Printed: February 12, 2016
Compliance Affidavit
All non-organic ingredients used in a product making an “Organic” and “Made with
Organic” claim must meet the NOP requirements for Genetically Modified Organisms
(GMO’s), Irradiation, and Sewage Sludge (where applicable).
QAI requests that the supplier and/or manufacturer of the non-organic
ingredient(s) completes the following affidavit for each non-organic ingredient used
in “Organic” and “Made with Organic” products:
I hereby declare that the following is true for the ingredient(s) named below:
_______________________________________________________________________
_______________________________________________________________________
as supplied to (Name of QAI Certified Client):
_______________________________________________________________________
(Circle Yes or No – Please note, if you answer No to any of the points, the ingredient is not allowed in organic products)
Yes
No N/A The ingredient(s) listed above is not derived from products or
ingredients that contain genetically modified organisms (GMO’s) and
has not been produced with GMO processing aids.1
Yes
No N/A The ingredient(s) listed above has not been irradiated.
Yes
No N/A The ingredient(s) listed above has not been produced with sewage
sludge
Name of Person Completing this Form:______________________Title:______________
Signature:______________________________________
Date__________________
Company Name:__________________________________________________________
1
For non-organic, non-agricultural ingredients or nutrient vitamins and minerals, you may complete the
respective QAI GMO Affidavit and the QAI Nutrient GMO Affidavit in lieu of answering the first question
above. The GMO requirements for non-agricultural materials and nutrients are slightly different than those
for agricultural materials.
AESOP 9331; ISSUE 2; STATUS-PUBLISHED; EFFECTIVE 28 JUN 2010; AUTHORITY JACLYN BOWEN
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Assurance International (QAI). No part of this document may be reproduced or transmitted in any form or by any means, electronic or
mechanical, without written permission (except for the express purpose of preparing and transferring information to QAI in execution
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