CONTROLUNION

A P P L I C A T I O N FORM GLOBALGAP

GLOBALG.A.P. C E R T I F I C A T I O N - CROPS BASE

C o m p a n y ñame: (Please use f u l l ñame o f C o m p a n y AddreSS: ( S t r e e t , post c e d e , C i t y ,
c o m p a n y w i t h e , g . L t d , , I n c , SAC, SA, SARL, BV) p r o v i n c e , c o u n t r y , P.O^ B o x )

'=}f,S Ceu.<^ (y¿^oj

Legal Representative: A C o n t a c t p e r s o n : (m «idítion)
Ñame: M^f^Y <^Af^AJA<^'b^ fei»(íE(2d>Ñame: ^Tonio 'Pe^í¿i5t<2oJ
Role : íCSvS&JT?^ CP-/^6^4^L Role : A'S^S^ca^
Phone numbers: E-mail address:

V A T n u m b e r / Company registration Global Location Number/GLN f r o m G S I (¡f

number/ Chamber of commerce no.: in available):
country of registration

G P S c o o r d i n a t e s of s e a t a d d r e s s G L O B A L G . A . P . n u m b e r ( G G N ) if a l r e a d y
(+/-10m) exists

G L O B A L G . A . P . I F A v 5 (mark preferred modules with " X " ) - C r o p p r o d u c t i o n

Fruit & Vegetables (FV) Combinable crops (CC) Tea Hops
Flowers & Ornamentáis Plant Propagation Material (PPM)
(FO)

G L O B A L G . A . P . C r o p s f o r p r o c e s s i n g (mark preferred modules with " X " )

Fruit & Vegetables
Combinable crops

Add-Ons
Albert Heijn Protocol for Residue Control
G L O B A L G . A . P . R i s k A s s e s s m e n t o n S o c i a l P r a c t i c e ( G R A S P ) Piease fíil in Annex I
T R 4 Biosecurity Add-on for B a n a n a s
T E S C O N U R T U R E M o d u l e - Fruit and Ñame of primary suppiier:
Vegetables 0-key of primary suppiier:
T E S C O N U R T U R E M o d u l e - Flowers Exporting company Ñame:
and Ornamentáis

Ce;rtÍfÍcatÍon O p t i o n s (mark preferred option with " X " )

Option 1 Single site Option 1 Multi-sites with QMS
Option 1 Multi-sites without QMS Option 2

I n c a s e of option 2 a n d option 1 MS w i t h Q M S
Ñame of Internal auditor(s)
Ñame of Internal inspector(s)

A d d i t i o n a l S e r v i c e s (¡f needed)
Pre-SCOping - T M Í S helps y o u t o i d e n t i f y t h e e x t e n t o f t h e c o m p l i a n c e of c u r r e n t f a r m i n g s y s t e m as p e r
GLOBALGAP r e q u i r e m e n t s p r i o r t o t h e f i r s t i n s p e c t i o n / a u d i t .
Application for off-site/on site module audit/inspection ( C B m a y decide t o o f f e r i t )

Attach extra sheets ifneeded.

GAPAPPL Fni(21) CB t N yaüdíro"'-! 90917 Conlrol Union Certifications Head office: P.O.Box 161 8000, A D Zwolle, The
Netherlands 1/5
OBLIGATORY from: 01-10-17 Tel.: +31-(0)38-426-0100 Fax.: +31-(0)38-423-7040
\www.controlunion .com/certification
 Application for U n a n n o u n c e d R e w a r d P r o g r a m - O N L Y for o p t l c l i e n t s

Attach extra sheets ifneeded.

GAPAPPl.FO1(21).CB.ENj;aiÍ0from19O9t7 Control Union Certifications Head office: P.O.Box 161 8000, A D Zwolle, The
Netherlands 2/5
OBLIGATORY from: 01-10-17 Tel.: +31-{0)38-426-0100 Fax: +31-(0)38-423-7040 www.controlunion.com/certification
 H a v e y o u e v e r b e e n a s s i g n e d w i t h a G L O B A L G . A . P . N u m b e r ( G G N ) ? Note: Non
communication of GGN will result in a fine by GLOBALG.A.P.
Y e s , G G N : cZü Reason of C B change:
No

