ISWA 142- Annual Certificate Change Request Form

This form is to request any changes to your Halal certificate, except adding products, which can be requested through the form at the following link:

http://ushalalcertification.globalhightech.net/forms/view.php?id=7049

What is the name of your company (as it appears on your Halal certificate)?
Has your company been certified by us with any previous names? If so, please list the name here:
Contact Name Contact Name Title First Middle Last Suffix
Email
What is the full address of the manufacturing plant? What is the full address of the manufacturing plant?
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Legal Establishment Number:
Establishment Number Issued By:

Establishment Number Issued By: USDA FDA EPA Other Other
When does your Halal certificate expire? When does your Halal certificate expire? / MM / DD YYYY
Change Request
What change would you like made to your Halal certificate?

What change would you like made to your Halal certificate? Product(s) Removed Product(s) Name Change Separate Products on Multiple Certificates Formatting Change Change of the Company Name Other Other
Please describe in detail how you would like the Halal certificate changed:
Please attach any documents clarifying the changes you would like made.

Attach Files
I acknowledge that requesting changes to my Halal certificate carries an administrative fee of $50