APPLICATION FOR HALAL CERTIFICATION

Please note all information is Confidential:-

Date:

Plant Name: Web:

Address:

Street Name / Suite #:

City: Province / State: Postal Code / Zip:

Phone: Fax: Toll Free:

Plant Contact: Title:

Phone: Email:

Alternate Contact: Title:

Phone: Email:

R & D Contact: Email:

1) Please indicate the closest major city/ town and the distance to the facility:

2) Please indicate the geographic areas where you plan to market the product (s):

Canada USA Indonesia Malaysia Singapore Qatar
UAE Saudi Arabia Egypt Kuwait

Other:

3) Nature of Product:

4) Brand name of Product to be certified:

Describe all the manufacturing process in this plant: