INFORMATION OF APPLICANT Legally Registered Business Name Business Trade Name Vat Certificate No Physical Address Postal Address Postal Code Contact No Email Address INFORMATION OF APPLICANT Name and Surname Job Title Contact No Email Address DETAILS OF FINANCE REPRESENTATIVE Name and Surname Contact No Email Address Certification Scheme (Please tick the Scheme you are applying for) ABATTOIR SCHEME Scope: Pre-slaughter process, slaughter process and post slaughter process SheepPoultryBovine PRODUCTION PLANT SCHEME Scope: Receiving & storage, Processing/ Production and packaging Food ManufacturingPharmaceutics FOOD OUTLET SCHEME Scope: Preparation of Raw materials to finished consumables TakeawaysRestaurantsCatering SUPERMARKET SCHEME Scope: Storage, preparation, and dispatch In House - ButcheryDeli CounterMeat CounterPoultry CounterHot Foods/ InteractiveBakery Counter DISTRIBUTION CENTRE SCHEME Scope: Storage and dispatch Additional Services (Please tick the Service you are applying for) Home-Based (Halal Acceptability Letter)Government Tenders (Halal Acceptability Letter)Imports (Registered as an Importer on Consignment Basis)Exports (Registered as an Exporter on Consignment Basis) Declaration I, the undersigned, hereby declare that the information I have written on the application form and the documents I have submitted to be true and accurate. I further understand and agree that any false or misleading information will justify a denial of acceptance of this application. I declare that the attached Raw Materials Matrix with the respective supplier’s Halal Certificates fully covers all the ingredients/specifications used in the products referred to in the finished product list. Full Name and Surname Dated SIGNATURE (Please use your mouse to sign your signature)
