Bord Bia Horticultural Quality Assurance Scheme

Bord Bia Horticultural Quality Assurance Scheme

Registration Form

BLOCK CAPITALS ONLY PLEASE

Company Name
To appear on certificate if applicable / Producer Number:
For office use only
Contact / Dept. Reg No.
Position / New Applicant Please ü
Please tickü Grower Grower- Packer Distributor Prepared

Please list additional sites on the back

Postal
Address
Site 1 Address
Tel: / Mob: / Fax:
Email:

This Section is for Grower & Grower Packer

Please tick ü

SECTOR: Potatoes Field Vegetables Fruit Protected Crops Mushrooms Amenity

CROP/s - PLANTS / Acres Planted
1
2
3
4
5
·  I/We agree to allow right of access to all areas and relevant personnel for the inspector to carry out inspections and agree to provide documentation and records required for examination.
·  I understand that Bord Bia reserves the right to inform the relevant authority in the event that information becomes available in the course of an audit which could lead to a food safety or health & safety issue.
·  I understand that the validity of my certificate can only be checked through the Bord Bia web based service (validity of certificates and current approval status) and this facility is publicly available.
·  I have access to a copy of the standard and understand the scheme rules.
·  I am committed to complying with the requirements for certification.
. SIGNATURE:______DATE:______

See Schedule of Charges on Reverse. Application Fee Enclosed Yes/No (Delete as appropriate)

Additional Sites:

Site 2
Postal
Postal
Postal
Directions
Site 3
Postal
Postal
Postal
Directions
Directions from Nearest Town

Please ü Audits Available

Grower Packer Audit (BB) / €350.00 plus Vat €430.50
Ornamental Audit / €350.00 plus Vat €430.50
Global Gap Audit (GG) / Contact for details
Tesco Nurture Audit (TN) / Contact for details
Double or Triple audits (combination of above audits) / Contact for details
Packer Audit / Contact for details
Prepared Fruit and Vegetables Audit / Contact for details

Price includes Vat @23%

Note:

1. All details furnished are confidential to Bord Bia and the Auditing Body Management Systems Certification.

2. Applications should be accompanied with a cheque for the appropriate application fee, made payable to

"Bord Bia".

3. Return application forms plus application fee to this address: AgriData, Cluen, Bansha, Co Tipperary.

If you require additional documentation please contact or ph: 01 614 2234