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