New/Modified Label Affidavit

Please fill out this affidavit if you are using a new or modified label on your organically certified product.

General Information / DATE (M/D/Y):

CONTACT INFORMATION

Operator/Manager Name:
Operation Name:
Associate (Member) Number: / Producer Number:
Chapter (if applicable):
Name of person overseeing organic production (if different from operator/manager):
Check ALL the programs for which the product will be represented. Please remember that the label(s) may only be used to represent programs for which the product is certified for/verified to.
Certification Programs:
OCIA International National Organic Program (NOP) Québec Standards (CAAQ) Japan Agricultural Standard (JAS)**
Verification/Equivalency Programs:
EU 2092/91(OCIA certification recommended) Bio-Suisse** Swiss Ordinance (OCIA certification recommended)
JAS Equivalency
**Requires the submission of additional questionnaires**
Additional Label Information
Select the reason(s) for submitting the New/Modified Label Affidavit:
New (previously uncertified) product New/modified label for previously certified product
Private label Other (specify)
The following additional finished labels will be used on my organic products:
Product Name Brand / Package Size / Requested Labeling Category
“100 % Organic” / “Organic” / “Made with Organic…” / Indicates Organic Ingredients
The following information must be included with the New/Modified Label Affidavit for each new label submitted:

OCIA Organic Product Ingredients checklist (if changes to product have been made or if new product)
Copy of the new or revised label (or a draft or sketch of the proposed new or revised label if not completed)
If this is a new (previously uncertified) product, please submit an OCIA Additional Processed Product/Production Line/Program Affidavit with this form
If this is a private label and the certified processing or packaging facility is NOT indicated on the label, please submit verification that a Private Label Licensing Agreement has been signed

This/these product(s) label(s) were not included with my OCIA Organic Processing/Handling Plan Questionnaire for the year, and were not submitted as part of my OCIA application. I would like this/these label(s) to be approved for my certified organic product(s). I affirm that all statements made in this Affidavit are true, correct, and complete. I also affirm that I understand the standards/regulations for the specific program(s) that the label(s) represent(s).
Owner/Manager Signature: Date (M/D/Y):
CDT Decision: Verified Compliant Not Compliant
CDT Comments:
CDT Member ID #: / Date (M/D/Y):

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