Kosher申请表KLBDKosher权威英文清真犹太认证网

GENERALCONTACTINFORMATION

DateofApplication:

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Companyname:

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Address:

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City:

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PostCode:

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Country:

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Phone:

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Fax:

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Email:

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WebAddress:

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ContactName:

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JobTitle:

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DirectTelephoneNo:

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Email:

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AlternativeContactName:

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JobTitle:

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DirectTelephoneNo:

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Email:

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AccountsContactName:

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JobTitle:

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DirectTelephoneNo:

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Email:

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MarketingContactName:

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JobTitle:

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DirectTelephoneNo:

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Email:

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CompanyRegistrationNumber:

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VATNumber(EuropeOnly):

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AnnualTurnoverUSD/STG/Euro:

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HowdidyouhearoftheKLBDKosherCertification?

a)Recommendation -Name:

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Company:

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-Supplier/Distributor/Importer/MarketingAgent(pleasecancelnotapplicable)

b)Exhibition- Name:

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c)WebSearch-SearchEngine:

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d)DirectMail -from

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e)Other,pleasestate -

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FORINTERNALUSEONLY

AppNo:

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KLBDNo:

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MANUFACTURINGPLANTINFORMATION-

Part1-LocationandContactInformation

Note:IfthereismorethanonefactorylocatedinadifferentlocationpleasecompleteaseparateManufacturingPlantInformationpageforeachfactory.Ifthepackingfacilityisalsolocatedinadifferentlocation,pleasefillintheformandindicateaccordingly.

AddressofFactory

Nameoffactory:

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Address:

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City:

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PostCode:

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Country:

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Phone:

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Fax:

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Email:

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FactoryManager:

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Email:

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RawMaterialPurchasingManager: Email:

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Ifthefacilityisnotlocatedinamajorcity,pleaseindicatetheclosestmajorcityandthedistancetothefacility:

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Nameofthenearestinternationalairporttothefactoryanddistancetothefactory:

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Describeallthemanufacturingprocess(es)inthefactory:

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MANUFACTURINGPLANTINFORMATION-

Part2-GeneralProcessingInformation

1.DidthecompanyeverapplyforKoshercertification?Yes*

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No

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Ifyes,pleasestatetheKosherAgency:

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2.Wasthecompanyeversupervisedbefore,eitheronayearlybasisorforaspecificrunforanotherbuyer?…Yes*

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No

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IfyespleasestatetheKosherServicethatwascertifying:

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3.Hasthefactoryorproducingplanteverproducedarunofmeatorseafood(fish,shellfish,seaanimals)?……Yes*

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No

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Ifyes,pleasestatethewhenapprox:

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4.Is/Hasthefactoryorproducingplantproducingoreverproduced:

ProductsthatuseDairyderivedmaterials?Yes*

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No

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ProductsthatuseMeatderivedmaterials?Yes*

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No

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ProductsthatuseGrapederivedmaterials?Yes*

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No

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ProductsthatuseFishderivedmaterials?Yes*

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No

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5.Is/Hasthefactoryorproducingplanthaveaconnectingplantinthesamesitethatmanufactures:

ProductsthatuseDairyderivedmaterials?Yes*

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No

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ProductsthatuseMeatderivedmaterials?Yes*

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No

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ProductsthatuseGrapederivedmaterials?Yes*

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No

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ProductsthatuseFishderivedmaterials?Yes*

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No

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6.Isthecompanyusingitsownplantoranothercompany’splanttoproducetheproducts?Yes*

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No

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Ifyes,pleasestatethecompanythatisusedfortheproductionandthenumberofrunsamonthapprox.:

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7.Doesthecompanyusethepackagingservicesofanothercompany?Yes*

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No

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Ifyes,pleasestatethecompanythatisusedforthepackagingandthenumberofrunsamonthapprox.:

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8.Isthecertificationfor:

EXPORTTOISRAEL:

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EXPORTTOTHEUSA:

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UK/EUUSE:

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GENERAL:

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9.(Optionalquestion.OnlyfillifyouareawareofPassovercertification)

Isthecertificationfor:

INCLUDINGPASSOVER:

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EXCLUDINGPASSOVER:

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MANUFACTURINGPLANTINFORMATION-

Part3-ProductInformation

PleaselistallproductstobecertifiedKosher:(ifmorespaceisneededpleaselistproductsonaseparatesheetofpaper).

