ISWA/125-Membership Renewal Form

ISWA/125-Membership Renewal Form

Please make sure to have the following documents before you fill out the form:

Required:
• Labels for each product with complete ingredients lists (specification sheets are accepted)
• Any flavorings need to be declared.
• Current Halal Certificates (from the slaughter plant) for any animal by products (meats, gelatin, casings, anything with animal by-products, etc.).
• If any alcohol is being used in the product, you must know the following:
-Type of alcohol
-Amount in ingredient
-Amount in the final product
• Information about the manufacturing plant (i.e. legal establishment numbers, plant numbers, relevant personnel, and general information on the manufacturing procedure).
• For Abattoir/Slaughter plants: provide the information relevant to slaughtering/harvesting (i.e. stunner type, model, etc.)
• Contact information for application.
• Contact information for audits.
• Preferred shipping method information (for sending certificates) and account information.

Optional:
• Current Halal certificates for any other ingredient or products.
• Any additional certifications (Kosher, Organic, etc.)

Notes:
• The application will have to be completed in one sitting (It can’t be saved).
• It can take up to 45 minutes to fill out the application.

1. Company Name:
2. Name of Company (as you would like it to appear on the Halal Certificate):
3. When does your current Halal certificate expire? 3. When does your current Halal certificate expire? / MM / DD YYYY
4. Contact(s) Name and Title:
5. Phone Number:
Please use international format, with country code (1 For U.S.A.) ex. +13013280592

Please include country code.
6. Extension:
7. Mobile Number:
Please use international format, with country code (1 For U.S.A.) ex. +13013280592

Please include country code.
8. Fax Number:
Please use international format, with country code (1 For U.S.A.) ex. +13013280592
9. Website:
10. Contact Email:
11. Mailing Address: 11. Mailing Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
12. Preferred Shipping Method:

12. Preferred Shipping Method: FedEx UPS USPS (No charge if within the United States) DHL Other Other

Your selection will be your default mailing method.
13. Shipping Account Number (if USPS, write N/A):
Billing Information

This is the description of your section break.
14. Billing Contact and Title:
15. Phone Number:
Please use international format, with country code (1 For U.S.A.) ex. +13013280592
16. Mobile Number:
Please use international format, with country code (1 For U.S.A.) ex. +13013280592
17. Fax Number:
Please use international format, with country code (1 For U.S.A.) ex. +13013280592
18. Email:
19. Billing Address: 19. Billing Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
20. Manufacturer/Processing Plant Name:
21. Personnel Responsible for Audit (Name and Title):
22. Email for Personnel Responsible for Audit:
23. Phone Number:
Please use international format, with country code (1 For U.S.A.) ex. +13013280592
24. Additional Plant Personnel (Name and Title):
25. Email for Additional Plant Personnel:
26. Phone:
Please use international format, with country code (1 For U.S.A.) ex. +13013280592
27. Establishment Number Issued By:

27. Establishment Number Issued By: USDA FDA EPA State/County/City License Other Other
28. Legal Establishment Number:

This question is required for all clients, without exception.
29. Address: 29. Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
30. Which category best describes your production?

30. Which category best describes your production? CI: Processing of perishable animal products (Production of animal products including fish and seafood, meat, eggs, dairy and fish products) CII: Processing of perishable plant products (Production of plant products including fruits and fresh juices, vegetables, grains, nuts, and pulses) CIII: Processing of perishable animal and plant products (mixed products) –(Production of mixed animal and plant products including pizza, lasagne, sandwich, dumpling, ready to-eat meals) CIV: Processing of ambient stable products (Production of food products from any source that are stored and sold at ambient temperature, including canned foods, biscuits, snacks, oil, drinking water, beverages, pasta, flour, sugar, food-grade salt) CV: Animal slaughtering (Processing of carcasses including slaughtering in slaughterhouses, cutting, cleaning and packing.) E: Catering (Domestic Only): Catering (Preparation, storage and, where appropriate, delivery of food for consumption, at the place of preparation or at a satellite unit) GI: Provision of Transport and Storage Services (Storage facilities and distribution vehicles for the storage and transport of perishable food and feed Associated packaging c GII: Provision of Transport and Storage Services for Ambient Stable Food and Feed (Storage facilities and distribution vehicles for the storage and transport of ambient stable food and feed Associated packaging c) I: (Domestic Only) Production of Food Packaging and Packaging Material (Production of food packaging material) K: Production of (Bio) Chemicals-- Production of (Bio) Chemicals (Microbiology, Production of food and feed additives, vitamins, minerals, bio-cultures, flavourings, enzymes and processing aids. Pesticides, drugs, fertilizers, cleaning agents, cosmetics, textiles, leather products, .... etc.) If Other, please explain: If Other, please explain:
31. Any Additional Information for the Above Question:
32. If meat/poultry processing, how many USDA inspectors are on the premises?
33. If meat is stored on the premises, please list all types of meat stored:
34. If a storage facility, please list origin of product and where product will be stored:
35. Is there refrigeration or freezing storage on site?

35. Is there refrigeration or freezing storage on site? Yes No
36. How many Quality Control Personnel are on site?

36. How many Quality Control Personnel are on site? 1-5 More than 5 There are no Quality Control Personnel on site.
37. How many employees are involved with the management of Halal products?
38. Are the machines used in processing of pork or pork by-products?

38. Are the machines used in processing of pork or pork by-products? Yes No
39. Are the machines used in processing cleaned and sanitized between the processing of different products?

39. Are the machines used in processing cleaned and sanitized between the processing of different products? Yes No
40. If no, explain.
41. How often are the machines sanitized?
42. Is there any alcohol present in the cleaning products used on the machines?

42. Is there any alcohol present in the cleaning products used on the machines? Yes No
43. If yes, please list the cleaning products.
44. Please attach any certifications your facility has (BRC, ISO, SQF, NSF, Organic, Kosher, etc.).

Attach Files
45. How many HACCP programs, if any, are there in the facility?

Write the total number of HACCP Programs. If none, write N/A
46. List all HACCP programs (if there are none put N/A)

Write the total number of HACCP Programs. If none, write N/A
47. Do you understand that audits must be conducted annually?

47. Do you understand that audits must be conducted annually? Yes No
48. Please provide us with 3-5 preferred dates for an audit. Audits must be conducted while Halal production is being run.
47. What products are you renewing? Please list each individual product by name.
49. What is the total number of products that are being renewed?
50. Please attach a label for each product being renewed. Each product must have a matching label.

Attach Files
51. What new products are you adding that are not currently listed on your Halal certificate, if any? Please list each individual product by name.
52. What is the total number of new products that are being added?
53. Please attach a label for each product being added. Each product must have a matching label.

Attach Files
55. What is total number of products to be listed on the Halal certificate (both new products and products being renewed).
56. Please attach an ingredient list and/or specification sheet for each product to be listed on the Halal certificate.

Attach Files
57. Do you product contain any flavorings (i.e. Natural Flavor, Artificial Flavor, Smoke Flavor, etc.)

57. Do you product contain any flavorings (i.e. Natural Flavor, Artificial Flavor, Smoke Flavor, etc.) Yes and I will attach a specification sheet that lists the ingredients in the flavorings. No, my products do not contain any flavorings.
58. Please attach specification sheets for any flavorings. The specification sheets must list the ingredients in the flavorings.

Attach Files
59. Do your products contain any alcohol?

59. Do your products contain any alcohol? Yes No
60. If yes, please list the type of alcohol and the percentage in the final product.
61. You may attach any specification sheets related to the alcohol content of the final product or any ingredients.

Attach Files
62. Is any alcohol used as a production aid or at any other time during the production process?

62. Is any alcohol used as a production aid or at any other time during the production process? Yes No
63. If yes, please elaborate.
64. Please declare any and all meat and/or poultry in the products.

64. Please declare any and all meat and/or poultry in the products. Beef and I will attach a Halal certificate for it. Chicken and I will attach a Halal certificate for it. Lamb and I will attach a Halal certificate for it. Turkey and I will attach a Halal certificate for it. Goat and I will attach a Halal certificate for it. Bison and I will attach a Halal certificate for it. There is no meat or poultry in my products. Other Other
65. Please attach a valid Halal certificate for any meat and/or poultry in your products.

