/ Islamic Coordinating Council of Victoria

APPLICATIONFORHALAL CERTIFICATION (Food Processing)

SECTION 1: APPLICANT INFORMATION

Name ofOrganisation:

Establishment no:

Business/ TradingName:

ABN: ______

Type of business Legal status (please tick one or more):
 Sole Trader /  Partnership /  Trust
 Private Company /  Public Company /  Other: ______

Trading Site Address: __

MailingAddress: Post Code:______

InvoicingAddress (if different from above): Post Code:______

Current Proprietor established since ______

Is the Applicant part of a Larger Group: No Yes Name of the Group______

Website:______

.SECTION 2: CONTACT PERSON/ AUTHORISED REPRESENTATIVE FOR THIS APPLICATION

Full Name ofContactPerson: Title: ______

Position: ______

Full Name ofAuthorised Representative: Title: ______

Position: ______

MailingAddress: Post Code ______

Contact: Business: ______Mobile: ____E-Mail: ______

SECTION3: LOCATION DETAILS AND SCOPE (Separate Application Form Required For Each Location)

Name of Facility/Site: ______

Physical Address of the facility/site: ______

Scope of Halal Certification being sought: (eg Production and packaging of Fresh Chilled Meat)______

______

Export destinations (countries) where the accredited product/s are to be offered from this facility:

______

Certification Standard/s:
A.  Indonesian Halal StandardB. Kingdom of Saudi Arabia Halal Standard
C.  Malaysian Halal StandardD. GSO Halal Standard: ______(Specify Category from Table A below)
E. SingaporeHalal StandardF. Egypt Halal Standard
G.  Any other Halal Standard: ______(Specify)
Audit Type:
A. Initial Certification B.  Change in Scope – Addition of Products/Services
C.  Re-Certification D. Change in Scope – Addition of Sites or Decrease of Scope

Per your scope, what are the significant processes and/or products to be covered under the certification? ______

______

______

Is there any part of the significant processes that is outsourced?______

______

Are there legal/regulatory requirements relevant to the scope of the certification (eg, Food Safety Certification, Government/Local Council regulations)? ______

______

______

Details of any other certification (like ISO, HACCP) already obtained ______

Details of any other products produced at the same site that are non-Halal or that contain any obvious non-Halal ingredients such as pig ingredients or alcohol? ______

______

Total Number of Employees * / Number of Shifts and Hours / Number of Employees/ Shift *
* Employees include permanent and non-permanent (seasonal, temporary and sub-contracted) personnel.

Convenient days, dates and times for inspection visit

Days / Mon / Tue / Wed / Thursday / Friday
Date
Time

Products and Ingredients

Details of Product(s) Requiring Halal Certification (Please complete product Data Sheet per each product)

No of Product / Name of Product / Product Data Sheet Attached Y/N
1
2
3
4
5
6
7
8
9
10

Please attach Product Data sheet/s with details (as per format in Attachment A).

For laboratory testing, do you agree to use ICCV’s preferred laboratory and pay related costs? ____

Alternatively, please provide your preferred laboratory contact details below:

Laboratory Name: Tel: ______

Contact Person: Position: ______

Address: Post Code ______

Production and Processing Line

Are the Halal and Non-Halal products processed by the same equipment?

N/A  No  Yes 

Are the Halal and Non-Halal products processed in the same day?

N/A  No  Yes 

Are Halal and Non-Halal products separated or segregated at Cold Storage?

N/A  No  Yes 

Is daily documentation kept for the Halal and Non-Halal Production?

N/A  No  Yes 

Name of Document ______

Halal Integrity and Tracking

Is there a procedure to ensure Halal products are not contaminated by Non-Halal products?

N/A  No  Yes 

Is there a procedure to trace or back track Halal and Non-Halal products?

N/A  No  Yes 

Is there a routine cleaning procedure for the equipment and premises?

