INFORMATION FORM FOR GLOBALG.A.P. CERTIFICATION

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1 F01(GGP)e(v10)-08/11 P a g e 1 INFORMATION FORM FOR GLOBALG.A.P. CERTIFICATION In order to establish an estimate adapted to your project, please fill out and sign this form and fax it to: or it at Company name or Grouping : CONTACT INFORMATION Address : Phone number : Fax number : TVA number (Europe) : Country : You are : An individual producer GENERAL INFORMATION ON YOUR PROJECT A producer group ( Producers must have legal entities, farms cannot be the property of the Farmer Group) A multi-site opération: company who has several production sites operating independently (different locations, separated facilities, different staff etc), but which in itself are not separate legal entities and the management is centralized (ie for example a large company which has several farms that all belong to it and are centrally managed by the company) Are you already GLOBALG.A.P. certified? yes no If yes, what is your GLOBALG.A.P. registration number (N GGN):.. REQUESTED SERVICES Desired GLOBALG.A.P. services : Mock audit / pre-audit Certification audit Other (training, ) : Product display : Product in bulk (non packaged) Handled products/packaged * : on the field in a packing facility *from the first of January 2011 if the product belongs to you while he is packed, the packing must be included in the audit scope

2 P a g e 2 Activities subcontracted (pesticides applications, transport ) :.. Desired time of the audit / control(s) :.. For the purpose of an initial intervention, all your activities, harvesting and packing included must be reviewed on site Desired language for the audit / inspection and language of your documents :... Are you already certified or in process of certification (clearly indicate)? Organic production (CE, NOP, JAS) Other certification (Packaging station IFS/BRC, ISO 9001, ) :.. Certification(s) organization(s) :. For the applicant (contact person) : First name :... Last name :.. Position in the company : Date :... Place : Signature : Stamp : PLEASE ALSO COMPLETE : - The PAGE 1 if you are a simple individual producer - The PAGE 2 if you are a producer group or a multi-site operation - The PAGE 3 if you pack your products in a packing facility REVIEW OF OFFER section reserved for ECOCERT DATE : VISA : Comments :.

3 P a g e 3 PAGE 1 : SIMPLE INDIVIDUAL PROCUCER (Option 1) GLOBALG.A.P. CROPS Number of plots Estimated period Harvest period* Packing period Production method (open field or under greenhouse?) Surface area (ha) Destination countries (please indicate all the countries) * Harvests : indicate precisely if 1st harvest or following harvest of the year (n harvest). Total surface area of your farm (in hectares) : Number of storage facilities for fertilizers and pesticides : Crops that you DON T want to certify GLOBALG.A.P. : - Do you buy the same products as yours to no certified producers? (eg : you produce apples, which are GLOBALG.A.P. certified, but you also buy apples to a producer not certified) yes no -Have you checked out (evidences available) that plant protection products used (commercial name and active molecules) are properly approved for each crop: - in the production country? yes no - in each destination countries? yes no - Do you have an updated Maximum Residual Lists (MRL) for each crop : - in the production country? yes no -- in each destination countries? yes no - Have you performed a self-assessment inspection according to GLOBALG.A.P. check lists (registrations and checklists available)? yes no

4 P a g e 4 PAGE 2 : - PRODUCER GROUP (Option 2) - MULTI-SITES OPERATION (Option 1 multi-sites) Please indicate all the following information for each crop you want to certify : Are the crops cultivated open field or under greenhouse?... What is the harvesting period of each crop?. What is the packing period of each crop?. What are the destination countries of the crops?... Do you have the GLOBALG.A.P. standard and have you impletemented the actions and documentation required to obtain the certification? yes no For the producer groups (Option 2 ) Please send us the list of your producer members following the template below : FIRST NAME LAST NAME ADDRESS CROP(S) SURACE AREA OF EACH CROP Do some of your producer members have parallel production (ie for a determined crop, one part will be certified and one part will not) or parallel ownership (ie buying the same crop as their certified crop to other producers)? yes no Do you buy the same crop as the certified crop to producers who are not members of the producer group? yes no For the multi-sites operations (Option 1 multi-sites) Please send us the list of your production sites following the template below : NAME OF THE SITE PERSON IN CHARGE OF THE SITE ADDRESS PHONE / FAX / CROP (S) SURACE AREA OF EACH CROP Have you implemented a quality management system for the management of your production sites? yes no If you do parallel production (which means, for a crop, a part will be certified and a part will not) : Which sites have the certified crop and which sites have the no certified crop?...

5 P a g e 5 PAGE 3 : PACKING FACILITY Company name and detailed address Are you the Station owner? If the station does not belong to you, is it GLOBALG.A.P. certified by its owner? What is the GGN number? Distance of operation (km) Have you implemented a traceability system for GLOBALG.A.P. products? yes no Is the station used for the packing of products from other producers GLOBALG.A.P. certified? yes no

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