STATUTORY DECLARATION ORGANIC PROCESSORS

Transcription

1 Autralian Certified Organic Pty Ltd ABN PO Box 810 NUNDAH BRISBANE QLD 4012 Ph: Fax: STATUTORY DECLARATION ORGANIC PROCESSORS NOTE: PLEASE RETURN THIS COMPLETED DOCUMENT TO THE ACO OFFICE AT: ADDRESS STATED ABOVE INSTRUCTIONS FOR COMPLETING THIS DOCUMENT Thi Statutory Declaration form the bai of your application for certification. To avoid any delay, it i important that each ection of thi document i completed accurately. Pleae read the following detail carefully, failure to provide the neceary information will reult in thi document being returned for additional information. To minimie delay with your application pleae enure thi document and any attached information i either typed or printed in black or blue pen CLEARLY in CAPITAL LETTERS. If certification i required for more than one FACILITY, on eparate title or under eparate management ytem, a Statutory Declaration mut be completed for each FACILITY. ALL QUESTIONS MUST BE ANSWERED, WRITE N/A, NIL OR NONE IF NOT APPLICABLE. Thi document mut be igned on each page and where indicated on the lat page, in the preence of a witne, a pecified in eligible witne lit Page 5-7. Within one month of receipt of thi document: An ACO authoried auditor will make an appointment to viit your FACILITY for an evaluation for certification. Thi firt audit of your property hould occur within the firt three month from your application unle you have elected for the fat track payment option. Sample/ of PRODUCT may be taken for chemical reidue teting. The auditor report i forwarded to the Certification Review Committee, which analye all factor relating to organic proceing. The applicant will be advied of the outcome of the certification review within 6 week of the firt audit occurring, unle there are mitigating circumtance. THE FOLLOWING CHECKLIST MUST BE COMPLETED PRIOR TO POSTING YOUR APPLICATION. THIS WILL ASSIST IN THE APPRAISAL OF YOUR APPLICATION. CHECKLIST All ection of the Statutory Declaration have either been anwered or marked NA Thi Statutory Declaration ha been initialled and dated at the bottom of every page by the client, in the preence of the witne (a pecified in eligible witne lit Page 5-7) who ha alo initialled and dated the bottom of every page. PLEASE NOTE: FAMILY MEMBERS ARE INELIGIBLE TO WITNESS. Additionally, the client and witne have printed their name, igned in full and dated thi Statutory Declaration where indicated in the boxed ection. Organic Handling Plan ha been filled out. Document required in Organic Handling Plan have been attached. That an area ketch and a written decription giving clear direction from the nearet town to the facility involved i encloed to enable the auditor to viit the property. TICK WHEN COMPLETE Proceor Stat Dec Iue 1 Reviion 3 [APPROVED BY: Kellie Lewi 23/05/2013] (Page 1 of 7 )

2 STATUTORY DECLARATION ORGANIC PROCESSORS 1. LICENSEE(S) DETAILS I, BEING THE PERSON RESPONSIBLE FOR THIS DECLARATION (HEREIN REFERRED TO AS THE OPERATOR): Given Name TRADING AS: Trading Name DO SOLEMNLY AND SINCERELY DECLARE: 2. OPERATION DETAILS OPERATION TYPE: (pleae tick) Company Partnerhip Sole Operator Public Company BUSINESS NUMBERS: Trut ABN ARBN (If applicable) 3. POSITION DETAILS MY POSITION IS: (pleae tick) Sole Owner Partner Secretary Co-owner Director Shareholder Employee Manager Conultant Sharefarmer 4. SHAREHOLDER / PARTNER DETAILS SHAREHOLDER / PARTNER 1: Other (pleae pecify) Given Name SHAREHOLDER / PARTNER 2: Given Name SHAREHOLDER / PARTNER 3: Given Name SHAREHOLDER / PARTNER 4: Given Name Proceor Stat Dec Iue 1 Reviion 3 [APPROVED BY: Kellie Lewi 23/05/2013] (Page 2 of 7)

