APPLICATION FORM

FOR A LICENCE TO USE

THE GOVERNMENT 5 A Day LOGO

Organisation details
Name: / Business sector:
Address:
Contact: / Job title:
Tel: / Fax: / Email:

Complete the appropriate application form depending upon the product/promotional material for which you are applying to use the government 5 A Day logo. You should read the general and nutrition-relatedcriteria in the licensing guidelines before completing this application form.

If you are applying for a licence for a product range, you only need to complete one application form for that range. (If you have insufficient space, provide information on additional pages).

  • Fruit and vegetables (eg, fresh, frozen, canned; loose or pre-packed)
  • Unsweetened 100% fruit juice, vegetable juice, smoothies
  • Fruit and vegetables (100% concentrated purée)
  • Beans and other pulses
  • Fruit and vegetables (dried)
  • Promotional material only

Email the completed application form to or send to: 5 A DayLicensing Administrator, Diet & Obesity Team, Public Health England, 2C Skipton House, 80 London Road, London, SE1 6LH.

Application completed by:Date:

Job title:

APPLICATION FORM FOR A LICENCE TO USE

THE GOVERNMENT 5 A Day LOGO

Fruit and vegetables

Specify type(s) of fruit/vegetable,eg, apples

Does the product contain any added:SugarFatSalt

If you have answered yes to any of the above the product cannot carry the government 5 A Day logo

Is product:FreshFrozenCanned

(Tick onebox only)

Is product to be sold:LoosePre-packedOther

(Tick one box only)

If pre-packed state the net weight of the pack: gOR

If sold by number, number per pack:

If canned also state the drained weight:g

Do you wish to use the government

5 A Day logo?YesNo

If yes, complete the following details:

(Tick the relevant box(es))

On individual pieces of fruit/vegetable

On the pack

On promotional material/point of sale

If applicable, specify details of promotional material/point of sale:

Complete the following details if you also wish to use the “1 of your 5” or “2 of your 5” logo:

Specify typical serving size: g

How many portions of fruit/vegetables does

a typical serving contain: portions

Detail the portion explanation you propose to use:

Forward a copy of the product specification(s) with this application.

Target market:

APPLICATION FORM FOR A LICENCE TO USE

THE GOVERNMENT 5 A Day LOGO

100% fruit juice, vegetable juice, smoothies

Specify whether the product/range is fruit/vegetable juice or a smoothie

Does the product/range contain any added:SugarFatSalt

If you answered yes to any of the above the product cannot carry the government 5 A Day logo

Specify packaging type:

State net quantity of pack: g/ml

Tick if the quantity is in g or ml:gml

Do you wish to use the government

5 A Day logo?YesNo

If yes, complete the following details:

(Tick the relevant box(es))

On the pack

On promotional material/point of sale

If applicable, specify details of promotional material/point of sale:

Do you wish to use the ‘1 of your 5’logo?YesNo

(Note that juices and smoothies can only count as one portion of fruit or vegetables)

If yes, complete the following details:

Specify the typical serving size:g/ml

Specify if the quantity is in g or ml:gml

Detail the portionexplanation you propose to use:

Forward a copy of the productspecification(s) with this application

Target market:

APPLICATION FORM FOR A LICENCE TO USE

THE GOVERNMENT 5 A Day LOGO

Fruit and vegetables (100% concentrated purée)

Specify variety(ies) (eg, tomato, garlic):

Does the product/range contain any added:SugarFatSalt

If you have answered yes to any of the above the product cannot carry the government 5 A Day logo

Specify packaging type:

State the net quantity of the pack: g/ml

Specify if the quantity is in g or ml:gml

Do you wish to use the government5 A Day logo?Yes No

If yes, complete the following details:

(Tick the relevant box(es))

On the pack

On promotional material/point of sale

If applicable, specify details of promotional material/point of sale:

Do you wish to use the ‘1 of your 5’logo?YesNo

(Note that 100% concentrated puree can only count as one portion)

If yes, complete the following details:

Specify the typical serving size:g / ml

Specify if the quantity is in g or ml:gml

Detail the portion explanation you propose to use:

Forward a copy of the product specification with this application

Target market:

APPLICATION FORM FOR A LICENCE TO USE

THE GOVERNMENT 5 A Day LOGO

Beans and other pulses

Specify the type(s) of bean or pulse:

Does the product/range contain any added:SugarFatSalt

If you have answered yes to any of the above the product cannot carry the government 5 A Day logo

Is the product:DriedCanned

(Tick onebox only)

Is the product to be sold:LoosePre-packed

(Tick onebox only)

If pre-packed state the net weight of the pack: g

If canned also state the drained weight:g

Do you wish to use the government

5 A Day logo?YesNo

If yes, complete the following details:

(Tick the relevant box(es))

On the pack

On promotional material/point of sale

If applicable, specify details of promotional material/point of sale:

Do you wish to use the ‘1 of your 5’logo?YesNo

(Note that beans and pulses can only contribute one portion)

If yes, complete the following details:

Specify the typical serving size (as cooked):g

Detail the portion explanationyou propose to use:

Forward a copy of the product specification with this application

Target market:

APPLICATION FORM FOR A LICENCE TO USE

THE GOVERNMENT 5 A Day LOGO

Fruit and vegetables (dried)

Specify the type(s) of fruit or vegetable:

Does the product/range contain any added:SugarFatSalt

If you have answered yes to any of the above the product cannot carry the government 5 A Day logo

Is the product to be sold:LoosePre-packed

(Tick one box only)

If pre-packed state the net weight of the pack: g

Do you wish to use the government 5 A Day logo? Yes No

If yes, complete the following details:

(Tick the relevant box(es))

On the pack

On promotional material/point of sale

If applicable, specify details of promotional material/point of sale:

Do you wish to use the ‘1 of your 5’logo?YesNo

(Note that dried fruit and vegetables can only contribute one portion)

If yes, complete the following details:

Specify the typical serving size (as eaten):g

Detail the portion explanation you propose to use:

Forward a copy of the product specification with this application

Target market:

APPLICATION FORM FOR A LICENCE TO USE

THE GOVERNMENT 5 A Day LOGO

Promotional material only

Specify the type(s) of promotional material (eg, advertising, carrier bags, premises,etc):

Detail how the government 5 A Day logo will be used

Forward a copy of the proposed material with this application

Target market:

APPLICATION FORM FOR A LICENCE TO USE

THE GOVERNMENT 5 A Day LOGO

ADDITIONAL INFORMATION

To be completed by all applicants

Provide details, where relevant, of anticipated timescales for the use of the logo, likely exposure,number of products/volumes soldand any advertising or other promotional plans

Provide details of a nominated contact for PRpurposes

Contact: / Job title:

March 2016