FOR ASSESSOR USE ONLY / NEW / RENEWAL / INDEPEND OWNED / MANAGED

NSF Certification UK– SECTION A

To be completed in full (in block capitals)

FREEDOM FOOD SCHEME – PIGS (incl own Transport)

APPLICATION FORM

DETAILS OF MAIN UNITComplete separate Section A for each new site address

APPLICANT NAME
FARM / UNIT NAME / DEFRA HOLDING NO:
ADDRESS / Postcode
On Farm Contact: / Position: / Telephone No:
Fax No: / Mobile No: / Email Address:
Name Marketing/Producer Group / Web Site Address:
www.
Total Range (Ha) / Specify other sales outlets

DO YOU HAVE ANY OTHER SITES ? YES / NO please complete separate section A for each additional site

Any other animals/species on site (eg laying hens): please state which:

PIG DETAILS:

BREEDING SOW NUMBERS
By housing type below / NUMBERS OF REARING PIGS PRODUCED
BETWEEN ______Kg to______Kg
By housing type below / NUMBERS OF REARING PIGS PRODUCED
BETWEEN ______Kg to______Kg
By housing type below
Controlled
environment housing / Access to unroofed open air runs/
paddocks / Access to roofed yards/runs / Controlled
environment housing / Access to unroofed open air runs/ paddocks / Access to roofed
yards/runs / Controlled
environment housing / Access to unroofed open air runs/
paddocks / Access to roofed yards/runs
Name of Pig Supplier / Freedom Food Reg No.
Name of customer (rearer/finisher) / Freedom Food Reg No. (If applicable)
Name of Abattoir/Processor / Freedom Food Reg No. (If applicable)
Name of Freedom Food Haulier / Freedom Food Reg No.
Member of other assurance schemes ? Please give details :

The applicant is obliged to disclose in writing to Freedom Food Ltd details of any previous convictions in the past 3 years (or any longer period which corresponds with any sentence imposed by the Court) and pending prosecutions relating to any offence involving the care, handling, rearing, transport, slaughter or sale of animals or produce.

Please do not submit an application unless you have fully read the RSPCA standards and believe you meet full compliance with them.

I agree to abide by the NSF Certification UK Scheme regulations and requirements of the Freedom Food Scheme.

Signed by the applicant or authorised signatory on membership application

Signed: ______Position: ______Date: ______

FREEDOM FOOD CHARGES

PLEASE ENCLOSE PAYMENT WITH APPLICATION:

FREEDOM FOOD CHARGES / PLUS VAT @ 20.0% / Total
JOINING FEE / £30 / £6.00 / £36.00
Freedom Food Scheme assessment Breeder / £119 / £23.80 / £142.80
Freedom Food Scheme assessment Rearer / £119 / £23.80 / £142.80
Freedom Food Scheme assessment Finisher / £119 / £23.80 / £142.80
Freedom Food Scheme assessment Breeder/Rearer (Rearer/Finisher) / £176 / £35.20 / £211.20
Freedom Food Scheme assessment Breeder/Rearer/Finisher / £233 / £46.60 / £279.60
£
CHEQUE ENCLOSED

If you would prefer to pay by BACS, our account details are:

Sort code:60 11 17

Account number:69595259

Account name:Freedom Food Limited

Note : A receipted invoice will be sent by return

FOR OFFICE USE ONLY
PAID (incl VAT)
YES / NO / Part of Group?
YES / NO / Folder requested?
YES / NO / To DC / Assessor / Date sent

APPLICATION REVIEW SECTION – FOR OFFICE USE ONLY

………………………………………………………………………………………………………………………………………….
Signature Name Date
Authorised by approved application reviewer

Pigs Section A Issue 15 PleaseReturn to Freedom Food HO with Payment FF03P