APPLICATION FOR CERTIFICATION

Company or organisation to be audited

Company Name:
Address:
City, Region/State
Zip/Postal code, Country
Contact name: Tel No.
Contact e-mail address: Website URL:
Application completed by: Date:

Certification type(s) requested

You must contact BRCGS prior to requesting an audit. A certificate
BRCGS Food Do you have? will not be issued without a Program License Agreement (PLA)
Additional Modules High care areas BRCGS Gluten Free
BRCGS Plant Based
FSMA Module High risk areas Certification Program
MSCA Module Ambient high care areas Global Standard
plus AOECS
FSSC 22000 BRCGS Packaging
ISO 22000 IFS Food HAVI Module
HAVI Module (Please also complete section A)
IFS Broker BRCGS A&B IFS Logistics BRCGS S&D
(Please also complete section B) (Please also complete section C)
FSMA FSVP FSMA QIC (FDA TPP)
BRCGS START!
Certification audit Consultative audit IFS Wholesale/C&C Basic level
Gap assessment Regulatory audit (Please also complete section E)
Intermediate level
(Please also complete section D)

Additional audit options

(can be conducted on the same visit as the above main visit)
AOECS Addendum V-Label – Vegan and vegetarian food products
(Please provide a copy of your licence or application to AOECS) (Separate questionnaire will be sent)
Realize – Food Safety Culture Assessment FSMA Food Defence
(Separate questionnaire will be sent) (Separate questionnaire will be sent)

Current or previous certification

(Please indicate any third-party certification you already have or have previously had.
BRCGS Site Code / IFS Date of last
Scheme Expiry date
COID / FSSC COID unannounced audit

Scope of certification requested

What is your proposed scope of certification?
(What products and processes do you want included?)

Do you require any exclusions? Please detail

Are there any traded products and/or fully outsourced

products? Please give details
Are there any operations and/or storage performed on
another site? Please give details
Request audit to be conducted unannounced?
Do you supply or provide services to Costco Yum! (KFC, Pizza Hut or Taco Bell)

Company details
(please complete fully this section as it determines the audit time)
Total Headcount (total employees including temporary workers)
Number of production Full Time Equivalents (FTE) on main shift
Number of HACCP/HARPC/HARA Plans/studies (A study corresponds to a hazard analysis for a
family of products/services with similar hazards, similar production technology and similar storage technology)
Facility size (metres square including storage on/off site)
Was a consultant used in the development of the Management System?
Please provide the name of the consultant used.
Language of the audit

Document: GF 0101 – Application for Certification Issue n°: 17 Page n°: 1 of 2

APPLICATION FOR CERTIFICATION
Section A – BRCGS Packaging and Packaging Materials
Raw materials used:
Types of manufacturing technology (e.g. injection moulding,
thermoforming, extrusion, lamination, printing, die cutting,
corrugating, conversion into bags etc.).

Section B – IFS Broker and/or BRCGS Agents & Brokers

Does the company also have own logistic activities?
Please give details
Is this a virtual location? (all Do you have additional
individuals working online and Yes No office locations?
not based in a physical office) How many?
Number of product types
Number of supplying sites
traded
Import Distribution Pre-shipment inspection
Services offered: Export Product development Repacking
Storage Product testing Further processing

Section C – IFS Logistics and/or BRCGS Storage & Distribution

Does the company also have own broker activities?
Please give details
Product varieties:
Storage conditions: Transportation: Other activities:
Food/ingredients
Ambient Ambient Cross docking
Packaging
Temperature controlled Temperature controlled Open product handling
Consumer products
BRCGS activities only:
10 Wholesale 14 Product inspection 16 Quantity control 18 Cleaning processes
12 E Commerce 15 Contract packaging 17 Contract freezing etc. 19 Waste recovery

Section D – FSMA
PC Human Food Dietary supplements Food Packaging
Which FSMA regulation(s) is PC Animal Food Low Acid Canned Food Produce Safety
audit/certification required
Juice HACCP Acidified Foods Intentional Adulteration
for:
Seafood HACCP Intentional adulteration Other
For FSMA QIC (VQIP), what are the FDA product codes to be included in scope?
(To determine FDA product codes of food products manufactured at the facility, please visit:
https://www.accessdata.fda.gov/scripts/ora/pcb/index.cfm?action=main.pcb)
Is the facility registered with FDA? Yes No
Within the past 2 years, has the facility issued a food safety recall? Yes No
Does the facility have any pending/recent FDA compliance actions? Yes No
Is this a supplier audit required by a US importer? Yes No
Please specify US importer name (if available):
Does the certification applicant confirm all ingredients/raw materials are approved or Yes No
allowed for use in the US? Don’t know
Do any of the following criteria apply to the products in scope?
A petition for approval On the banned
Categorized as GRAS Subject to prior sanctions
has been submitted substances list

Section E – IFS Wholesale/C&C

Wholesale Classic Wholesale Plus Cash & Carry Classic Cash & Carry Plus
No treatment / processing With treatment / processing No treatment / processing With treatment / processing

For more details, please visit sgs.com

Document: GF 0101 – Application for Certification Issue n°: 17 Page n°: 2 of 2