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Name of company:
Exact address:
Contact person (Name and phone number):
What does your factory produce?:
What is the product needing Kosher Certificate?:
What is the product used for?:
Do you use grapes (or derivatives of grapes ie. Grape juice, wine, raisins, vinegar) in your product or at all in your factory?:
Do you use any animal fat in your product or in your factory anywhere?:
Do you use any oils in your factory for anything? Please specify:
Do you use any parts of any animals in your product or at all in your factory?:
Do you use any milk or milk products in your factory?:
List all the E numbers used in your factory:
What are the ingredients in your product?:
What other ingredients do you use in any other parts of the factory?:
What else do you make on the same line/ in the same containers as the product needing the kosher certificate?:
We would like to make surprise visits to your factory from time to time. Do you have any objections?:
Is Any Alcohol used in the processing of the product(s)?:
Is there any animal fat, meat and / or insect extracts / derivatives used in the product?:
Does the product contain any animal / human enzymes / derivatives such as rennet, pepsin, L-cysteine, gelatin, glycerin etc.:
Does the product contain derivatives from Crustaceans or any other marine source such as shellfish, molluscs, squid, etc?:
Does the product contain any components derived from wine/ liquor e.g. Cognac, rum, sherry, wine powder, fusel oil, cream of tartar, tartaric acid, etc.:
If any other alcohol is used e.g. ethanol, kindly define exact nature, description, source, quantity and application in products.:
Is the processing equipment only used for products of non-animal / non-alcoholic nature?:
Is the product Vegan suitable?:
Please provide details of colors and flavours used in the product including name of manufacturer and solvent/carrier used.:
Name of Pervious Kosher Certificate agency:
Has any Rabbi ever previously visited the plant:
Please explain why you are seeking kosher certification:
Are same lines used for Kosher and Non-Kosher.:
Please attached list of ingredient suppliers name and detail: