Control Union Certifications

Application form Tesco Nurture’s

APPLICATION FORM

Tesco Nurture (TN)

FOR INSPECTION by Control Union Certifications

NAME OF COMPANY APPLYING AND LEGAL STATUS
(please use full name of company with e.g. Ltd., Inc, SAC, SA, SARL, BV) /
ADDRESS OF COMPANY
(Street, post code, town, province, country, P.O. Box)
COMPANY’S LEGAL REPRESENTATIVE
(name of person and function) / COMPANY’S CONTACT PERSON
(complete if different from Legal Representative)
TELEPHONE / FAX NUMBER
/
E-MAIL (and/or website)
X / Applying for the first time
X / Indicate changes if you are already a Skal International licensee.
Applying for:
X / Option 1 - Individual Farmer applying
X / Option 2 - Farmer Group applying ► Fill in ‘TN option 2 quotation request form’ as well (attached)
X / TN – Organic
Are you registered with Tesco Primary Supplier?
X / No
X / Yes: Name of the Primary Supplier and you registration number:

1.  Product information

Which products do you want to have certified? If it concerns changes mention all the products and indicate which one is changed, added or withdrawn.

Name Product
/
Ha
/ Changed, added or withdrawn (if applicable)

2.  Agricultural units/ Group Members

If you are an individual grower, please describe below the activities of all agricultural units.

If you are a Grower Group (option 2) please list all the registered members. If it concerns changes mention all the units and indicate which one is changed, added or withdrawn.

Name unit /
Address and country
/ Name of operator / Changed, added or withdrawn (if applicable)

3. Pack houses/Processing units

Please describe below the activities of all processing locations.

If you are a grower group (option 2) include the central administration office. If it concerns changes mention all the units and indicate which one is changed, added or withdrawn.

Name unit /
Address and country
/ Process(-es)
(e.g. storage washing, cutting, selection, packing) / Changed, added or withdrawn (if applicable)

Undersigned declares to have completed this application form truthfully.

NAME COMPANY
LEGAL REPRESENTATIVE (The person of the company, accepted by the Chamber of Commerce registration as assignment authorized.)
FUNCTION WITHIN COMPANY
DATE & SIGNURTURE

Based on the above information, Control Union Certifications will draw up a no-obligation offer for a contract.

Attach extra sheets if needed.

TNAPPL.F01(05) Control Union Certifications Head office: P.O.Box 161 8000 AD Zwolle, The Netherlands 1/3

Tel.: +31-(0)38-426-0100 Fax.: +31-(0)38-423-7040 www.controlunion.com/certification

TN OPTION 2 / P.M.O.

TN Option 2 Quotation request form

1. Details of TN Approved Subcontractor:

Address:

Email:

Contact person:

2. Background details of PMO or GO:

Country of location:

Number of Packhouses:

Number of proposed TN farm members:

Total number of PMO members:

Number of TN internal auditors:

3. Types of TN crops:

Protected crops under glass or plastic:

Field horticultural crops:

Tree or Perennial crops:

4. Tesco NC Product Risk rating ( see TN Scheme Regs. Appendix 2 ):

Number of farms with TN crops:

High: Medium: Low:

5. QMS system in operation:

ISO 9000/2000:

Globalgap Option 2:

Another:

6. Additional Comments:

Please type, no handwriting. Ensure that all information is supplied.

TNF030b TN Option 2 Quotation Form Page 3 of 1 Issue 1 April 04