APPLICATION FORM FOR AYUSH PRODUCT ... - Foodcert India

1. Name of Applicant :
2. Contact person & details :
3. Shifts operated and timings :
APPLICATION FORM FOR AYUSH PRODUCT CERTIFICATION
(Initial or Renewal)
4. Address of Production locations for which the certification sought :
4.a No. of employees at each of the production location Dept wise and shift wise:
(Enclose a separate sheet if required including Regular, Temporary/seasonal, part time)
5. Corporate/Administrative office address :
5.a No. of Employees at the corporate/administrative office :………………………………………………….
5.b The number of employees connected with production/quality related issues at the factory out of numbers
mentioned as per 5.a (At corporate office (administrative office))
6. Distance to the site from Nearest
town : ……………………………………………………………………….
7. Certification criteria against which certification is requested :
(Note : Ayush Standard Mark for Domestic market & Ayush Premium Mark for domestic/Export Market)
8. Products being manufactured under each dosage form at the location for which Ayush Products Certification
is applied.
___________________________________________________________________________________________
___________________________________________________________________________________________
9. Whether the above products falls under herbal products.(This is applicable only in case of Ayush Premium
Mark)
10. Details of Drug license/approval from Ayush Department held for the above products including GMP
Certificate details
11. Description of production processes for each dosage form
12. Existing manufacturing and testing facilities: (Attach List of equipment installed separately)
Affix Self Attested
Passport size
Photograph
13. Details of own lab facility at the factory and the parameters for which inhouse testing facilities are available.
A.Y/F-01, Revision: 03,
1 st July 2010
Page 1 of 4

14. If testing facilities are outsourced, give the details of parameters for which testing is outsourced and the name
& address of Lab:
15. Details of the raw materials/ingredients used in the production and the seasons during which these materials
procured:
16.a Whether maturity period is set out has been followed:
16. Scope of the products to be covered during assessment and to be mentioned on the certificate:
17. Whether production operating facilities in existence for more than one year and since how long you are into
production:
18. Whether minimum of five commercial batches of products of dosage form for which certification being
sought have been manufactured during the current license period: Mention the five batch numbers and
Manufacturing dates for atleast one product under each dosage form.
19. Whether Registered Exporter with any association or Government agencies, if yes please furnish the
details……………………………………………………..
20. Nature of legal entity (individual/firm/company/society etc.), & furnish the registration details
(incorporation certificate in case of Pvt. Or Ltd company or partnership deed.)
……………………………..………………………………………………………..
21. Whether certified by any other agency for any standard/scheme, if yes Registration Number, Validity period,
Products covered, standard for which registered and name of the certification agency:
22. Reasons for transfer from previous agency, incase earlier registered for Ayush Certification Scheme:
23. Countries the products intended to be traded:
24. Whether any consultant is engaged or proposed to be engaged for advice or implementation of at your
location. Give the name(s):
25. Whether any suspension/cancellation/withdrawal of any certification/approvals under any regulations.:
26. In case of Premium Mark whether the importing country has stipulated any regulations, if so furnish the
details
The applicant hereby declares that there are no judicial proceedings pending/completed relating to their
operations/product/ misuse of Ayush Certification mark, any proceedings by any regulatory body or
A.Y/F-01, Revision: 03,
1 st July 2010
Page 2 of 4

