SIKS- Services International Kosher Supervision Ltd.

Print, Complete this form and Fax it back to Fax # 972-2-651.9087 or #39-011-533938

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COMPANY PROFILE DATE:

COMPANY

ADDRESS

CITY STATE ZIP COUNTRY

PHONE FAX E-mail

COMPANY CONTACT

TITLE PHONE E-mail

ALTERNATE CONTACT

TITLE PHONE E-mail

BILLING CONTACT

TITLE PHONE E-mail

MARKETING CONTACT

TITLE PHONE E-mail

COMPANY PRESIDENT/DIRECTOR E-mail

Please explain why you are seeking Kosher Certification (i.e. what are your marketing goals?):

Under which category of foods would you list the product(s) (eg. Baked foods, snacks etc.) ?

Have any of your products ever had Kosher Supervision and Certification? YES ( ) NO ( )

If yes, by whom?

Are any of them currently certified Kosher? : YES ( ) NO ( )

If yes, by whom?

How many plants are included in this application? Please attach a set of forms for each plant.

APPLICATION FOR KOSHER CERTIFICATION PLANT PROFILE

Please complete a separate Plant profile for each facility.

P L A N T

ADDRESS

CITY STATE ZIP COUNTRY

PHONE FAX E-mail

PLANT CONTACT

TITLE PHONE E-mail

ALTERNATE CONTACT

TITLE PHONE E-mail

If the facility is not located in a major city, please indicate the closest major city and the distance to the facility:

Describe all the manufacturing processes in the facility:

Please use additional sheets if necessary.

FOR INTERNAL USE ONLY:

APPLICATION FOR KOSHER CERTIFICATION PLANT RAW MATERIAL LIST

Please submit a separate form for each plant.

Please list all the raw materials in the facility (including release agents etc.) whether intended for kosher use or otherwise.

1) Please give the name of the ingredient exactly as it appears on the label. Do not give the generic name if it does not appear on the label. If a number is part of the name include it as well (eg. Flavours use numbers). With an ( * ) please identify any ingredients intended for use exclusively in products you do not wish to certify.

2) Please give the name of the manufacturing source exactly as it appears on the label. It is not the name of the broker or distributor unless it appears on the label.

3) Please give the exact brand name as it appears on the label.

4) Bulk transport refers to tanker trucks, ships, railcars,totes etc., It does not refer to Drums or other containers which are not normally refilled.

5) Please submit Letters of Kosher Certification (L.O.C.) for each of the ingredients listed (they may be obtained through your suppliers). Submitting these letters together with your application will help expediate the process.

6) R.M.C. is the raw material code used internally by your company.

PLANT LOCATION

Ingredients Manufacturing Source Brand Name

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APPLICATION FOR KOSHER CERTIFICATION

PRODUCT INFORMATION

PLANT

Please submit a copy of a label for each product.

1. Please list the name of each product for which you are seeking Certification and check the appropriate column(s).

Please indicate if the product is for retail, industrial/ institutional distribution.

2. Please list each brand name of any product for which you are seeking certification and check the appropriate column(s).

3. For private labels, enter the name of the private label company that owns the brand name.

Please provide the name, address, and contact person for each private label company.

LOCATION

Please indicate the countries where you plan to market the products :

Are any of these products also produced in a plant not included in this application?

Yes ( ) No ( )

If yes, where and by whom :

Are any other products produced in this plant ?

Yes ( ) No ( )

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PRODUCT NAME BRAND NAME PRIVATE LABEL COMPANY