Applicant Company

Street

ZIP Code, City

Country

Name of NOP Certificate Holder if different as Applicant Company:

NOP Certificate Number/Assessment Number Ecert or Shortname

Name of the products for which the USCOEA compliance confirmation shall be issued:

I, herewith confirm that:

The above-mentioned products are not produced on fields treated with sodium nitrate (Chilean Nitrate). This applies only to raw materials and does not apply to processed products.

The above-mentioned products are not produced by hydroponic or aeroponic systems (does not apply to processed products).

In case of livestock, poultry and egg production, all documentation concerning density ratio of animals is kept and readily available to Kiwa BCS.

All USCOEA-compliance confirmations from suppliers are submitted to Kiwa.

All USCOEA-retail labels are submitted to Kiwa BCS for approval prior to use.

With my signature below I do recognize that I have taken acknowledgement of the valid scale of fees provided by the invoicing Kiwa BCS office and I declare that I have truthfully filled in all the information required.

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Date	Stamp and Signature of Applicant