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Application Form

NMIS application form for the issuance of GMP/HACCP Certificate

Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Rev.01.2013
Republic of the Philippines

Department of Agriculture

NATIONAL MEAT INSPECTION SERVICE
Visayas Ave., Diliman, Quezon City

APPLICATION FOR THE ISSUANCE OF GMP/HACCP CERTIFICATE TO
MEAT ESTABLISHMENTS
1. Food Safety Program
______ GMP
______ HACCP

2. Type of Audit
3. Type of Meat Establishment
________Certification
______SLH
_____CS
________Renewal/Verification
______ PDP
_____MC P
________Surveillance
______MPP
________Close-Out
4. Meat Establishment Profile
Name of Owner/Operator: __________________________________________________________________________________________
Name of Company: ___________________________________________________________________________________________________
Meat Establishment Address: ________________________________________________________________________________________
Accreditation No: _____________________
Email Add: ______________________________________
5. Documentation Packet
6. Payment Mode
GMP: _______GMP /SSOP Manual
________ GMP Certification P 2,000

Pre-requisite Programs:

Mailing Fee

_____ Calibration

______ Product ID system
______ Product Traceability
______ Product Recall
______ Training
______ Labeling
______Allergen
______Approved Supplier
_____ Glass, wood and loose items policy
_____ Disposal of Non-Conforming Products


_______ Documentation packet is required for the
Product description/ingredients
_______ certification (new) of both GMP/HACCP.
Process flow diagram

______ Product profile is required per HACCP
Hazard analysis & CCP determination
______ product Table (7 principles)
HACCP certification
_____ _ HACCP Team/Management
Commitment



P 165 Total Amount Paid ________

Date Issued ___________

________ HACCP Certification P 5,000.00/product
Mailing Fee
P 165 Total

OR # ____________________
Date Issued _________________
No. of Product/s: __________ Total Amount Paid: _____________

I hereby certify that the above statements are
true and correct to the best of my knowledge and
documentary requirements submitted are complete.

HACCP:
Product profile:
: ____Scope of HACCP program

Note:


OR # ____________________

_________________________

____________________________

Date of Application

Signature of Applicant
(Over printed name)

Documentation packet is required for the
Certification (new) of both GMP/HACCP.
Product profile is required per HACCP
Product certification

(This portion to be filled out by NMIS authorized representative)

NMIS ACKNOWLEDGEMENT RECEIPT:

Date Received : ________________________________________
____________________________________________________
NMIS Authorized Representative
(Signature over printed name)
 
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