有机产品认证调查表_认证，BSCI认证，有机认证

Application Form for Organic Certification有机认证申请表

In order to help us estimate the cost of inspection and certification, please supply the following information, by indicating as many details as possible and omitting items that do not apply. 为了预估检查和认证费用，请尽可能详细提供下列信息，不适用的栏目请忽略不填。

1	Company Name and legal form of the company 认证委托方的名称和法律形式:
	General Manager or other responsible person 总经理或其他负责人姓名:
	Street and N°街道和编号:	PO Box邮政信箱:
	Post Code邮编:	City城市:
	Country国家:	Phone电话:
	Fax传真:	Mobile手机:
	Contact person for certification认证项目联系人:	Contact person's Email 联系人电邮:

2.1

Type of Operation to be Certified (more than one can be ticked) 要认证的操作类型（可多选）:

Farm (Crop Production)

农场（种植业）

Farmer Group农户团体

Food Processing食品加工

Wild Collection野生采集

Farm (Livestock)农场（畜牧业）

Beekeeping养蜂业

Trade / Export贸易/出口

Other其他:

Crop Production 种植业:

Number of farms

农场数量:

Total hectares

总面积（公顷）:

Distance from farm(s) to address indicated under (1) above

农场到上面（1）中所提供地址的距离:

km公里

Name and location of farm

农场名称及所在位置

Crop

作物

Hectares种植面积（公顷）

Sowing Time播种时间

Harvest Time收获时间

Approx. quantity harvested per year

预计年收获量

Type of Production生产类型: Open Field开放的耕地 Greenhouse Cultivation 温室栽培

2.2

Food Processing食品加工:

Type of processing加工类型:

Number of units

加工厂数量:

Distance from unit(s) to address indicated under (1) above

加工厂到上面第（1）中所提供地址的距离:

km公里

Total number of employees in the processing unit(s) 加工厂雇员总数:

加工厂名称及所在位置Name and location of units

Raw material原料

Final product成品

Annual capacity (MT)

年生产能力（吨）

Steps of processing 加工步骤:

2.3

Wild collection野生采集:

Name of collection area

采集区名称:

Size of area

采集面积:

km²

平方公里

N° of pickers采集者数量:

N° of buying centres收购点数量:

Distance from collection area to address indicated under (1) above

采集区到上面第（1）中所提供地址的距离:

公里

采集点名称及所在位置Name and location of collection area

Wild collected species (please attach a list if not enough space) 野生采集品种（如格子不够可新增行）

Collection Time

采集时段

Collection Area (Hectares) 采集区面积 （公顷）

Approx. quantity per year

预计年采集量

2.4

Livestock畜牧业:

Number of farms

农场数量:

T Total hectares

总面积（公顷）:

Distance from farm(s) to address indicated under (1) above

农场到上面第（1）中所提供地址的距离:

km公里

Type of animals动物类型

Number数量

Type of animals动物类型

Number数量

2.5

Beekeeping养蜂业:

Location of colonies

蜂群位置:

N° beekeepers

蜂农数量:

N° of apiaries

蜂场数量:

N° of colonies

蜂群数量:

N° of postharvest units

采蜜后处理单元数量:

Migration

是否迁移?

Yes是 No不

Distance from apiaries to address indicated under (1) above

养蜂场到上面第（1）中所提供地址的距离:

km公里

2.6

Trade / Export贸易/出口:

Office is the same as under (1)办公室同上（1）所以提供地址:

Other address

使用其他地址:

Trader stores, packs or labels

进行储藏，包装或贴标的贸易商:

Trader only handles paper works

仅处理文书工作的贸易商:

3	Are subcontractors involved at any stage? 在哪些阶段涉及分包商？
	No subcontractors involved, all the units described under 2.1 through 2.6 belong to the company indicated in Section (1) above 不涉及分包商，上述2.1到2.6的所有环节都属于上面第（1）部分所列的公司:
	The following subcontractors (not belonging to your company) are involved 涉及到下列分包商（不属于您公司）:
	Entity分包商实体名称	Activity分包活动	Location地址

4	Standards for which you request certification您想要申请认证的标准:
	Regulation (EC) 834/07 on organic farming for the EU market* 针对欧盟有机市场的欧盟有机农业规章Reg.（EC）834/07*:
	NOP (National Organic Program) for the organic US market 针对美国有机市场的NOP（美国国家有机项目）标准:
	JAS (Japanese Agricultural Standard) for the organic market in Japan针对日本有机市场的JAS（日本农业标准）有机标准:
	GB/T19630 (China Organic Standard) for the Chinese organic market 针对中国有机市场的中国有机标准
	Other organic standard (please specify)其他有机标准（请指出）:

*In non-member countries, this Regulation can be implemented only in an "equivalent" way.在非欧盟国家，该规章仅能以“等效”形式实施

5	Certification history认证历史:
	Do you have a copy of the standard(s) according to which you request certification? 您是否有所申请的认证标准？	Hardcopy 纸质文件 No copy没有 Access through internet 从网络获取
	Which of the following statements is correct下面哪条陈述是正确的?
	This is the first time I apply for certification according to the above mentioned standards 这是我们di一次依据上述所选标准申请认证
	I am currently certified by ，but I am considering to change 我（们）目前由认证（认证机构名称），但我（们）考虑转换机构
	My certificate issued by has expired我（们）的证书已经过期，认证机构是
	My certificate issued by was suspended or revoked 我（们）的证书被（认证机构名称）暂停或撤销

6	Any other relevant information其他相关信息:

I herewith declare, that all documents or situations I report to CHANGE are authentic. I have been informed sufficiently about the requirements for certification (organic standards, CHANGE rules for application, inspection and certification). The rules are understood. I confirm above application scopes (products, standards etc.) and guarantee organic production according to the standards, applicable laws and regulations. I promise that no prohibited substance will be used in entire organic operations in the future; Meanwhile establish management system and keep relevant records according to above certification requirements. In case that prohibited substances were used due to force majeure, I would timely report usage to CHANGE and all yields herewith would be sold as conventional products, otherwise I’m willing to bear all the consequences arising therefrom. 我在此声明，我向CHANGE提交的认证资料及情况完全属实。我已被充分告知了认证要求（有机标准、CHANGE关于申请、检查和认证的规定）并理解了这些规定。我确认上述申请认证的范围（产品、认证标准等）并担保完全按照上述标准及适用的法律、法规进行有机生产。我保证在今后的有机操作全过程中不使用任何禁用物质；同时依据上述认证标准要求建立管理体系并做好相关记录，并接受行政监管部门和CHANGE委派的检查组的监督和检查。如因不可抗力原因使用了禁用物质，我将及时向CHANGE报告禁用物质的使用情况，其生产的产品将只作为常规产品销售，否则，本单位愿承担由此造成的一切后果。

Place and date

地址和日期:

Name of signatory

签署人姓名:

Signature, company stamp签名，公司盖章

Application Form for Organic Certification有机认证申请表

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