1. P r o d u c t s f o r
1.1 I n t e g r a t e d F a r m a s s u r a n c e - I F A
Crop Ñame Harvesting 1" harvest Further harvest in H a Parallel Produce Countries
as p e r period(s} (for p e r e n n i a l c r o p s : Production' Handiing of
in H e c t a r e s
GLOBALG.A.P. non ( y e t ) p r o d u c i n g (Yes/ No) ^ (yes/No) destination
Product list área m u s t b e l i s t e d h e r e

Covered Non-covered Covered Non-covered

) €fcr-DEc NO /JO
' —

Parallel Production^ - Parallel Production Is the situation where a farmer produces the same product
partiy as certified and partiy as non-certified. NEW! I t is aiso PP if a PG has certified and non-
certified members for the same product!
' I f no Produce handiing, piease fill in the last declaration under Point 4.

1.2 C r o p s f o r P r o c e s s i n g - C f P
Crop Ñame Harvesting harvest Further harvest Processing Parallel Processor and
as per period(s) in H a /utilization Production^ c o u n t r y of
in Hectares
GLOBALG.A.P. (for p e r e n n i a l (Yes/ N o ) processor
Product list crops: non (yet)
p r o d u c i n g área
m u s t b e listed h e r e

Covered Non- Covered Non-

covered covered

'All produced amount of the applied product must be Intended for processing, both fresh consumption and
processing are not allowed in parallel under CfP. If a product is to be certified, but partiy goes for processing,
partiy for fresh consumption then it shall be certified under IFA.

1.3 C f P - T e c h n o l o g y d e s c r i p t i o n , r i s k s a n d r i s k m i t i g a t i o n -- i^íust f o r C f P
Piease describe here what happens with the products (eg. cooking, pasteurization, pathogen-killing
washes, irradiation), what the final products are (eg juice, pulp, frozen, dried), what the identified
risks and how those will be handied/mitigated (contract with processors, HACCP, processing flowchart
may be attached.)

1.4.1 P r o d u c t s a p p l i e d f o r A l b e r t H e i j n P r o t o c o l
Piease specify w h a t a r e t h e p r o d u c t s applicable f o r AH p r o t o c o l f r o m t h e list m e n t i o n e d a b o v e

1.4.2 P r o d u c t s a p p l i e d f o r T E S C O N U R T U R E M o d u l e
Piease specify w h a t a r e t h e p r o d u c t s applicable f o r AH p r o t o c o l f r o m t h e list m e n t i o n e d a b o v e

Attach extra sheets if needed.

GArMPPL.FD1i21).CB.EN_validfro!Ti190917 Control Union Certifications Head office: P.O.Box 161 8000, AD Zwolle, The
Netherlands 3/5
OBLIGATORY from: 01-10-17 Tel.; +31-(0)38-426-0100 Fax: +31-(0)38-423-7040 www.controlunion.com/certlfication
 2. P r o d u c t i o n S i t e s (e.g. farm sites, fields, arable lands, herd).
Note: I n c a s e of Producer Groups/ Multi-sites with QMS piease fill in the attached excel sheet.
Note: if parallel production is applicable, all Production sites applied for certification and sites that are not

Sites applicable for certification

Ñame unit Address and Ñame of Crops Area (Ha) Added/
country contact Grown Changed/
person Withdrawn
Covered Non-
covered

Sites Not applicable for certification

3 . P r o d u c e H a n d i i n g U n i t s / P r o c e s s i n g u n i t s (e.g. storage, packinghouse).

Ñame unit Address and Process (-es) Crops Parallel Added/
country + GEO (e.g. storage, handied Ownership"* Changed/
coordinates packing) (Yes/ No) Withdrawn

Parallel Ownership" - Parallel Ownership is the situation where producers buy (and handie) non-
certified products of the same products they grow under certified production. NEW! I t is aiso PO if a PG
handies certified and non-certified amounts of the same product even from its producers!

4. Product custody declaration for Fruit a n d Vegetable producers;

I d e c l a r e t h a t (Mark w i t h an 'X' oniy if applicable)
The same p r o d u c t ( s ) is/are aiso packed f o r o t h e r G L O B A L G A P c e r t i f i e d p r o d u c e r s in m y
Product Handiing Unit
The same p r o d u c t ( s ) is/are aiso packed f o r o t h e r n o n G L O B A L G A P c e r t i f i e d p r o d u c e r s in
m y Product Handiing Unit
The produce handiing operation is s u b c o n t r a c t e d t o another G L O B A L G A P c e r t i f i e d
p r o d u c e r ( s ) . Piease fill in point 5 as w e l l .
The produce handiing operation is s u b c o n t r a c t e d t o o t h e r n o n G L O B A L G A P c e r t i f i e d
p r o d u c e r / c o m p a n y . I f t h e produce handiing u n i t / p r o d u c e r has IFS, BRC certifícate, include
t h e certifícate n u m b e r and v a l i d i t y . Piease fill in point 5 as w e l l .
Exclusión of p r o d u c t h a r v e s t a n d / o r p r o d u c e h a n d i i n g is applicable. Product(s),
excíusion(s), o w n e r s h i p ( s ) and j u s t i f i c a t i o n :

