To Be Completed in Full (In Block Capitals)

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 - PULLETS

APPLICATION FORM

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

APPLICANT NAME
UNIT NAME / DEFRA HOLDING NO : / / /
ADDRESS / On farm contact
Position :
PostCode / Tel :
Fax No / Mobile No / Email Address / Web Site Address www.
Site Identification / address if different from above / House ID / House name / Organic approved / Number of birds / house

* J = Pullets

Name of each poultry house manufacturer

Any other systems/species on same site? (ie cage, chickens etc) : please state which -

Name & address of Hatchery for Freedom Food chicks
Name of Freedom Food Haulier(s) & Reg. no(s)
Member of other assurance schemes ? Please state which :

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.

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 :

VAT @ 20.0% / Total
JOINING FEE / £30 / £6.00 / £36.00
Up to 12,000 birds / £119 / £23.80 / £142.80
Additional multiples of 12,001 up to 24,000 birds / £176 / £35.20 / £211.20
Additional multiples of 24,001 up to 36,000 birds / £233 / £46.60 / £279.60
Additional multiples of 36,001 up to 48,000 birds / £290 / £58.00 / £348.00
Additional multiples of 48,001 up to 60,000 birds / £347 / £69.40 / £416.40
Additional multiples of 60,001 up to 72,000 birds / £404 / £80.80 / £484.80
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 – OFFICE USE ONLY

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

Pullets Section A Issue 6 PleaseReturn to Freedom Food HO with Payment