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Tel:0755-83135803
Cell: 13714067366
广东省深圳市福田区车公庙
泰然九路海松大厦 201B-8
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PARTICULARS OF APPLICANT 申请事项
Organisation Name 公司名称 :
Organisation Address (Postal Adress) 公司地址：
Organisation Telephone 电话： Organisation Fax传真:
Corporate Website 公司网址: Corporate Email 公司邮箱:
Contact Person Name 联系人: Contact Person Designation 联系人职务:
Contact Person Tel/Fax联系人电话/传真: Contact Person Email 联系人邮箱:

PARTICULARS OF MANUFACTURING FACILITY 工厂信息
Manufacturing Organisation Name 工厂名称:
Manufacturing Organisation Address (Postal Adress) 工厂地址:
Manufacturing Organisation Telephone工厂电话: Manufacturing Organisation's Fax工厂传真:
Corporate Website网址: Corporate Email 电邮:
Contact Person Name 联系人: Contact Person Designation 联系人职务:
Contact Person Tel/Fax 联系人电话/传真 : Contact Person Email 联系人电邮:
Name Of The Nearest Major City To The Factory (离工厂最近的大城市)： Name Of The Nearest International Airport To The Manufacturing Facility (离工厂最近的国际机场)：
Name Of The Nearest Domestic Airport To The Domestic Manufacturing Facility (离工厂最近的国内机场 )： Total Number Of Hours From The Corresponding Airport To The Manufacturing Facility (国际/国内机场到你们工厂开车多长时间)：
If refer to big group company, having many factories prepared to be qualified, please fill applications separately. 如果是集团公司，下属有多家工厂，请每个工厂单独填写申请表。

LIST OF PRODUCTS FOR HALAL 申请认证产品、原料清单

No. Product Brand 产品品牌 Product Name 产品名称 Ingredient Lists 原料清单 Ingredients With Halal Certificates 是否有通过清真认证（Yes/ No） Supplier`s Name 供应商名称 Ingredients Contains Alcohol Derivative 是否含有酒精来源（Yes/ No） Ingredients Contains Animal Origin 是否含有动物来源（Yes/ No）
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No. Product Brand 产品品牌 Product Name 产品名称 Ingredient Lists 原料清单 Ingredients With Halal Certificates 是否有通过清真认证（Yes/ No） Supplier`s Name 供应商名称 Ingredients Contains Alcohol Derivative 是否含有酒精来源（Yes/ No） Ingredients Contains Animal Origin 是否含有动物来源（Yes/ No）
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No. Product Brand 产品品牌 Product Name 产品名称 Ingredient Lists 原料清单 Ingredients With Halal Certificates 是否有通过清真认证（Yes/ No） Supplier`s Name 供应商名称 Ingredients Contains Alcohol Derivative 是否含有酒精来源（Yes/ No） Ingredients Contains Animal Origin 是否含有动物来源（Yes/ No）
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No. Product Brand 产品品牌 Product Name 产品名称 Ingredient Lists 原料清单 Ingredients With Halal Certificates 是否有通过清真认证（Yes/ No） Supplier`s Name 供应商名称 Ingredients Contains Alcohol Derivative 是否含有酒精来源（Yes/ No） Ingredients Contains Animal Origin 是否含有动物来源（Yes/ No）
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No. Product Brand 产品品牌 Product Name 产品名称 Ingredient Lists 原料清单 Ingredients With Halal Certificates 是否有通过清真认证（Yes/ No） Supplier`s Name 供应商名称 Ingredients Contains Alcohol Derivative 是否含有酒精来源（Yes/ No） Ingredients Contains Animal Origin 是否含有动物来源（Yes/ No）
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No. Product Brand 产品品牌 Product Name 产品名称 Ingredient Lists 原料清单 Ingredients With Halal Certificates 是否有通过清真认证（Yes/ No） Supplier`s Name 供应商名称 Ingredients Contains Alcohol Derivative 是否含有酒精来源（Yes/ No） Ingredients Contains Animal Origin 是否含有动物来源（Yes/ No）
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Please add another sheet should there be more than products to be halal-certified. 多种产品，可以另加表格。

BRIEF EXPLANATION TO MANUFACTURING PROCESS
请概要介绍认证产品的生产过程.

NAME OF PRODUCT（申请认证产品名称）
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NAME OF PRODUCT（申请认证产品名称）
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LIST OF ALL PRODUCTS MANUFACTURED IN THE MANUFACTURING-PLANT
请列出工厂生产的所有产品

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DECLARATION ON ALCOHOL AVAILABILITY
不含酒精成分的清真声明

I/We hereby declare that all the products that are applying for halal certification， in our factory: does not include any alcohol or its derivatives in the purchase of raw materials, manufacturing, processing, cleaning & packing.

OR

I/We hereby declare that all the products that are applying for halal certification in our factory: uses ethanol, methanol & isoproponol derived from synthetic alcohol for the purpose of industrial cleaning only. There is absolutely no usage of alcohol derived from alcohol beverages.

Name & Designation of Staff Providing the Declaration:

Signature of Staff Providing the Declaration:

Date of Declaration:

Company Stamp

 

DECLARATION ON ANIMAL ORIGIN
不含动物成分的清真声明

I/We hereby declare that all the products that are applying for halal certification in our factory: does not include any animal or its derivatives in the purchase of raw materials, manufacturing, processing, cleaning & packing.

Name & Designation of Staff Providing the Declaration:

Signature of Staff Providing the Declaration:

Date of Declaration:

Company Stamp

 

DECLARATION ON PAYMENT
现场付款的声明

I/We hereby declare that factory : Factory`s name will provide full cash payment (100%) upon the completion of the official halal audit, regardless on the final findings & result. processing, cleaning & packing.

Name & Designation of Staff Providing the Declaration:

Signature of Staff Providing the Declaration:

Date of Declaration:

Company Stamp

 

DECLARATION BY APPLICANT
清真认证声明

I/We hereby declare that all the above information supplied by me/us and supporting documents, to the best of my knowledge and belief, are true and that I have not willfully suppressed any material facts which is requested for in his application. Any false declaration will be subjected to my/our application being cancelled/rejected. 我/我们在此声明，所有提交的资料属实的。没有蓄意捏造任何清真认证所需的产品信息。 如有任何伪造信息，我们同意取消认证资格。

Name and Signature of Applicant
申请人签名：

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Date of Application 认证日期：

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Company/Establishment Stamp公司盖章：

 

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Tel:0755-83135803 Cell: 13714067366 广东省深圳市福田区车公庙泰然九路海松大厦 201B-8