3 5. CONTACT DETAILS MY CONTACT DETAILS ARE: Telephone (BUS) Telephone (AH) Mobile FAX (BUS) FAX (AH) 6. PROCESSING FACILITY ADDRESS DETAILS POSTAL ADDRESS: PHYSICAL ADDRESS: Addre Suburb Potcode Addre Suburb Potcode 7. BUSINESS ACTIVITIES THAT CORE BUSINESS ACTIVITIES ARE: 8. CERTIFICATION TYPE THAT CERTIFICATION IS SOUGHT AS AN: (pleae tick) Independent Proceor Contract Proceor Independent Packer Contract Packer AND THAT THE NAMES OF RELEVANT OTHER PARTIES OR BUSINESSES ASSOCIATED WITH THE HANDLING AND PROCESSING OF CERTIFIED PRODUCTS ARE/WILL BE (IF YOU ARE CONTRACT PACKER/PROCESSOR, YOU MUST WRITE DOWN THE COMPANY YOU ARE PACKING/PROCESSING FOR.) 9. CURRENT CERTIFICATION ARE YOU CURRENTLY CERTIFIED WITH ANY OTHER CERTIFYING BODIES? (pleae tick) Ye (pleae provide detail below) HAVE YOU BEEN CERTIFIED WITH ANY OTHER CERTIFYING BODIES AND HAVE YOU EVER BEEN DENIED CERTIFICATION OR DECERTIFIED? (pleae tick) Ye (pleae provide detail below of certification body and reaon) Proceor Stat Dec Iue 1 Reviion 3 [APPROVED BY: Kellie Lewi 23/05/2013] (Page 3 of 7)

4 10. PROCESS DESCRIPTION THAT THE DESCRIPTION OF PROCESSES INVOLVED IN HANDLING AND PROCESSING ORGANIC CERTIFIED PRODUCT IS? 11. OTHER CERTIFIED PRODUCTS THAT THERE ARE PRODUCTS, OTHER THAN ACO CERTIFIED PRODUCT HANDLED AND PROCESSED? (pleae tick) NO Ye (pleae provide detail below) 12. FURTHER COMMENTS (If necearily) THAT FURTHER COMMENTS ARE: 13. NOTIFICATION THAT ANY DEPARTURE FROM THE REQUIREMENTS SPECIFIED BY THE CURRENT BIOLOGICAL FARMERS OF AUSTRALIA FOR ORGANIC PRODUCTION, PROCESSING AND MARKETING MUST BE NOTIFIED TO THE ACO IN WRITING AS THIS OCCURS. 14. DECLARATION A. I UNDERSTAND THAT REGULAR SAMPLES OF MY/OUR PRODUCE WILL BE SUBJECT TO A RANDOM CHEMICAL RESIDUE TEST AND COULD BE AT MY OWN EXPENSE WHERE IT CANNOT BE VERIFIED THAT CONTAMINATION DID NOT OTHERWISE ARISE FROM PROCESSING PRACTICES: (pleae tick) Ye B. I HAVE READ AND UNDERSTOOD THE CURRENT VERSION OF THE BIOLOGICAL FARMERS OF AUSTRALIA CO- OP LTD STANDARD HEREIN REFERRED TO AS"THE AUSTRALIAN ORGANIC STANDARD",WHICH IS ADMINISTERED BY ACO: (pleae tick) Ye C. I ACKNOWLEDGE THIS DECLARATION IS MADE WITH A CLEAR UNDERSTANDING OF THE REQUIREMENTS SET OUT IN THE CURRENT ACO AND ACO S CERTIFICATION PROGRAM "ORGANIC STANDARD": (pleae tick) Ye Proceor Stat Dec Iue 1 Reviion 3 [APPROVED BY: Kellie Lewi 23/05/2013] (Page 4 of 7)

5 D. I ACKNOWLEDGE THAT KEEPING COMPREHENSIVE RECORDS OF PRODUCTION ACTIVITIES AND SALES, AS SPECIFIED IN THE ACO STANDARD, IS A KEY ASPECT OF ATTAINING AND MAINTAINING CERTIFICATION: (pleae tick) Ye E. I ACKNOWLEDGE THAT ANY DEPARTURE FROM THE PRINCIPLES OF THE ACO, AS OUTLINED IN THE ACO STANDARD, MUST BE NOTIFIED IN WRITING TO THE ACO CERTIFICATION OFFICE: (pleae tick) Ye F. I/WE ARE AWARE I/WE WILL BE LIABLE FOR PENALTIES APPLICABLE TO THE RELEVANT STATE FOR ANY WILFULLY MADE FALSE STATEMENT: (pleae tick) Ye G. I DO SINCERELY DECLARE THAT THE STATEMENTS MADE IN THIS APPLICATION ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF: (pleae tick) Ye\ I HAVE READ AND UNDERSTOOD THE CURRENT VERSION OF THE BIOLOGICAL FARMERS OF AUSTRALIA CO-OP LTD STANDARD HEREIN REFERRED TO AS"THE AUSTRALIAN CERTIFIED ORGANIC STANDARD", WHICH IS ADMINISTERED BY ACO AND WILL COMPLY WITH ALL RELEVANT PROVISIONS OF THE CERTIFICATION PROGRAMS: (PLEASE TICK) Ye SIGNED: Print Full Name Clearly Signature Date WITNESSED BY: Print Full Name Clearly Signature Date ELIGIBLE WITNESS CATEGORY Pleae tate profeion (Page 5-7) ALL PAGES MUST BE SIGNED, DATED AND WITNESSED (BY AUTHORISED WITNESS LIST BELOW), OTHERWISE DOCUMENT WILL BE RETURNED. Family member are ineligible to witne documentation. The following lit detail people that are able to witne a tat dec under the Statutory Declaration Regulation of 1993 which i bound by the Statutory Declaration Act of 1953 under Autralian Commonwealth Law (doe not differ to individual tate) A tatutory declaration under the Statutory Declaration Act 1959 may be made before (1) a peron who i currently licened or regitered under a law to practie in one of the following occupation: The following lit detail people that are able to witne a tat dec under the Statutory Declaration Regulation of 1993 which i bound by the Statutory Declaration Act of 1953 under Autralian Commonwealth Law (doe not differ to individual tate) A tatutory declaration under the Statutory Declaration Act 1959 may be made before (1) a peron who i currently licened or regitered under a law to practie in one of the following occupation: Chiropractor Dentit Legal practitioner Medical practitioner Nure Optometrit Patent attorney Pharmacit Phyiotherapit Pychologit Trade mark attorney Veterinary urgeon Proceor Stat Dec Iue 1 Reviion 3 [APPROVED BY: Kellie Lewi 23/05/2013] (Page 5 of 7)

