0032-11022013
1. CertifierName and Address
Address: / Phone:
Cell phone:
City, Zip Code, and Country: / Fax:
E-mail:
2. Name and ContactInformation for the Accreditation Manager
Name:
Address: / Phone:
Cell phone:
Zip Code and Town: / Fax:
E-mail:
Please list all dba’s (doing business as) and brand names:
3. Prior Certification Experience and Accreditation
When did the certifier start to inspect and certify operations:
Under which standard(s):
Is the certifier currently ISO 17065 accredited: Yes □No□
If yes: please attach copy of current certificate
If no: is the certifier accredited for any other standard? (please list standard)
4. Adverse Public Records
Within the last 3 years, has your organization ever been suspended, reprimanded, been held as negligent in any of its inspection and certification activities or has your accreditation been revoked or has any such action been proposed? Yes□ No□
If yes, please list all instances and attach public records or describe how such records can be accessed.
5. Additional Information
Does the certifier certify operations according to its own or any other Fair Trade or similar standard?Yes□ No□
If yes, please note the standard and the contact information of the standard holder:6. Signatures of Certifier Representative and Accreditation Manager
Ideclare to be legally entitled to request Accreditation for the FairTSA standard:
______
Signature of Certifier Representative Title Date
______
Signature of Accreditation Manager Title Date
7. Attachments
1. Copy of ISO 17065 Accreditation Certificate
2. Documentation of involvement in organic certification activities under national laws such as EU, NOP, NPOP, COS, or other national organic laws.
3. Copy of Certificate of Incorporation
4. Copy of wire transfer in the amount of $1,550.00 to Global Innovations for Fair Trade
5. Other attachments, if applicable