Form No.

1A

Part I
APPLICATION FOR HALAL SUPERVISION AND CERTIFICATION
OF HALAL FOOD PRODUCTS

(Instruction: Please submit this application with required product information as outlined below:)

Company/Applicant name:________________________________________ Reg. No.__________

Address: ________________________________________________________________________
Tel. ____________________ Fax ________________ E-mail: ____________________________
Application authorized by: _________________________ Designation: ____________________
Plant address: ____________________________________________________________________
Contact person at plant: _____________________________ Designation: ____________________
Tel. _________________ Fax ___________________ E-mail: _____________________________
Brand name of product to be certified: ________________________________________________
Nature of product: ____Medicine ____Food Supplement _____Cosmetics/Toiletries ____Packaging
____Animal Feeds ____Others, pls. specify: _____________________________
Number of factories/processing plants owned by the company: _____________________________
Name of factory/plant: _______________________________________________________
Address: __________________________________________________________________
Nature/type of products produced: _____________________________________________
What factory plant is applied for: _____________________________________________________
What products are produced in this factory/plant: ________________________________________
List of products to be certified:
1. ________________________________
2. ________________________________
3. ________________________________
4. ________________________________
5. ________________________________
6. ________________________________

7. ________________________________
8. ________________________________
9. ________________________________
10. ________________________________
11. ________________________________
12. ________________________________

(Please attach List of Ingredients in each product applied for and provide information about each ingredient, including
including specification sheets and suppliers. Attach a separate sheet if needed).

Nature of Plant:

Pork Free ________

Meat Free ________

Alcohol Free __________

In case of approval of this Application for Halal Certification, we bind ourselves to maintain the halal standard quality of our product/s as
mandated and implemented by the IDCP. It is understood that in case of violation of any of the injunctions on Halal Certification and
Accreditation, the IDCP may cancel their halal certification/accreditation issued pursuant hereto, even during the period of such
certification/accreditation without prior notice and without prejudice to the legal consequence of such violation.

Name: _______________________________
Date: _______________________________

___________________________________
Signature & Stamp

-----------------------------------------------------------------------------------------------------------------------------------------------(Note: The IDCP guarantees that all the information submitted for this purpose shall be strictly confidential and may not be
disclosed to anyone without the permission of the Company).