6 (2) a peron who i enrolled on the roll of the Supreme Court of a State or Territory, or the High Court of Autralia, a a legal practitioner (however decribed); or (3) a peron who i in the following lit: Agent of the Autralian Potal Corporation who i in charge of an office upplying potal ervice to the public Autralian Conular Officer or Autralian Diplomatic Officer (within the meaning of the Conular Fee Act 1955) Bailiff Bank officer with 5 or more continuou year of ervice Barriter Building ociety officer with 5 or more year of continuou ervice Chief executive officer of a Commonwealth court Clerk of a court Commiioner for Affidavit Credit union officer with 5 or more year of continuou ervice Employee of the Autralian Trade Commiion who i: (a) in a country or place outide Autralia; and (b) authoried under paragraph 3 (d) of the Conular Fee Act 1955; and (c) exerciing hi or her function in that place Employee of the Commonwealth who i: (a) in a country or place outide Autralia; and (b) authoried under paragraph 3 (c) of the Conular Fee Act 1955; and (c) exerciing hi or her function in that place Fellow of the National Tax Accountant Aociation Finance company officer with 5 or more year of continuou ervice Holder of a tatutory office not pecified in another item in thi lit Judge of a court Jutice of the Peace Jutice of the Peace (Commiioner for Declaration) Magitrate Marriage celebrant regitered under Subdiviion C of Diviion 1 of Part IV of the Marriage Act 1961 Mater of a court Member of Chartered Secretarie Autralia Member of Engineer Autralia, other than at the grade of tudent Member of the Aociation of Taxation and Management Accountant Member of the Autralaian Intitute of Mining and Metallurgy Member of the Autralian Defence Force who i: (a) an officer; or (b) a non-commiioned officer within the meaning of the Defence Force Dicipline Act 1982 with 5 or more year of continuou ervice; or (c) a warrant officer within the meaning of that Act Member of the Intitute of Chartered Accountant in Autralia, the Autralian Society of Certified Practiing Accountant or the National Intitute of Accountant Member of: (a) the Parliament of the Commonwealth; or (b) the Parliament of a State; or (c) a Territory legilature; or (d) a local government authority of a State or Territory Miniter of religion regitered under Subdiviion A of Diviion 1 of Part IV of the Marriage Act 1961 tary public Permanent employee of the Autralian Potal Corporation with 5 or more year of continuou ervice who i employed in an office upplying potal ervice to the public Permanent employee of: (a) the Commonwealth or a Commonwealth authority; or (b) a State or Territory or a State or Territory authority; or (c) a local government authority; with 5 or more year of continuou ervice who i not pecified in another item in thi lit Peron before whom a tatutory declaration may be made under the law of the State or Territory in which the declaration i made Police officer Regitrar, or Deputy Regitrar, of a court Proceor Stat Dec Iue 1 Reviion 3 [APPROVED BY: Kellie Lewi 23/05/2013] (Page 6 of 7)

7 Senior Executive Service employee of: (a) the Commonwealth or a Commonwealth authority; or (b) a State or Territory or a State or Territory authority Sheriff Sheriff officer Solicitor Teacher employed on a full-time bai at a chool or tertiary education intitution Proceor Stat Dec Iue 1 Reviion 3 [APPROVED BY: Kellie Lewi 23/05/2013] (Page 7 of 7)