4 . 1 F o r T e a : T h e G G N of t h e p r o c e s s i n g u n i t ( s ) a s i n d i c a t e d o n t h e C h a i n o f C u s t o d y
certifícate ,

5. S u b c o n t r a c t o r s Are any of your production/processing/handling activities done by subcontractors

(e.g. C h e m i c a l treatment)? If yes, piease mention below.
Subcontractor Address and country Activity/Process Certified (Globalgap, I F S , BRC
etc)or not (if y e s include GGN,
cert no, validity)

Attach extra sheets ifneeded.

GAPAPFl..F0l!21),C®.ENji'alidfrom190917 Gontroi Union Certifications Head office; P.O.Box 161 8000, AD Zwolle, Tfie
Netherlands 4/5
OBLIGATORY from; 01-10-17 Tel.;+31-(0)38-426-0100 Fax;+31-(0)38-423-7040 www.controlunion.com/certification
 l i l i I

6. D e c l a r a t i o n o n d i s c l o s u r e of i n f o r m a t i o n in G L O B A L G . A . P . datábase
I agree on the disclosure of information in one of the following ways in the GLOBALGAP datábase: mark the
preferred data reléase level with a "X". These options are based on GLOBALG.A.P. General Regulation Data
Access Rules.
Data reléase level For optl/Producer Only for
Group opt2
Members
Only obligatory data is open for public

All Company address data is open for public as well.

7. P r e f e r r e d a u d i t p e r i o d ;

Undersigned declares t o have completed this application f o r m t r u t h f u l l y .

ÑAME C O M P A N Y f^^^ 3 ^
ÑAME O F T H E L E G A L R E P R E S E N T A T I V E

FUNCTION W I T H I N COMPANY ^ ^

DATE & SIGNATURE

Based on t h e above information, Control Union Certifications wiii

d r a w up a no-obiigation offer for a contract.

Attach extra sheets ifneeded.

GAPAPPL.FOI (21 ).GBEN_vatidfrom190917 Control Union Certifications Head office: P.O.Box 161 8000, A D Zwolle, The
Netheriands 5/5
OBLIGATORY from: 01-10-17 Tel.: +31-(0)38-426-0100 Fax: +31-(0)38-423-7040 www.controlunion.com/certification
 Annex I
Piease fill the below details for GRASP A s s e s s m e n t
N o t e : i n c a s e o f o p t 2 , thiis i s f o r t l i e P r o d u c e r G r o u p a n d P r o d u c e
Handiing Unit, for m e m b e r s u s e tiie F a r m e r list

Total n u m b e r of

empioyees (yearly

average)

W o r k e r A n a l y s i s ( P i e a s e m e n t i o n t h e a m o u n t of w o r k e r s p e r s i d e / c o l u m n )

High season Low season Local Migrant

1 Permanent/ indefinite
contract
2 Temporary/ definite
contract
O 30
-,—
3o
3 Causal workers/ 0 hr
— —
contract
4 Agency workers —
5 Students working

6 Homeworking .— (—
Total

Piease mention the ñame of the Worker Union

Are any workers covered by Collective Bargaining YES • piease explain:

Agreement (CBA)?

NO @
Is there a piece rate payment system? YES • piease explain:

NO •
Is accommodation(s) to the workers provided? YES • piease mention address(es)
of the place(s) below

NOB

Spoken languages on the farm: i-S^f Piease mention the languages below

Attach extra sheets ifneeded.

GAPAPPL.F01 (21 |.GB.EN va!idfrom190917 Control Union Certifications Head office: P.O.Box 161 8000, AD Zwolle, The Netheriands
6/5
OBLIGATORY from; 01-10-17 Tel.; +31-(0)38-426-0100 Fax; +31-(0)38-423-7040 www.controlunion.com/certification