P u n j a b H a l a l D e v e l o p m e n t A g e n c y Government of the Punjab (Pakistan) Website:
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1 APPENDIX-I (PHDA/REC-06) Rev: 02 APPLICATION FORM HALAL FOOD MANAGEMENT SYSTEMS (Requirements fr any rganizatin in Halal fd chain) 4/6 Shaheen Cmplex, Egertn Rad, Lahre Tel: website: Page 1 f 11
2 PLEASE COMPLETE THE APPLICATION FORM AND RETURN IT TO THE ADDRESS SHOWN ABOVE, WE WILL THEN SUBMIT A QUOTATION TAILORED EXACTLY TO YOUR SITUATION, THE INFORMATION PROVIDED SHALL BE TREATED WITH STRICT CONFIDENCE. NO APPLICATION FEE SHALL BE CHARGED FOR THIS APPLICATION. SECTION A COMPANY DETAILS Cmpany Name: Cmpany Registratin N. Cmpany Site Pstcde: Tel N.: Cntact persn: (Name & Designatin): Pstcde: Tel N.: Cntact persn (Name & Designatin): Standard PS 3733 MS 1500 Accreditatin PNAC JAKIM Prducts and Services (please detail the prducts yu prduce and the services yu prvide) Scpe (Please nte that this descriptin shall be the Certificatin scpe shwn n the certificate f apprval issued by PHDA) N. f Emplyees 1. Management 2. Administratin 3. Prductin/Prcess 4. Quality 5. Maintenance/Service, etc. Ttal Seasnal: Temprary: Subcntracted: N. f Shifts 1 st Shift N. f Emplyees 2 nd Shift N. f Emplyees 3 nr Shift N. f Emplyees Lcatin (Please give infrmatin and/r enclse a site plan shwing the fllwing) Page 2 f 11
3 Lcatin f site including neighbrs, layut plan, strage, prcess and administratin facilities, site services including drainage, access rutes, etc. SECTION B Activities and Prcesses n site: (please list dwn all site activities) List f Prducts/Brands: (use Annexure-I) Prduct/Brand t be certified: List f incming material, tgether with supplier details i.e. telephne; fax; ; cntact persn details in the attached frmat: (Use Annexure-II) Brief Descriptin f Prduct Prcess Flw (use Annexure- III) Gegraphical Business Targeted Area (use Annexure -IV) List f subcntracted activities: (i.e. Machining, calibratin, delivery/lgistics, etc.) SECTION C List f Halal Cntrl Pints (hazards/risks in activities) Any ther existing certified management system (If yu have any ther certificate, please cmplete belw) Standard: Certificatin Bdy: Apprval Date: Valid Until: Cpy f certificate attached: Management Representative (Name & Cntact N.) Target date fr Audit: Declaratin: I/we undertake that the infrmatin prvided fr Halal Certificatin is based n real practices. We als undertake that we will prir infrm t PHDA if any change ccur in the frmulatin hereafter. Authrized Signature Psitin Reviewed by Manager Cmpliance Cmpany Stamp Date FOR PHDA USE ONLY Date THANK YOU FOR COMPLETING THE APPLICATION FORM Page 3 f 11
4 Nte: Kindly ensure prir facilitatin n the fllwing items: 1. Kindly endrse the applicatin with cmpany stamp. 2. Please return cmpletely filled applicatin frm tgether with the required full disclsures thrugh (inf@phda.cm.pk) r pst t the ffice address. 3. Applicatin frms will nly be accepted when fully cmpleted and duly signed by the Prprietr /Directr r authrized representative. Failure t adhere t the abve guidelines, may delay the prcess % certificatin fee will be charged in advance at the time f the cntract submissin. SECTION D Scpe f applicatin (The scpe f ne specific client rganizatin may cver mre than ne categry.) Halal prduct/service categries Categry cdes Categries Examples f sectrs A Farming 1 (Animals) animals; fish; egg prductin; milk prductin; beekeeping; fishing; hunting; trapping B C D E Farming 2 (Plants) Prcessing 1 (Perishable animal prducts) Prcessing 2 (Perishable