Halal Certification Application Form

Halal Certification Application Form

1. Company/Business Name:
2. Business Status (Corporation, Pvt ltd. Partnership, Ltd Co. Trust etc.):
3. Registration No:
4. Registered by:
5. Products/Brands to be Halal Certified:
6. Details of Products/Brands, including flavors/ types etc (pls use Annexure-1)
7. Registered Office Address:
8. Present Address:
i) Tel: / ii) Tel: / iii) Fax:
iv) E-Mail: / v) Website:
9. Plant Address: /
10.Warehouse address (if different then manufacturing plant)
i) Tel: / ii) Tel: / iii) Fax:
11. Contact Person:
Designation: / i) Address:
ii) Tel: / iii) Fax:
iv) Cell: / v) E-Mail:
12. Describe a brief History of Supply Chain of Ingredients/Raw Materials:
13. Briefly describe the Product process flow:
14. Geographic areas where Product is/will be marketed ( Country of destination):______
I/we undertake that the information provided by us for Halal Certification is based on real practices. All the ingredients/Raw Materials are mentioned truly in the application/annexure (being used in the formulation).
We also undertake that we will inform the LLC Halal Control Lithuania if any changes occur in the formulation hereafter.
Applicant Name:
Designation:
Signature:
Company Seal & Stamp:
Date:
Confidentiality Statement:
LLC Halal Control Lithuania, undertakes that it will guarantee all information supplied by or obtained from the application in respect to its processes, business secrets, prices and operations in the strictest confidence and it will not disclose such information for the benefit of any other person or company.
Note: Kindly ensure prior facilitation on the following items:
1. Kindly endorse the application with the applicant’s signature & company stamp.
2. Please return completely filled application form together with the required full disclosures to email:
3. A cover letter to be submitted on the official company letterhead, outlining the following:
a. Brief Company Profile.
b: Brief Description of Product Process Flow.
c. Any other relevant info which will be useful for Certification Process.
3. Kindly enclose a complete list of raw material, together with supplier; manufacturer; telephone; fax; email; contact person details in the attached format: (Find Annexure II)
4. Kindly enclose copy of any Halal certificates that you may already have for any of your products/ ingredients that you want us to certify.
5. Application forms will only be accepted when fully completed and duly signed by the Proprietor/Director or authorized representative. Failure to adhere to the above guidelines may delay the processing of your application.

Annexure I

Detail List of Products/Brands

(all columns must be filled & sent with the application to calculate the fees)

No. / Brand/Product Name / Description / Major Ingredients to be used
1
2
3
4
5
6
7
8
9
10

Annexure II

List of Raw Materials

(with Supplier/Manufacturer details)

Sr No. / Ingredient/ Raw
Material / Product
Code / Supplier / Contact Person / Tell: / Email / Manufacturer
(if different from the supplier)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

LLC Halal Control Lithuania. Švitrigailos str. 7-414, LT-03110 Vilnius, Lithuania.

Tel. +37065514242. Email: