certification application form - NASAA

CERTIFICATION
APPLICATION FORM
(US NOP)
NASAA CERTIFIED ORGANIC Pty Ltd
ACN 101 829 163 ABN 60 101 829 163
PO Box 768 Stirling SA 5152 Ph: (08) 8370 8455 Fax: (08) 8370 8381
Email: enquiries@nasaa.com.au Web: www.nasaa.com.au
Applicants’ Name(s) in full: ………………………………………………………………………
………………………………………………………………………………....…………………….
Trading as: …………………………………………………A.B.N............………………………
Postal address: ……………………………………………………………………………………
…………………………………………………………………………Post Code………………..
Location of farm or facility ………………………………………………………………………..
……………………………………………………………………………………………………….
Telephone No: (……)…………………………… Fax No: (……)………………………………
Email address ……………………………………………………………………………………..
The operation is: Farm /Livestock Handling ........ Other
1. Have you or your organisation ever made application to an organic certification agency in
the past?
................................................................................................................................................
2. If Yes to question 1, please enclose with your application details giving the name of the
certification organisation and a full description of the outcome to that application. If you
were refused certification or were decertified, please supply to NASAA Limited a copy of
any notification supplied to you by the certifier in question and documented evidence to
support the corrective actions taken to comply with non-compliances.
STANDARDS
All applicants need to have read and understood the relevant US NOP Standards, which have
been supplied with this application form.
PRIVACY & CONFIDENTIALITY
a) NASAA CERTIFIED ORGANIC Pty Ltd (NASAA) is committed to handling personal
information about the applicant(s) in accordance with the Privacy Act.
b) NASAA may collect and hold information about the applicant(s) for the purposes of
assessing, reviewing and making decisions about the applicant(s) suitability for
ORGAA/NASAA/JAS/NOP certification; maintaining that certification over time and
providing information on services and products that NASAA considers may be useful and
informative. An applicant/licensed operator may have access to their personal files held by
NASAA.
c) NASAA will handle all such personal information confidentially and will not divulge it to any
party outside NASAA without the applicant’s written permission except that:
i. Generalised information may be extracted to be used for statistical purposes without
disclosing personal details
ii. NASAA may release such information to those bodies to which it is accredited and
other certifying organisations in some circumstances as well as meeting any lawful
obligations imposed upon it by statutory authorities.
iii. NASAA may publish notice of the applicant’s certification, if granted, on its website,
unless formally notified to the contrary.
Date Received
……../……../……..
Reg #……………NOP
Fee Paid: ..……….……
App Fee: ………………
Receipt No ……………
________________________
US NOP APPLICATION
FEE
AUD$275 (less 10% for
overseas)
(non-refundable)
INITIAL INSPECTION
Deposit to be agreed and
paid in advance
Please send in your
application and
assessment fee only at this
stage.
NASAA will supply a
written assessment of the
costs of NOP certification,
which is payable prior to
inspection as laid out in the
NASAA Fee Schedule.
Please pay by cheque or
Postal Order (payable to
NASAA Limited
Or by Direct Deposit,
Quoting applicant Name
to:
NASAA Ltd
Bank: NAB
Branch: Stirling, SA
BSB: 085-436
Acct: 049955748
3. DECLARATION
I provide the above information on the understanding it is confidential and will be
used only by NASAA for the purposes of this application. I understand that if the
information I have supplied is incorrect, my application shall be null and void.
Signed ……………………………………………………….………… Date: .……/….…/……
DOCUMENT NO F1.09 USNOP APPLICATION FORM Page 1 of 2
Amended 5/4/05
REVISION C
F:\Quality Manual\Forms\1. APPLICATIONS & FEES\c. USNOP\F1.09 USNOP APPLICATION FORM.doc

DOCUMENT NO F1.09 USNOP APPLICATION FORM Page 2 of 2
Amended 5/4/05
REVISION C
F:\Quality Manual\Forms\1. APPLICATIONS & FEES\c. USNOP\F1.09 USNOP APPLICATION FORM.doc