vegetable prducts) Prcessing 3 (Prducts with lng shelf life at ambient temperature) fruits; vegetables; cereals; spices; hrticultural prducts including all activities after farming, e.g. slaughtering meat, pultry, eggs, dairy and fish prducts fresh fruits and fresh juices; preserved fruits; fresh vegetables; preserved vegetables canned prducts; biscuits; snacks; il; drinking water; beverages; pasta; flur; sugar; salt F Feed prductin animal feed; fish feed G Catering htels; restaurants H Distributin retail utlets; shps; whlesalers I Services water supply; cleaning; sewage; waste dispsal; develpment f prduct, prcess and equipment; veterinary services J Transprt and strage transprt and strage K Equipment manufacturing prcess equipment; vending machines L (Bi)chemical manufacturing additives; dietary supplements; cleaning agents; prcessing aids, bicultures and micrrganisms M Packaging material Manufacturing packaging material N Other materials manufacturing csmetics, textile, leather prducts etc. Page 4 f 11
5 ANNEXURE-I List f Prducts/Brands N. Brand/Prduct Name Descriptin Majr Ingredients t be used Page 5 f 11
6 ANNEXURE-II List f Raw Materials, Tgether With Supplier/Manufacturer N. Ingredients/Raw Material Cde Supplier Supplier Cntact Details Manufacturer (if different frm supplier) Either Supplier/ Manufacturer Prviding Halal certified Ingredients/Raw Material 1. Cntact persn: Cntact persn: Yes N 2. Cntact persn: Cntact persn: Yes N Page 6 f 11
7 3. Cntact persn: Cntact persn: Yes N 4. Cntact persn: Cntact persn: Yes N 5. Cntact persn: Cntact persn: Yes N Page 7 f 11
8 ANNEXURE-III Brief Descriptin f Prduct Prcess Flw (Please describe belw) Page 8 f 11
9 ANNEXURE-IV Gegraphical Business Targeted Area Prductin Summary Lcal Cntributin Exprt Cntributin % % Lcal Break Up Sindh % Punjab % Balchistan % Khyber Pakhtunkhwa % Exprt Break Up Asia % Eurpe % Australia % Africa % Americas % Cuntries name where yu exprt significantly N. Cuntry Name Exprt % FOR PHDA USE ONLY Reviewed by Sharia Advisr Date Page 9 f 11
10 SECTION E This part has t be filled by the authrized fficial f PHDA: Certificatin / Registratin Required: Cde Allcatin: Sr. Scpe Categry Sectr Qualificatin Cde 1 Recmmended Team and Team Leader: Apprved HFMS-LA and Team members (if any), and cvering the needed cdes Audit Type Audit Team Members Expected Time f Audit / Sign Stage I On / Off Site Stage II Surveillance I Surveillance II Authrized (Name & Signature): Date: Page 10 f 11
11 Calculatin: 1. Calculatin f MD fr initial audit: i. Minimum audit time fr single site: Ta = B + H + (PV + FTE)*CC B is the basis n-site audit time, H is the audit days fr each additinal HACCP / Halal studies and applied nly fr prducts/services in fd chain. PV is the audit days fr prduct variety, FTE is the audit days per number f emplyees, CC is the factr as multiplier fr prcess r prductin cmplexity class. ii. Minimum audit time fr each additinal site: Tasv = Ta * 50/ MD allcatin (Certificatin / Re-certificatin): TA (n-site) Subject a) Stage 1 On / Off Site b) Stage 2 On-Site c) Surveillance 1 d) Surveillance 2 MD Allcatin Nte: The minimum time includes stage 1 and stage 2 f the initial certificatin audit but des nt include the time fr preparatin f the audit nr fr writing the audit reprt. 3. Cmments (if any): 3. The MD- and cde allcatin is perfrmed by: Psitin: Sign and Date: Apprval by Sr. Technical Manager: 1. The cde allcatin abve is perfrmed crrect: YES NO 2. Cmments (if any): 3. Sign: Date Page 11 f 11
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