AF3.1.2 Extension of Scope
Certification Application Form
Version: 28/6/2010
Page 1 of 3
NASAA Certified Organic P/L
PO Box 768 Stirling SA 5152 TEL +61 (08) 8370 8455 FAX +61 (08) 8370 8381
EMAIL enquiries@nasaa.com.au WEB www.nasaa.com.au
Extension of Scope is required where any certified operator desires to add products or services to the certification.
Refer to the Certification Contract Schedule and Certificate. In most cases where crops or products are not listed
then they are not certified. (Please check with the office if you are not sure).
This form is applicable to:
Producers: Section A: Applicant Details
Section B: Farm Processing
and
Section C: Processed farm products
(For extension of certification with new land and/or crops/livestock please
complete the AF3.1.1 Additional Acreage & Additional Crop/Livestock Application Form)
Section: D: Declaration
Section E: Payment Details
Processors, Input Manufacturers and other types of licensees:
Section A: Applicant Details
Section: D: Declaration
A.
Section B: Processing
Section C: Products
Section E: Payment Details
Applicant Details
Name of Licensee:
Certification number:
Certification Category (ie producer, processors):________________________________
B.
Additional Processing Activities
Please complete for each processing activity (attach more tables as necessary). Attach as separate sheet(s)
Process Flow Chart:
• Identify organic critical control points and describe how the integrity of the organic product will be maintained at
each point.
• Include a description of hygiene and pest control practices.
• Attach an updated site map and floor plan if new equipment is to be used.
• Attach extra information if there is insufficient space below
Processing/manufacturing
activity 1
Activity
(e.g., Olive oil production)
Processor
(e.g., Smith’s Olive Press)
Certified
(Y/N)
Certifier
Process
or reg.
no.
Certificate
expiry
date
OK
OK
Process description
Organic critical control points
How organic integrity is
maintained at each point
Hygiene practices
Pest control practices
NCO use only
SL?
F:\3. QUALITY DOCUMENTS\3. Forms\3. CERTIFICATION\1. ADDITIONS & CHANGES\AF3.1.2 Extension of Scope of Existing Certification
Application.doc
ABN 60 101 829 163
AF3.1.2 Extension of Scope
Certification Application Form
C.
Version: 28/6/2010
Page 2 of 3
Additional Products
Please complete a separate ingredients list (below) for each product (add rows and attach more tables as
necessary).
•
The mass of each ingredient must be shown for products that contain any solid ingredients.
•
The volume of each ingredient must be shown for products that contain only liquid ingredients.
•
Please refer to Section 2.20-2.21 of the NASAA Organic Standard for detailed instructions on calculating
ingredient percentages.
•
Complete all columns for certified ingredients or the first four columns for non-certified ingredients.
•
For Input Manufacturers attach product specifications for each product to be added.
Product name
Product 1
Ingredient
Mass or
volume
(kg or L)
Total
% of total
Cert. level
(Org, In
Conv or
not
certified)
Supplier
% Cert
Product
level
OK
Supplier
OK
Certifier
Suppli
er reg.
no.
Certificate
expiry
date
OK
OK
Suppli
er reg.
no.
Certificate
expiry
date
OK
OK
Comments
NCO use only
Product name
Product 1
Ingredient
Mass or
volume
(kg or L)
% of total
Cert. level
(Org, In
Conv or
not
certified)
Total
% Cert
Product
level
Certifier
Comments
NCO use only
F:\3. QUALITY DOCUMENTS\3. Forms\3. CERTIFICATION\1. ADDITIONS & CHANGES\AF3.1.2 Extension of Scope of Existing Certification
Application.doc
ABN 60 101 829 163
AF3.1.2 Extension of Scope
Certification Application Form
D.
Version: 28/6/2010
Page 3 of 3
Declaration
The information provided within this document is complete and accurate to the best of my knowledge. I understand
that NCO will rely upon the answers and information contained in this application in deciding whether to certify,
processes and products in accordance with the NASAA Organic Standard, and that it is important to the scheme of
certification operated by NCO that the answers and information provided in this form are true and accurate.
Name: _____________________________________Position:________________________________
Signed:_____________________________________________Date: __________________________
E.
Payment Details
The Application fee covers administration costs to process the application. Where technical review is required, an
Assessment Fee may be charged. Please refer to the NCO Fee Schedule for the Additional Area/product/Scope
Application Fee. The application fee is non-refundable.
TOTAL AMOUNT PAYABLE
$
Cheque: Made payable to NASAA Certified Organic Pty. Ltd.
Or by Credit Card:
VISA
MASTERCARD (please circle)
CARDHOLDER’S NAME................................................................………………………………………………….
CARD NO..........................................................................................................EXPIRY DATE…………………..
Direct debit: to NASAA Certified Organic Pty Ltd account; BSB 085-458, Account No 83-272-8926
For International Transfers: BIC/Swift Code: NATAAU3303M
F:\3. QUALITY DOCUMENTS\3. Forms\3. CERTIFICATION\1. ADDITIONS & CHANGES\AF3.1.2 Extension of Scope of Existing Certification
Application.doc
ABN 60 101 829 163