suspension/ cancellation/withdrawal of any certifications/approvals under any regulations or otherwise. In
case of any proceeding pending/completed, furnish full details in a separate note.
The undersigned applicant/authorized representative applies herewith for Ayush products certification scheme for the
above-mentioned location(s) and requests FoodCert India Pvt Ltd , Quality House, H.No:8-2-601/P/6,
Road.No:10, Banjara Hills, Panchavati Colony, Hyderabad-500034, India, called here after as FCI, to carry out
assessment and to grant the certificate on successful completion of the assessment.
The applicant hereby undertakes to comply with all the requirements as mentioned below:
1. To be responsible and authorized for the production and management of the above-mentioned products.
2. To be familiar with the certification procedures and to implement and adhere to the requirements of the scheme.
3. To refrain from any publicity to this certification application as long as the certificate has not been granted.
4. Not to file any suit or claim against FCI or its assessors/staff for any monetary recoveries or for any other damages of any
nature whatsoever, which the applicant suffers as a result of not granting the certificate or as a result of the failure by FCI in
dealing with this application, for the reasons beyond the control of FCI.
5. To agree that FCI shall not be liable to the applicant in any respect if it is prevented from discharging such obligations arising
out of this application, as a result beyond the control of FCI.
6. To agree with the Letter of Offer made by FCI with the financials and other terms and to pay the mentioned amount within
fifteen days from the date of invoice forwarded by FCI.
7. All travel expenses including boarding and lodging expenses for the assessment activity and testing charges, market samples
cost shall be arranged by the applicant and shall be born by the applicant in addition to the fees charged towards application,
inspection and certification. In case those expenses are incurred by FCI, then the amounts shall be paid to FCI by applicant
within 15 days from the date of invoice.
8. Disputes if any arising out of this application between FCI and the applicant arising out of the terms and conditions of the
application form and the letter of offer submitted by FCI shall be governed by laws of India and subject to the jurisdiction of
competent courts in the city of Hyderabad for which the applicant has agreed.
9. Agree that application charges / inspection charges paid under this application shall not be refundable to the applicant and these
expenses stands as forfeited.
10. To prefer the first assessment to be carried out as from week number:………….. and in any case to inform FCI 60 days in
advance about the proposed date of assessment.
11. Agree that FCI can schedule assessment based on the availability of the Assessors.
12. To comply with any additional requirements as may be stipulated or required by FCI basing on the scheme requirements being
assessed.
13. The applicant is responsible for the product liability, if any arises, in case of pesticide residuals exceeding MRLs or indicates
forbidden chemical usage or any other factors.
14. To be familiar with and to accept that with the underwriting of this application form a mutual agreement has been entered with
the FCI for a period of 3 years.
15. This is to confirm that I have not applied to any other inspection body for the scheme.
A.Y/F-01, Revision: 03,
1 st July 2010
Page 3 of 4

16. Make no use of FCI / Accreditation bodies logos or statements inferring to registration, with the scope which could be
misleading or unacceptable to FCI and in such an event, registration can be suspended by FCI.
17. Upon successful registration agree to have its name, location and scope of application included in FCI, Directory of Registered
Customers.
18. Upon suspension/withdrawal of its certification, discontinue use of all advertising material and return original copy of
certificate as required by FCI.
19. Maintain all records of complaints relating to products compliance and to take appropriate actions and to make available to FCI,
when requested, the records of all complaints and corrective actions taken.
20. To allow personnel from accreditation bodies or provisional assessors of FCI to accompany FCI assessors for
witnessing/Conducting the assessments.
21. Agree for the deployment of assessor or scheduling of assessment by FCI for conducting investigation or assessment or
additional visits as result of complaints on the products or visits to the applicant sites/offices etc and to pay the man day
charges plus all travel, stay, food and incidental expenses in connection with these visits.
22. Agree to enter into such certification agreement/agreement for registration disclosure as may be required by FCI before or
after at the time of granting of certificate.
23. To use certification only to indicate as being in conformity with the scheme being registered.
24. Agree to follow the requirements of FCI while making reference to its certification program in its communications via media
etc.
25. Agree to inform FCI in case of any significant changes affecting the products design or specification or changes in the
management/ownership or changes in the certification system.
26. By signing the application the applicant is agreeing the terms and conditions and enters into a contractual agreement
with FCI to carryout assessment and registration services.
FCI obligations to the applicant:
1. Maintain all information pertaining to the applicant as confidential and not to disclose to other parties without the
written consent of the applicant except to as required to be submitted to regulatory authority, accreditation bodies
and in pursuance of court order under information to the applicant.
2. Notify the applicant of any complaints on the applicant received by FCI.
3. Issue of registration or certificate on successful completion of the assessment and after compliance of all
requirements as specified by FCI and scheme owner unless the issue of certificate is prevented by reasons, which
are not under the control of FCI.
4. Maintaining Directory of customers with the scopes granted/applied.
………………………….. …………………………
Name Designation
…………………………. .……….. .…………………………
(Signature) Date Place
FoodCert India Pvt Ltd
Quality House, H.No:8-2-601/P/6, Road.No:10, Banjara Hills, Panchavati Colony, Hyderabad-500034
Ph.No: +91-40-23313547, 23310013, Fax : +91-40-23313048, Email: foodcert@foodcer.in; Web : www.foodcert.in
A.Y/F-01, Revision: 03,
1 st July 2010
Page 4 of 4