Application form
[for oriGIn’s members]
Please fill in this form as complete as possible return it to info@origin-gi.com. Any information provided
will be treated confidentially according to oriGIn’s standard practices.
GENERAL INFORMATION
Name of your organization or group of producers:.........................................................................................
………………………………………………….............................................................................................
Date of creation: ……………………………………………………………………………………………...
………………………………………………………………………………………………………………...
Product/s: ...…...…………………………………………………………………………………………….
Requirements (if any) to become a member of your organization or group of producers:…………………...
………………………………………………………………………………………………………………...
………………………………………………………………………………………………………………...
………………………………………………………………………………………………………………...
Structure
of
the
organization
(brief
description):…………………………………………………………………………………………………
………...............................................................................................................................................................
...........................................................................................................................................................................
...........................................................................................................................................................................
Number of people working within the organization: ...………………………………………………………
…………………………...................................................................................................................................
Main activities of the organization: …………………………………………………………………………..
………………………………………………………………………………………………………………...
………………………………………………………………………………………………………………...
………………………………………………………………………………………………………………...
President: ……………………………………………………………………………………………………..
Director
/
Secretary
general
/
other:
…………………………………………………………………………………………...............................
Address: ...…………………………………………………………………………………………………….
Telephone: ………………………………Fax:: …………………………………………………...................
E-mail:…………………………………………………. Website:……………………………………...........
Focal point with oriGIn: ………………….……………………………………………………………...
Address: ………………………………………………………………………………………………………
Telephone: ………………………………Fax:: ……………………………………………….......................
E-mail:………………………………………………………………………………………………………...
THE PRODUCT/S
Technical information
Type of products /s: …………………………………………………………………………………………..
Country and/or region from which the product/s originates: ………………………………………………...
…………………............………………………………………………………………………………...........
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Name of the Geographical Indication/s used to identify your product/s:……………………………………..
......................…………………………….........................................................................................................
...........................................................................................................................................................................
Name in local dialect (if any): ………….……………………………………………………….....................
Description of the product/s (including specific characteristics , raw material, elaboration process, time of
elaboration, etc):……………………….……………………………………………………………………...
……………………………………………………………………………..………………………………….
…………………………………………………………………………………………………………...........
........................................................................................................................................................... ………...
Description of the geographical area (including extension, environmental conditions and other relevant
factors) …...……………………………………………………………………………..…………………….
…………………………………………………………………………………………………………...........
...........................................................................................................................................................................
...........................................................................................................................................................................
Link between the product/s and the geographical area (including factors such as tradition, know-how,
reputation, etc.): ……………………………………………………………………………………………...
……………………………………………………………………...................................................................
…………………………………………………………………………………………………………...........
...........................................................................................................................................................................
Number
of
producers
of
your
GI(s):
…………………………………………………………………..............................................................
Does your product/s have internal regulations (specifications/cahier de charges)?
 YES (In this case, please attach it/them to this application).
 NO
Quality control system (briefly describe the system to ensure the respect of internal regulations )
……………………………………………………….......................................................................................
…………………………………………………………………………………………………………...........
...........................................................................................................................................................................
…………………………………………………………………………………………………………...........
Commercial information
Value chain (briefly describe the chain of production, including the average number of producers,
processors, distributors, etc.) …………………………………………………………………………………
………………………………………………………………………………………………………………..
………………………...............………………………………………………………………………………
…………….......................................................................................................................................................
...........................................................................................................................................................................
...........................................................................................................................................................................
Approximate annual volume of production: ...……………...….…………………………… (Year ..……...)
Markets (you are allowed to choose more than 1 option)
 Sales at local level
 Sales at national level
 Sales at international level
 Others (please, specify): ………………………………….................................................................
Approximate volume of exports per year: ……………………………………………….(Year…………..)
Countries where the product/s is / are exported to …..……………………….................................................
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Legal information
Are you aware of any misappropriation of the geographical names identifying your product/s?
 YES
 NO
If YES, please list the cases of abuses, including additional relevant information (pictures, labels,
documents, etc) ……………………………………………………………………………………………….
…………………………………………………………………………………………...................................
...........................................................................................................................................................................
Legal protection of the product/s at national level (please indicate existing legal vehicles available in
your country’s jurisdiction: PGI or PDO / Trademark / Certification mark / Collective Trademark / others)
……………………………………………………………………………………………………................
………………………………….…………………………………………………………………………….
…………………………………………………………………………………………………………...........
...........................................................................................................................................................................
Name of the national organism that confers protection (if any):…………..........
………………………………….......................................................................................................................
……………………………………………………………………...................................................................
Legal protection at international level (please indicate the international protection of your product/s, if
any:
e.g.
Lisbon
Agreement,
bilateral
agreements,
EU
register
etc.)………………………………………………………
…………………………………………………………………………………………………………...........
…………………………………………………………………………………………………………...........
...........................................................................................................................................................................
Please
add
any
addition
information
that
you
may
consider
relevant......................................................................................................................................................
...................................................................................................................................................................
......................................................................................................................................................
The
signatory,
in
representation
of……………………………………..
………………………………….………………………………... (please indicate the name of your
organization) requests to join oriGIn.
Name.................................................................................................................................................................
Position………………………………………………………………………………………………………..
Date ..................................................................................................................................................................
Signature …………………………………….................................................................................................
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