3.1.2en Form
Application Form for Organic Certification
v 25.05.2014
Application Form for Organic Certification
In order to help us estimate the cost of inspection and certification, please supply the following information,
by indicating as many details as possible and omitting items that do not apply.
1
Company Name and legal form of the company:
General Manager or other responsible person:
Street and N°:
Post Code:
Country:
Fax:
Contact person
for certification:
2
2.1
2.2
PO Box:
City:
Phone:
Mobile:
Contact person's
Email:
Type of Operation to be Certified (more than one can be ticked):
Farm (Crop Production)
Farmer Group
Food Processing
Wild Collection
Farm (Livestock)
Beekeeping
Trade / Export
Other:
Crop Production:
Number of farms:
Total hectares:
Distance from farm(s) to address indicated under (1) above:
Crop
Hectares
Crop
Food Processing:
Type of processing:
Number of units:
Distance from unit(s) to address indicated under (1) above:
Total number of employees in the processing unit(s):
Raw material
Final product
Raw material
2.3
km
Hectares
km
Final product
Wild collection:
Name of collection area:
Size of area:
km2
N° of pickers:
N° of buying centers:
Distance from collection area to address indicated under (1) above:
km
Wild collected species (please Approx. quanWild collected
Approx. quantity per year
attach a list if not enough space)
tity per year
species
2.4
2.5
2.6
Livestock:
Number of farms:
TTotal hectares:
Distance from farm(s) to address indicated under (1) above:
Type of animals
Number
Type of animals
km
Number
Beekeeping:
Location of colonies:
N° beekeepers:
N° of apiaries:
N° of colonies:
N° of postharvest units:
Migration?
Yes
No
Distance from apiaries to address indicated under (1) above:
km
Trade / Export:
Office is the same as under (1):
Other address:
Trader stores, packs or labels:
Trader only handles paperworks:
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3.1.2en Form
3
Application Form for Organic Certification
v 25.05.2014
2/2
Are subcontractors involved at any stage?
No subcontractors involved, all the units described under 2.1 through 2.6 belong to the
company indicated in Section (1) above:
The following subcontractors (not belonging to your company) are involved:
Entity
Activity
Location
4
Standards for which you request certification:
Please refer to: http://www.ceres-cert.com/portal/index.php?id=29&L=1
Regulation (EC) 834/07 on organic farming for the EU market*
NOP (National Organic Program) for the organic US market
JAS (Japanese Agricultural Standard) for the organic market in Japan
Other organic standard (please specify):
*In non-member countries, this Regulation can be implemented only in an "equivalent" way.
5
Certification history:
Do you have a copy of the standard(s) according to which you request Hardcopy
No copy
certification?
Access through internet
Which of the following statements is correct?
This is the first time I apply for certification according to the above mentioned standards
I am currently certified by
but I am considering to change
My certificate issued by
has expired
My certificate issued by
was suspended or revoked
6
Any other relevant information:
I hereby declare that I have been informed sufficiently about the requirements for certification (organic
standards, CERES rules for application, inspection and certification). The rules are understood.
Place and date:
Name of signatory:
Signature, company stamp
________________________________________________________________________
This part has to be completed by CERES! Review of the application
The certification requirements have been defined clearly: Yes
No
1
Any differences between applicant and CERES about cert. procedure have been cleared: Yes
No
2
CERES is able to perform the cert. service (incl. aspects like domicile, language, and any other specific
3
requirements) and application is accepted: Yes
No
Comments:
4
Date:
Signature: