Get Certified

Name of Firm*
Contact Person*
Position*
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Phone*
Fax*
Website
Email
Firm License No.
Attached License Copy
Max. file size: 256 MB.
Type of Business
Place of Product for Examination
If already using certification for my Products/Ingredients, please state the detail
Type of Food Seeking For Certification:
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No. Product Name/Brand Description Ingredients to be used
Declaration*
I declare and affirm that all items and information stated in this application are true according to my knowledge and belief. There is no such Haraam element included in the food like; Pork, Alcohol, Gelatin and Gum. Our products are Zabiha Halal. The name, address and contact person of our supplier/vendor is/are as follows
Supplier/Vendor Detail
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Name Address Contact Person Phone
Name*
Position
Signature
Date
MM slash DD slash YYYY

Service and Processing fees:
The Certificate is free but we accept donation for our expenses, the donation is tax exempt. (tax id 32-0370830)

This fee is valid for one year from the date of issue and it should be renewed 30 days prior to the expiry date.

No.	Product Name/Brand	Description	Ingredients to be used

Name	Address	Contact Person	Phone