Pleaseindicatethecodenumberofeachproductforwhichyouareseekingcertification.Thecodenumberiswhatyouwoulduseforsalesexternally.

Pleaselisteachbrandnamefortheproductthatyouareseekingcertification.Theremaybemorethanonebrandnamethattheproductissold.Inthiscasepleaselistitseparately.

Actualproductname:Enterthenameproduct’sactualdistinction.

IndicateiftheproductisusedforRetailorIndustrial/Institutionaldistribution.

Seeexample

A.Codenumberofproduct

B.BrandNameofProduct

C.ActualProductName

D.RetailorIndustrialuse

e.g.12345A3

AAA

Cashews

Retail

A.Codenumberofproduct

B.BrandNameofProduct

C.ActualProductName

D.RetailorIndustrialuse

MANUFACTURINGPLANTINFORMATION-

Part4-ProductFormulation

Pleaselistallingredientsproductbyproduct.Makesuretheexactnameoftheingredientislisted.Pleasemorecopiesofthispageifnecessary.(Noneedtoindicatepercentages)

NAMEOFPRODUCT

includetheproductcodeandactualproductname

INGREDIENTUSEDINTHEMANUFACTURING

Fullnameandbrandoftheingredientnottheformula.Includeanyprocessingaidslikeantifoamingagents,releaseagents,solventsetc

Usethefollowingexampleasguideline

e.g.12345A3AAACashews

RawCashews

PeanutOil-KnifeBrand

GranulatedSugar

NAMEOFPRODUCT

includetheproductcodeandactualproductname

INGREDIENTUSEDINTHEMANUFACTURING

Fullnameandbrandoftheingredientnottheformula.Includeanyprocessingaidslikeantifoamingagents,releaseagents,solventsetc

MANUFACTURINGPLANTINFORMATION-

Part5-IngredientsInformation

NameofPlant:

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1.Listallrawmaterialsinthefacility(includingreleaseagents,processingaids,antifoams,preservativesetc.)evenifnotintendedforkosheruse.

2.Identifywithanasterisk(*)anyingredientsintendedforuseexclusivelyinproductsthatyoudonotwishtocertify.

3.SubmitaLetterofKoshercertificationandclearlyidentifytheexactingredientbeingused.Ifyousubmitviafax,donothighlight.WherenoLetterofCertificationisavailable,supplydeclarationofitsmanufacturingprocess.BoththeingredientnameandsourcenamemustmatchtheLetterofCertification.

Definitions:

INGREDIENTNAME:Givethenameexactlyasitappearsonthelabel.Includeallflavourandproductcodenumbers

SUPPLIER:Includethefulladdressofthesupplierifthesuppliersnameappearsinthelabel.Ifnotleavethisspaceblank.Youneedtofillinthemanufacturer’scolumninanycaseaswell.

MANUFACTURER:Givethemanufacturingsourceexactlyasitappearsonlabel.

BRANDNAME:ListBrandNameexactlyasitappearsonthelabel.

PACKAGING:IndicateifingredientisreceivedinBags,Cartonboxes,Trucktanker,Shiptanker,Drumsthatarenotnormallyrefilled.

CERTIFYINGAGENCY:IndicatetheKoshercertifyingagencythatcertifiesthisingredient.

INGREDIENT

NAME

SUPPLIER

NameandFullAddress

MANUFACTURER

NameandFullAddress

BRANDNAME

PACKAGING:

CERTIFYING

AGENCY

Usethefollowingexamplesasguidelines

RawCashews

Varioussuppliers

Sacks

PeanutOil

LamSoonEdibleOil

PasirGudang

Johor,Malaysia

Knife

Drums

KLBD

GranulatedSugarLOIGCXIGFine

CentralSugarsRefinery

SdnBhd

Batu3,40000ShahAlam

SelangorDarulEhsan

Malaysia

CSR

Bag

KLBD

*Peanuts

Varioussuppliers

Sacks

INGREDIENT

NAME

SUPPLIER

NameandFullAddress

MANUFACTURER

NameandFullAddress

BRANDNAME

PACKAGING:

CERTIFYING

AGENCY

INGREDIENT

NAME

SUPPLIER

NameandFullAddress

MANUFACTURER

NameandFullAddress

BRANDNAME

PACKAGING:

CERTIF