Download Format A

(To be furnished on the company letterhead.)

Information about the company

(FORMAT A)

Name of Company:
Office Details:Address:

Phone No.:            Fax No.:            Email ID:

Factory/Plant Details:Address:

Phone No.:            Fax No.:            Email ID:

Organizational Structure:Ltd.[   ]   Pvt. Ltd.[   ]   Partnership[   ]   Ownership[   ]   Other[   ]
GST Details:GST No. of  State of Recipient of  Service:

State Code of Recipient of Service:

Email ID Registered in GST portal:

Web Site:
Details of key person

CMD / MD / GM / Owner / Proprietor

:Name:

Designation:

Details of Person to be Contacted regarding HALAL concern:Name:                                                Position:

Phone No.:                    Cell No.:         Email ID:

Product Nature:Organic[   ]   Inorganic[   ]   Synthetic[   ]   Natural[   ]   Others[   ]
Product Brand:
Plant certification or particular product certification ( Please Specify) 

:

HACCP / ISO (If) Certificate No. & Date of Issue & Source:
Whether some other Plant (Same Product):
If yes, details::
Contact person & contact details:
Expected date (Period) of HALAL inspection:

 

Date: ___/___/_____.

 

Details of Signing Authority:

Name:

Designation:                                                 ________________             __________________

Signature                  Company Seal/Stamp