aquaculture Intertidal mudflat/hanging/ bottom-sowing culture其他/others:3. 是否申请附加服务/Applying for Additional Service（否，请忽略此项/If not, omit it.）： 预检查/审核/Pre-scoping 样本和残留分析，请注明需要分析的产品名称和数量/Samples and Residue Analysis, Please Notes the Names and Quantity.其他/Others:4. 申请产品信息/Applying for Products Information:4.1 作物类产品/ Products, plants to be certified(如：大田作物，水果，蔬菜，茶叶/e.g.: combinable crops, fruits, vegetables and tea) :产品名称/Name 露天/覆盖/Uncovered or Covered 公顷（Ha）一次收获或多次收获/ First harvest or further harvest收获时间Harvest time年产量/Annual Output 产品是否处理/Produce handling （Yes-No） 产品消费地/Consumer Destination4.2 畜禽类产品/ Livestocks to be Certificated(如：生猪，家禽，牛羊，奶牛/e.g.: Pigs, Poultry, Cattle & Sheep, Dairy):产品名称/Name品种/breed and variety存栏量/Stock Number年产量/Annual Output产品消费地/Consumer Destination4.3 水产类产品/Aquaculture to be Certified:(如：鱼，虾，贝，蟹等/e.g.: fish, shrimp, shellfish, Crab, etc.)：产品名称/Name品种/breed and variety养殖面积/Area（Ha）年产量/Annual Output产品消费地/Consumer Destination5. 农场信息/Farm Information：名称/Name地址/Address农场面积Farm Area联系人/Contact Person电话/Telephone Number产品名称/Product Name产品面积 Product Area6. 农产品处理场所信息（仅适用于作物类产品）/Produce Handling Site Information（only applicable to Fruit, Vegetable, and Tea）名称/Name地址/Address联系人/Contact Person电话/Telephone Number产品名称/Product Name产量Output7. 申请认证的产品当年是否进行过农残检测？/Does the product applied for certification have the in-season residue test report？: 否/No 是/Yes如果是, 请给出以下信息/If “Yes”, give the following information:a. 检测报告号/No. Of Test Report: b. 检测日期/Tested Date: c. 出具检测报告的检测机构名称/Name of the lab issuing the Test Report： d.该检测机构是否通过认可?/Is the lab accredited?否/No 是/Yes8. 申请GAP认证的同时，是否申请有机产品认证/If to apply Organic Certification When apply the GAP Certification: 否/No是/Yes（中国有机产品/China-Organic 欧盟有机产品/ Euro-Organic 美国有机产品/ America-Organic 日本有机产品/Japan-Organic）9. 申请认证依据标准/Applying for Certificate Standards：GB/T20014.1-2005GB/T20014.9-2008GB/T20014.18-2008GB/T20014.2-2008GB/T20014.10-2008GB/T20014.19-2008GB/T20014.3-2008GB/T20014.12-2008GB/T20014.20-2008GB/T20014.4-2008GB/T20014.13-2008GB/T20014.21-2008GB/T20014.5-2008GB/T20014.14-2008GB/T20014.22-2008GB/T20014.6-2008GB/T20014.15-2008GB/T20014.23-2008GB/T20014.7-2008GB/T20014.16-2008GB/T20014.24-2008GB/T20014.8-2008GB/T20014.17-2008良好农业规范认证实施规则（CNCA-N-004:2007） GLOBALGAP通则（GENERAL REGULATIONS）V3.1_Nov09 受检查方法良好农业规范管理体系文件； 适用的法律、法规、标准； 其他：10. 分包方/Subcontractors：请描述所有分包活动，如清洗、包装、加工、储存/Please describe any subcontracting activities, e.g. cleaning、package、processing、storage.分包方名称/Name分包方地址/Address分包活动/Subcontracting Activities涉及产品/Involved Products11. 是否曾被其他认证机构注册、检查或认证过/ Has the project ever been registered, inspected or certified before by another Certification Body?如果是，请列出以下信息/if YES, please mention：检查员名称/认证机构名称；先前的注册号码；更换认证机构原因。