N/A  No  Yes 

Is the cleaning product free from Non-Halal ingredients or materials?

N/A  No  Yes 

Additional Details/Information

SECTION 5: POLICIES

Confidentiality Policy: ICCV has policies and procedures in place regarding its management of confidential information. All information obtained from the application will remain confidential.

Non-Discriminatory Policy: ICCV shall make its services accessible to all applicants whose activities fall within its scope of operations. All applications will be treated fairly.

SECTION 6: CONDITIONS OF CERTIFICATION

To attain and maintain certification, an applicant must agree to:

1. At alltimes abidebyrules, fulfill the requirementsandtheguidelines for certification set by ICCV and/or other halal certification standards.

2. Allowthe Authorised Officers /Inspectors ofICCVunrestricted access to inspect thepremisesat any time without prior notice.

3. ImmediatelyadviseICCV ofanychangein the natureofbusiness and/ or changeofownership.

4. Paythe nominated fee forthe Halal Certificate andanyadditional feethat maybeimposedas a resultof anybreachthatmayrequire furtherinspectionsbyICCV.

5. Not to transfertheCertificate to anyoneorDuplicateit under anycircumstance.

6. Not to use any Label orLogo ofICCV oncethe Halal Certificatehas expired or has been withdrawn.

7. Not to cook, sell ordealin anyproduct that has not beencertified as Halal or is not considered Halal suitable.

8. Not to displaythe HalalCertificateat anypremises other than forwhich ithas been issuedto.

9. Return the Halal Certificateto ICCVafter its expiryor withdrawal.

10. Not to use its accreditation in such a manner as to bring ICCV into disrepute or make any statement relating to its accreditation misleading.

11. Retain all quality records and technical records supporting results.

In order to apply, The Applicant’s Authorised Representative must agree to the above conditions for accreditation and must attest that all statements made on the application are correct to the best of his/her knowledge.

I / We, acknowledge thatbreachofany oftheaboveconditions and/orguidelines may result intheCancellationofHalalCertificate.

Signed on behalf of the Applicant:

______

NameofAuthorised Representative Signature

______

Position Held Date

Table A - ClassificationofHalalproduct/Service Categories

Category
codes / Categories / Examples ofsectors
C / Processing1(Perishableanimal
products) / includes all activities after farming, e.g.animal slaughtering, poultry,eggs, dairyand fish products
D / Processing 2 (Perishable vegetable products / fresh fruits’ fresh juices; preserved fruits; fresh vegetables; preserved vegetables
E / Processing3
(Products with longshelflife at room temperature) / canned products; biscuits; snacks; oil; drinking
water; beverages; pasta; flour; sugar; salt
J / Transport and storage / Transport and storage

FOR OFFICE USE

Reviewed by ______Date______

Approved by ______Date______

Approved/Declined______CertificateNo ______PleaseNote:

CompletedapplicationformsshouldbesenttotheFinance Managerattheaboveaddress. Forfurtherenquiries,pleasecontact:

Finance Manager Tel.:(03) 9380 5467 Email:

F 39C Application Form Food Processing Rev 0: Issue 1: Date 15 September 2016 Page 1 of 7

/ Islamic Coordinating Council of Victoria

Attachment A – Product Data Sheet

(Please complete per each product)

Product Name: ______ProductCode: ______

Product Description: (Packaging shape and size) ______

Packaging Material: ______

NAME OF INGREDIENT / ORIGIN OF INGREDIENTS
(Animal, Plant, Synthetic) / PRODUCT CODE IF THERE IS ONE / SUPPLIER / MANUFACTURER / HALAL CERTFICATE YES/NO? NAME OF CERTIFIER / EXPIRY DATE OF HALAL CERTIFICATE / PIF OR PROD SPEC / ANY ADDITIONAL INFO/MATERIAL DESCRIPTION

F 39C Application Form Food Processing Rev 0: Issue 1: Date 15 September 2016 Page 1 of 7