Attach Files

Halal certificates should be facility certificates, not production certificates.
66. Does the Raw material (meat or poultry) come from a plant that does Temporary Immobilization by Gas aka Gas stunning (CAS)?

66. Does the Raw material (meat or poultry) come from a plant that does Temporary Immobilization by Gas aka Gas stunning (CAS)? Yes - Gas Stunning is used. No - Gas Stunning is not used. My products do no contain any poultry or poultry by-products.

Raw material cannot come from a plant that does gas stunning. We will verify this information.
67. Do your products contain any gelatin?

67. Do your products contain any gelatin? Yes, the gelatin is Halal certified and I will attach a Halal certificate for it. Yes, the gelatin is plant or fish derived and I will attach a specification sheet for it. No, my products do not contain any gelatin.
68. Please attach any required documentation for gelatin (Halal certificates or specification sheets).

Attach Files
69. Do your products contain any casings?

69. Do your products contain any casings? Yes, the casings are Halal certified and I will attach a Halal certificate for it. Yes, the casings are not animal derived and I will attach a specification sheet for it. No, my products do not contain any casings.
70. Please attach any required documentation for casings (Halal certificates or specification sheets).

Attach Files
71. Please declare any animal by-products that are present in your products that have not already been declared and attach a Halal certificate in the section below. If none, please write 'None.'
72. Please attach Halal certificates for any other ingredients.

Attach Files
73. Does the packaging of the final product(s) declare the production and expiration date?

73. Does the packaging of the final product(s) declare the production and expiration date? Yes No N/A
74. Do your approved Halal products currently bear our certification marks?

74. Do your approved Halal products currently bear our certification marks? Yes No
75. If not, would you like to start using our certification marks?

75. If not, would you like to start using our certification marks? Yes No I have already been approved to use the certification marks.

If yes, a link to request certification mark usage will be sent to you.
75. Where are the certification marks currently being displayed?

75. Where are the certification marks currently being displayed? Product labels Website Promotional Material We do not currently display your certification marks. Other Other
76. Please attach any other certifications your products have (i.e. Kosher, organic).

Attach Files
76. Do you intend to continue to use our certification marks?

76. Do you intend to continue to use our certification marks? Product labels Website Promotional Material We do not currently display your certification marks.
77. Are you an abattoir/slaughter plant?

77. Are you an abattoir/slaughter plant? Yes No
78. For abattoir slaughter plants: Has any information regarding your slaughter/temporary immobilization method (stunning) changed?

78. For abattoir slaughter plants: Has any information regarding your slaughter/temporary immobilization method (stunning) changed? Yes, our methods have changed. No, our methods have not changed. We are not an abattoir/slaughter plant.
79. If yes, please list and describe all changes:
80. Have you submitted valid test results?

80. Have you submitted valid test results? Yes, I have submitted valid test results. No, but I will be submitting valid test results as soon as possible. I have been given formal exemption from testing by the ISWA Halal Certification Department and will attach the formal exemption in the section below.

Test Results should be emailed to: testing@ushalalcertification.com
81. Exemption from testing issued by the ISWA Halal Certification Department:

Attach Files
82. Please list the specific countries your products will be sent to.
83. For any meat/poultry producers (abattoir/slaughter and further processors): Will you require export certificates?

83. For any meat/poultry producers (abattoir/slaughter and further processors): Will you require export certificates? Yes No I am not a meat and/or poultry producer.
84. Have there been any major changes to your halal program?

84. Have there been any major changes to your halal program? Yes No
85. If yes, please explain.
86. Please provide any additional information regarding your Halal program or renewal request.
87. Have you reviewed the most updated costs/fee schedule for Halal certification?

87. Have you reviewed the most updated costs/fee schedule for Halal certification? Yes No
88. We agree to always abide by the current guidelines and applicable standards.

88. We agree to always abide by the current guidelines and applicable standards. Yes No
89. Terms of Service:

89. Terms of Service: I hereby certify that all information provided in this application is TRUE and CORRECT and that I have read and agreed to ISWA HALAL TERMS of SERVICE.
90. Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.