PT.

AMCOR FLEXIBLES INDONESIA

FORM
Customer Application Questionnaire - Food Packaging FM-QEHS-TRD-032
Approved By Date Revision Page
Technical and R&D
R&D Manager 16-Jun-2015 2 1/3

CPS No Reference to
DPS No Refer to ACS
Date: No. CAQ

To: Amcor’s name & address

Customer Application Survey Form – Food Packaging

The information below is the types of food and conditions of use for our process and
product applications.

A. Product Information
Product Name:
Product Spec:
Product Weight (g)/Volume (ml)
Pack dimensions (mm)

B. Company Information
Company Name:
Address:
Person in charge:
Title / Department:
Email address:
Phone / Fax:

C. Customer Application Remarks

Direct
Intended Food contact
Indirect
Non food
Dry
Aqueous (what is the viscosity?________cps)
Acid / Base (pH < 4.5, 4.5-7 or >7)
Fat / Oil (%)
Alcoholic (%)
Dairy – milk powder (fat)
Food types Dairy – milk powder (skim)
Dairy – infant formula
Dairy – cheese
Dairy – other (specify)
Chicken- Processed
Meat – fresh
Meat – processed
Fish

PT Amcor Flexibles Indonesia

Jl. Gatot Subroto Km 5.4 Tangerang Banten 15134 Indonesia www.amcor.com

REF. No.: AFAP CAQ_Food Packaging Revision: 01

Date: 25th Nov 2-14
 PT. AMCOR FLEXIBLES INDONESIA
FORM
Customer Application Questionnaire - Food Packaging FM-QEHS-TRD-032
Approved By Date Revision Page
Technical and R&D
R&D Manager 16-Jun-2015 2 2/3

Ready meals – specify type of meal

Cold (ºC)
Filling Process Hot (ºC)
Room Temperature (ºC)
C. Customer Application Remarks
Machine: VFFS/HFFS*
Sate machine brand name______________
Thermoform
Seal: Fin / Lap seal*
What material seal to what material?_____
Packing equipment
Speed____________meter/min
Speed_____________strokes/min

Horizontal temperature____________0C
Vertical temperature____________0C
What is the pressure applied to seal bar?__________bar
Normal condition –
Frozen (ºC)
Chilled (ºC & min. / hr)
Pasteurization (ºC & min. / hr)
Boiling (ºC & min. / hr)
Post filling process Retort (ºC & min. / hr)
Retort Type / Model
/ Brand name
Microwave (ºC & min)
Vacuum
Gas flush – specify gas mix
Others (Please specify)
Room temperature (ºC)
Chilled (ºC)
Storage conditions
Frozen (ºC)
Others (ºC)
Final consumer
Mode of Distribution Products sold to (specify the country)
By Land / Air / Sea
Odour protection
Critical shelf life Light protection
parameters Oxygen sensitive
Moisture sensitive

PT Amcor Flexibles Indonesia

Jl. Gatot Subroto Km 5.4 Tangerang Banten 15134 Indonesia www.amcor.com

REF. No.: AFAP CAQ_Food Packaging Revision: 01

Date: 25th Nov 2-14
 PT. AMCOR FLEXIBLES INDONESIA
FORM
Customer Application Questionnaire - Food Packaging FM-QEHS-TRD-032
Approved By Date Revision Page
Technical and R&D
R&D Manager 16-Jun-2015 2 3/3

Others (Please specify)

Finished Goods shelf life Duration from packaging to consuming [best before date]

Ready to eat / drink

Cooking in packaging
Final Consumer usage
microwave cooking in packaging
Others (Please specify)
Possibility of repeat
Yes / No
serving in the original
packaging?
Related regulation
compliance and Please all countries product shall be sold into and specify
standards (Please also regulation (EU, USA FDA, Thai FDA, FSANZ, GB,
indicate countires that Indonesia HK regulations…etc)
shall be sold into)
Authorized Person in charge
signature:
Date :

PT Amcor Flexibles Indonesia

Jl. Gatot Subroto Km 5.4 Tangerang Banten 15134 Indonesia www.amcor.com

REF. No.: AFAP CAQ_Food Packaging Revision: 01

Date: 25th Nov 2-14