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    FORM JAKIM - Permohonan - Bagi - Produk - Tambah - Nilai - Berasaskan - Haiwan, - Susu - Dan - Telur

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    Nurul amirah
    This document contains an application form for halal certification from the Department of Islamic Development Malaysia (JAKIM). The multi-page form requests information about the applicant company, manufacturing facilities, products, ingredients, and supporting documents. If certified, the company would be able to label their food, beverage, supplement and cosmetic products as halal.

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    © All Rights Reserved
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    FORM JAKIM - Permohonan - Bagi - Produk - Tambah - Nilai - Berasaskan - Haiwan, - Susu - Dan - Telur

    Uploaded by

    Nurul amirah
    36 views9 pages
    This document contains an application form for halal certification from the Department of Islamic Development Malaysia (JAKIM). The multi-page form requests information about the applicant company, manufacturing facilities, products, ingredients, and supporting documents. If certified, the company would be able to label their food, beverage, supplement and cosmetic products as halal.

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    FORM JAKIM_-_Permohonan_bagi_Produk_Tambah_Nilai_Berasaskan_Haiwan,_Susu_dan_Telur

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    This document contains an application form for halal certification from the Department of Islamic Development Malaysia (JAKIM). The multi-page form requests information about the applicant company, manufacturing facilities, products, ingredients, and supporting documents. If certified, the company would be able to label their food, beverage, supplement and cosmetic products as halal.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    36 views9 pages

    FORM JAKIM - Permohonan - Bagi - Produk - Tambah - Nilai - Berasaskan - Haiwan, - Susu - Dan - Telur

    Uploaded by

    Nurul amirah
    This document contains an application form for halal certification from the Department of Islamic Development Malaysia (JAKIM). The multi-page form requests information about the applicant company, manufacturing facilities, products, ingredients, and supporting documents. If certified, the company would be able to label their food, beverage, supplement and cosmetic products as halal.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 9

    DEPARTMENT OF ISLAMIC DEVELOPMENT MALAYSIA (JAKIM)

    HALAL HUB DIVISION


    Level 6 & 7 Block D,
    Kompleks Islam Putrajaya (KIP)
    No.3 , Jalan Tun Abdul Razak, Presint 3,
    62100, Putrajaya
    MALAYSIA

    Tel : 603 – 8892 5000 Fax : 603 – 8892 5005

    Website : www.halal.gov.my
    COMPANY INFORMATION

    1. Company Name : 2. Company Registration No.

    3. Office Postal : 4. Telephone Num. :

    5. Fax Num. :

    Zip Code : 6. Website :


    District :
    Country : 7. e-Mail :

    8. Type of Application :
    Food & Beverages
    Food Supplement
    Cosmetic

    10. CONTACT PERSON (In Malaysia)

    Num. Name Designation Contact No. e-Mail


    11. HALAL LIAISON OFFICER

    Num. Name Designation Contact No. e-Mail

    12. NUMBER OF EMPLOYEES

    Management Operation

    Muslim Person (s) Person (s)

    Non Muslim Person (s) Person (s)


    MANUFACTURE/FACTORY INFORMATION

    Name : Tel. Num. :

    Address : Fax Num. :

    Website :

    Zip Code : Size of Premise :


    District :
    Country :

    Operation Hours : Num. of Shift :


    From : To :
    Storage Facilities Please tick √ if any.

    STORAGE FACILITIES / COLDROOM

    Storage Name : Tel. Num. :

    Storage Address : Fax Num. :

    Website :

    Zip Code :
    District :
    Country :
    ADDITIONAL INFORMATION

    PACKAGING MATERIAL

    Box
    Bottle
    Paper
    Plastic
    Aluminium Foil
    Others (please specify) :

    INTERNAL HALAL ASSURANCE SYSTEM

    QUALITY ASSURANCE AND GUARANTEE PROCEDURE

    Please specify the quality control

    HACCP
    GMP
    Others (please specify) :

    PLEASE INFORM IF YOUR PREMISES HANDLING AS FOLLOW :

    Material derives from pig / dog / human element Yes No


    Alcohol Yes No
    LIST OF PRODUCT

    NAME OF PRODUCT TO BE CERTIFIED (INCLUDING ADDITIVES, CULTURE MEDIUM AND RELATED ITEM)

    No Name of Product Product Brand

    Note :
    1. Product without ingredients used.
    2. Product with ingredients.
    3. Any changes on ingredients information, please used ingredient list and update the information.
    LIST OF INGREDIENT (1 PRODUCT PER PAGE)

    LIST OF ALL INGREDIENT USED

    Product Ingredient Name Source of Ingredient Manufacture Name & Address Halal Status

    *PLEASE MAKE SUFFICIENT COPY FOR EACH PRODUCT


    DECLARATION

    SUPPORTING DOCUMENT TO BE SENT TO JAKIM

    1. Certification of Company Registration

    2. Manufacturing License from Cosmetic & Drug Authority (for Health Product only)

    3. Copy of valid Halal Certification of ingredients or copy of product specification for ingredient that is not Certified

    4. Process flow chart and production procedure

    DOCUMENTS TO BE MADE AVAILABLE DURING AUDIT

    1. Internal Halal Assurance System

    2. Record of Internal Audit

    1. I declare that all particular stated here in together with the necessary documents attached are true to the best of my knowledge.
    2. I will provide any further documents or information asked by JAKIM to support this application.

    Chief Executive Officer / Owner

    e-Mail Address
    Date of Application

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