随附先前被检查/认证过的相关信息，如检查报告，认证证书复印件/ The name of the Inspection and / or Certification Body (-ies); the previous Registration Number; the reason for changing Certification Body. Enclose a copy of all information regarding the previous inspection(s) and/or certification(s),e.g. copy of inspection report, copy of certificate.12. 农产品处理声明/Produce handling Declaration（仅适用于作物、果蔬类产品/only for Crops、Fruit & Vegetable growers），声明如下/I declare:(只能选择一个/Mark only one option) 仅处理GAP注册的产品/Only GAP registered produce is handled in my produce handling sites. a. 农场内处理/handled in farmb. 农场外处理，请写出产品处理者的认证注册号码/Handled out of farm, Please list the Registration number: 不仅仅处理GAP注册的产品/Not Only GAP registered produce is handled in my produce handling sites请列出处理的其他产品的名称/Please list the name of other handled products： 不进行农产品处理（如储藏，清洗，包装，修整，化学处理等）/I dont have any produce handling activities/sites (e.g. storage, washing, cutting, packing, sorting) for the GAP registered products.注：只要收获后农产品（仅指作物类产品）在农产品处理阶段的所有权属于申请人，则现场检查和证书范围中必须包含农产品处理。As long as the harvested produce（only for crops） belongs to the producer during produce handling (by the producer or subcontracted) it must be included in the inspection and the certificate.13. 申请人声明/Applicant declaration： 申请人声明，申请人已了解良好农业规范认证要求，保证执行良好农业规范生产标准和法规要求/Applicant has understand the requirement of Good Agricultural Practice Certificate and ensure the implementation of the Criterions and Regulations； 申请人声明，申请认证的产品可能的消费国家/地区为/the applied products may sale to the country /region： ，且申请认证的产品符合产品消费国家/地区的相关法律法规要求/the applied products comply with the requirements of the applicable laws and regulations of consumer country/region 。 申请人声明（仅适用于GLOBALGAP认证），我同意GLOBALGAP通过以下途径公开我的认证信息/I agree on the disclosure of information of my activities in one of the following ways by GLOBALGAP: 向大众公开（通过GLOBALGAP）/Disclosure of Producer/Producer group data to the public (through GLOBALGAP) 仅向GLOBALGAP会员公开/Disclosure of Producer/Producer group data to GLOBALGAP members only 仅向GLOBALGAP公开Disclosure of Producer/Producer group data to GLOBALGAP exclusively14.申请人承诺/Applicant Promise：14.1保证对所申请认证的产品拥有所有权，对种植、养殖场所拥有所有权或使用权；14.2严格遵守相关法规、标准和良好农业规范认证实施规则等认证准则的规定要求。14.3始终遵守认证方案安排的有关规定；14.4为进行评价做出必要的安排，包括协助检查组审查文件、进入所有的区域、查阅所有的记录；14.5对产品的宣传仅在获准认证的范围内；14.6在使用认证结果时，不得损害中国质量认证中心的声誉或可能产生误导的宣传；14.7当证书被暂停或撤销时，应立即停止涉及认证内容的宣传，并按中国质量认证中心要求交回所有认证文件；14.8认证仅用于表明获准认证的产品符合特定标准；14.9确保不采用误导的方式使用或部分使用认证证书和报告；14.10在传播媒体中对产品认证内容的引用，应符合中国质量认证中心的要求；14.11获证后接受认证机构的不通知检查(选项2：100%，选项1：10%)。15. 申请材料：请按照附件：良好农业规范（GAP）认证所需文件清单提供申请材料。16. 在下面签名表示您已经完成表格的填写，接受以上各条款，并且您的信息诚实可靠/Signing in the following blank indicates that you have completed filling out the form, accept the Provisions above, and your information is realistic and credible .申请人名称（加盖公章）/Applicant name(official seal):授权人签字&日期/Authorized Person Signature & Date:注： 1.申请ChinaGAP-GLOBALGAP认证请用中英文填写以上表格，中、英文之间用“/”分开；2.在选项框“”内标注划“”涂黑表示申请人已认可并接受该选项；3.书面邮递申请书，请加盖骑缝章；4. 申请人应将申请书及附