ACP Application Form version 4 4 by qv98Vk7G

VIEWS: 6 PAGES: 1

									Assured Chicken Production Ltd
C/o NSF- CMi Certification
Long Hanborough
Oxford
OX29 8SJ

APPLICATION FORM
Please complete one application form per registration. An application fee of £103.67 plus VAT is payable upon
registration and must be sent to the CMi office with this completed form. An assessment fee of £185.00 plus VAT will
be invoiced separately following the audit.

Please tick site type:
Breeder Replacement                 Hatchery         Free Range                 Joint ACP/Freedom Food
Breeder Layer                       Grower (Chicken for Human Consumption)      Poussin
Processor: Product Traceability     Contract Catching Company       Integrated Catching/Transport/Slaughter
Standalone Transport

BUSINESS DETAILS (Please print in block capitals)
(This will be the address to which all correspondence for this site will be sent unless otherwise requested)
Business Name
Contact
Position
Address 1
Address 2
Address 3
Address 4
Postcode
Telephone
Fax
E-mail

SITE DETAILS
Site Address 1
Site Address 2
Site Address 3
Site Address 4
Postcode
Telephone
Fax
E-mail
Site Manager            Name                              Tel                               Mobile
Fields Person           Name                              Tel                               Mobile
Site Information                            Unit Type                                        Number of Birds/Eggs
                        Replacement                                          Bird places:
                        Layer                                                Bird places:
                        Hatchery                                             Eggs/week:
                        Grower                                               Bird places:
                        Catching/Transport/Slaughter *                       Delete Elements N/A
                        Processor: Product Traceability                      N/A
                        Contract Catching Company                            N/A
Number of
Sheds/Buildings

Please insert the names of the companies this site supplies and the % production:

               Company                           % Weekly Egg Production                          % Bird Production



I apply to join the Assured Chicken Production Scheme. If admitted to the Scheme I agree to abide by the Scheme
Rules. I enclose the registration fee of £121.81 (£103.67 + £18.14 VAT).

Please make cheques payable to CMi Certification.
                                                           st
Ref: Application Form                              Date 1 April 06                  Issue 3             Rev 1

Issued by:                                                      Page 1

								
To top