Company/farm name:
Main address:
Cip code: / City:
Name of owner:
Contact person
(if it is different from owner):
Invoice address
(if it is different from the above address):
Phone number: / Mobil number:
Fax.: / Homepage: / e-mail:
Pick out actual standard:
Standard GLOBALG.A.P. Version 4.0: □ Fruit and Vegetables; □ Flower and Ornamentals; □ Combinable crops; □ Dairy; □ Poultry; □ Turkey; □ Cattle sheep; □ Calf and young beef; □ Aquaculture; □ Chain of Custody Aquaculture; □ Chain of Custody Crop; □ Chain of Custody Livestock; □
Standard GLOBALG.A.P. Version 2.0: □ Plant Propagation Material
Standard GLOBALG.A.P. Version 2.1: Compound Feed Manufacturing; □ Aquaculture; □ Livestock
Standard GLOBALG.A.P. Version 1: □ Livestock Transport; □ GRASP; □ Localg.a.p.
Is the farm a Multi- site (More addresses with independent management each addresses)? Yes: □ (If yes please attach list with addresses for each site); No: □. Is there a quality management on the farm? Yes: □ ; No: □
(It is not a demand – it is just a possibility!)
If it is relevant: Former GLOBALG.A.P. number: / and former Certifying Company:
VAT number: / GLN number :
(If the company have one)
Crops
Crop / Area not covered 1. harvest
(in ha) / Area not covered further harvests *
(in ha) / Area covered 1. Harvest**
(in ha) / Area covered further harvest*
(in ha) / The whole crop?***
Yes/No / Harvest
Yes/No / Handling
Yes/No /
NB.: If the whole crop not is going to be certified, then must a list with fields/houses be attached where it clearly is picked out which fields/houses that are going to be certified and which not is going to be certified. If there are more crops, then put in more lines or include extra pages.
*Information´s about future harvest is only information´s that GLOBALG.A.P. wants to know it is not information´s that will be in the calculation for the offer.
** Not including individual plant/tree covers, nets, low tunnels, hail protection, mulches or anything that is not a greenhouse.
*** Rules for only certify a part of the crop, can be found in the GLOBALG.A.P. Regulations Part I
Livestock
Annual production of meat in tons: / Name of Livestock / Annual production in tons
Annual production of fresh milk in tons:
Meat is measured in metric tons, live weight. Dairy is measured in metric tons fresh milk
Aquaculture
Name of Aquaculture / Annual production quantity in tons / Broodstock / Seedlings – ova / Seedlings – juveniles
Aquaculture products are measured in metric tons, live weight harvested. For multisite producers the quantity is the annual total for all sites. Juveniles refer to: smolt, fingerling, alevin, nauplii, postlarvae, others.
Compound Feed Manufacturing
Annual production quantity in tons:
Chain of custody
Number of suppliers the company is sourcing from:
Please also fill out either Aquaculture, Livestock or Crop
GRASP
Option 1: / Option 2: / No. of employees
Additional information regarding the certification
Other addresses, where there are activities that have relation with the actual crops. (Fertilizer store, Chemical store, Packing, etc.) / Activity / Address
Do you take in products from other producers of the same varieties that you want to certify? If yes / Which products?
Who own the products?
Are there subcontractor activities? (consultants, companies that harvest or other activities, that have influence on quality, environmental, food hygiene or workers health and safety) If yes, please mention here which:
If there is export, which countries do the products go to?
Other remarks that can have interest for the certifications process:
The time the farm plan to be certified:
Who have filled the form:
If there are changes in the information in this form, must AgroManagement be informed.
The company is responsible for implementing the standard requirements before certification. The company must have worked with the system minimum 3 month before certification. For customers that not have been certified of AgroManagement before must the certification take place under harvest the first year for each crop. The follow years can the certification take place up to 6 months before the valid time is ended on the certificate without there are changes in the next period of valid time.
The customer must commit themselves to follow the GLOBALG.A.P. requirements and the certification rules for AgroManagement.
For Option 2 customers: A list with all producers must be attached this application. AgroManagement have a form for that – or the form that the standard requires can be used.
5. May 2014 Page 2 of 3