APPLICATION FOR KOSHER SUPERVISION

AND PERMISSION FOR USE OF THE B.C.K. SYMBOL

Date:

Company name:

Address of head office:

City:Province: Postal Code:

Telephone:Fax:

Applicant’s name: Position:

Name of purchasing agent for raw materials:

Nature of product:

Certification requested for: Retail Commercial

When is product produced? All year Seasonally, from: to:

Have you obtained Kosher Certification in the past? Yes No

If yes, by which Kosher Agency:

Are your products manufactured/packaged by other companies? Yes No

If yes, list product and company:

Plant where product is manufactured:

Plant #1:

City: Province: Postal Code:

Telephone: Fax:

Name of plant manager:

If plant is not located in a major city, advise name of closest city and distance to the manufacturing plant:

Are other products (not to be Kosher certified)

manufactured at this plant? Yes No

If yes, is the same equipment used? Yes No

If yes, advise brand name and product:

Plant #2:

City: Province: Postal Code:

Telephone: Fax:

Name of plant manager:

If plant is not located in a major city, advise name of closest city and distance to the manufacturing plant:

Are other products (not to be Kosher certified)

manufactured at this plant? Yes No

If yes, is the same equipment used? Yes No

If yes, advise brand name and product:

PLEASE ATTACH ONE LABEL FOR EACH PRODUCT TO BE KOSHER CERTIFIED

How did you hear about BC Kosher?

NOTE:

The Orthodox Rabbinical Council of British Columbia / B.C. Kosher covenants and agrees that it will not communicate or divulge or use for the benefit of any other person, partnership, association or corporation, any of the trade secrets, formulae or secret processes used or employed by the Company in or about its business that may be communicated to the Council by virtue of this Application.

Submission and investigation of this Application does not entail any commitment upon the part of the Applicant or the Council in any way, until agreement for said purpose is duly entered into by both parties.

A processing fee of $250.00 must be attached to this Application and will be used toward initial supervisory expenses.If however, initial supervisory expenses exceed the processing fee, you will be invoiced for this amount.

This processing fee is not a Kosher certification fee.

FOR OFFICE USE:

AuthorizedAuthorized

Date:Date:

SPECIAL INSTRUCTIONS:

Complete the following information in respect of products that require Kosher certification:

(use extra sheets if you need)

Brand Name / Product / Ingredients

Ingredient information: ATTACH THE LETTER OF CERTIFICATION FROM THE KOSHER AGENCY(use extra sheets if you need)

Raw Material Code / Name/Description of Ingredient / Name of Manufacturer / Name of Certifying
Agency / Expiry Date on
Letter of
Certification / Dairy or
Dairy
Equipment / Used in
Kosher
Product / Used in
Kosher
Equipment
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO
DAIRY DE PARAVE / YES NO / YES NO

Please attach a flow chart outlining your manufacturing process.