155 Lygon Street (PO Box 108) East Brunswick Vic 3057 Email: iccv@bigpond.com Fax: (03) 9380 6143 APPLICATION FOR HALAL CERTIFICATION (Abattoir) SECTION 1: APPLICANT INFORMATION Name of Organisation: Establishment no: Business / Trading Name: ABN: Type of business Legal status (please tick one or more): Sole Trader Partnership Trust Private Company Public Company Other: Trading Site Address: Mailing Address: Post Code: Invoicing Address (if different from above): Post Code: Current Proprietor established since Is the Applicant part of a Larger Group: No Yes Name of the Group Website: SECTION 2: CONTACT PERSON/ AUTHORISED REPRESENTATIVE FOR THIS APPLICATION Full Name of Contact Person: Title: Position: Full Name of Authorised Representative: Title: Position: Mailing Address: Post Code Contact: Business: Mobile: E-Mail: F39A Application Form Abattoir Rev No 1 NOV 2016 Page 1 of 6
SECTION 3: LOCATION DETAILS AND SCOPE (Separate Application Form Required For Each Location) Name of Facility/Site: Physical Address of the facility/site: Scope of Halal Certification being sought: Export destinations (countries) where the accredited product/s are to be offered from this facility: Certification Standard/s: A. Indonesian Halal Standard B. Kingdom of Saudi Arabia Halal Standard C. Malaysian Halal Standard D. GSO Halal Standard (Category C of GSO2055-2) E. Singapore Halal Standard F. Egypt Halal Standard G. Any other Halal Standard: (Specify) Audit Type: A. Initial Certification B. Change in Scope Addition of Products/Services C. Re-Certification D. Change in Scope Addition of Sites or Decrease of Scope Per your scope, what are the significant processes and/or products to be covered under the certification? Is there any part of the significant processes that is outsourced? Are there legal/regulatory requirements relevant to the scope of the certification (eg, Food Safety Certification, Government/Local Council regulations)? F39A Application Form Abattoir Rev No 1 NOV 2016 Page 2 of 6
Details of any other certification (like ISO, HACCP) already obtained Details of any other products produced at the same site that are non-halal or that contain any obvious non- Halal ingredients such as pig ingredients or alcohol? Total Number of Employees * Number of Shifts and Hours Number of Employees/ Shift * * Employees include permanent and non-permanent (seasonal, temporary and subcontracted) personnel. Convenient days, dates and times for inspection visit Days Mon Tue Wed Thursday Friday Date Time Species Name of Specie Quantity per day Brands List all the brands under which your products are sold: In the event laboratory testing is deemed necessary, do you agree to use ICCV s preferred laboratory and pay related costs? Y / N F39A Application Form Abattoir Rev No 1 NOV 2016 Page 3 of 6
If no, please provide your preferred laboratory contact details below (subject to approval by ICCV): Laboratory Name: Contact Person : Address: Tel: Position: Post Code Production and Processing Line Are Halal and Non-Halal products processed by the same equipment? Are Halal and Non-Halal products processed in the same day? Are Halal and Non-Halal products separated or segregated at Cold Storage? Is daily documentation kept for the Halal and Non-Halal Production? Halal Integrity and Tracking Name of Document Is there a procedure to ensure Halal products are not contaminated by Non-Halal products? Is there a procedure to trace or back track Halal and Non-Halal products? Is there a routine cleaning procedure for the equipment and premises? Is the cleaning product free from Non-Halal ingredients or materials? Additional Details/Information F39A Application Form Abattoir Rev No 1 NOV 2016 Page 4 of 6
SECTION 4: POLICIES Confidentiality Policy: ICCV has policies and procedures in place regarding its management of confidential information. All information obtained from the application will remain confidential. Non-Discriminatory Policy: ICCV shall make its services accessible to all applicants whose activities fall within its scope of operations. All applications will be treated fairly. SECTION 5: CONDITIONS OF CERTIFICATION To attain and maintain certification, an applicant must agree to: 1. At all times abide by rules, fulfill the requirements and the guidelines for certification set by ICCV and/or other halal certification standards. 2. Allow the Authorised Officers / Inspectors of ICCV unrestricted access to inspect the premises at any time without prior notice. 3. Immediately advise ICCV of any change in the nature of business and / or change of ownership. 4. Pay the nominated fee for the Halal Certificate and any additional fee that may be imposed as a result of any breach that may require further inspections by ICCV. 5. Not transfer the Certificate to anyone or Duplicate it under any circumstance. 6. Not use any Label or Logo of ICCV once the Halal Certificate has expired or has been withdrawn. 7. Not cook, sell or deal in any product that has not been certified as Halal or is not considered Halal suitable. 8. Not display the Halal Certificate at any premises other than the premises for which it has been issued. 9. Return the Halal Certificate to ICCV after its expiry or withdrawal. 10. Not to use its accreditation in such a manner as to bring ICCV into disrepute or make any statement relating to its accreditation misleading. 11. Retain all quality records and technical records supporting results. In order to apply, The Applicant s Authorised Representative must agree to the above conditions for certification and must attest that all statements made on the application are correct to the best of his/her knowledge. F39A Application Form Abattoir Rev No 1 NOV 2016 Page 5 of 6
I / We, acknowledge that breach of any of the above conditions and / or guidelines may result in the Cancellation of Halal Certificate. Signed on behalf of the Applicant: Name of Authorised Representative Signature Position Held Date FOR OFFICE USE Reviewed by Approved by Date Date Approved / Declined Certificate No Please Note : Completed application forms should be sent to the Finance Manager at the above address. For further enquiries please contact : Finance Manager Tel.: (03) 9380 5467 Email: iccv@bigpond.com F39A Application Form Abattoir Rev No 1 NOV 2016 Page 6 of 6