To Be Completed in Full (In Block Capitals)

FOR ASSESSOR USE ONLY NEW / RENEWAL INDEPEND OWNED / MANAGED NSF Certification UK– SECTION A To be completed in full (in block capitals) FREEDOM FOOD SCHEME - DUCKS APPLICATION FORM DETAILS OF MAIN UNIT Complete separate section A for each new site address APPLICANT NAME

UNIT NAME DEFRA HOLDING NO: / /

On farm contact:

ADDRESS Position: Post Code Tel: Fax No Mobile No Email Address Website Address: www.

Total Range (Ha) System/Range DEFRA Registered Y / N

Type of system / production Site Identification / address if Organic Number of DEFRA approved House ID different from above approved birds / house system & range Free Range Indoor

* K = duck indoor, KF/R = duck free range

Name of each poultry house manufacturer

Any other systems/species on same site? (ie cage, chickens etc) : please state which -

Name & address of Hatchery for Freedom Food chicks Name of Freedom Food Haulier(s) & reg no(s) Name of Freedom Food Abattoirs & reg no: Member of other assurance schemes? Please state which:

The applicant is obliged to disclose in writing to Freedom Food Ltd details of any previous convictions in the past 3 years (or any longer period which corresponds with any sentence imposed by the Court) and pending prosecutions relating to any offence involving the care, handling, rearing, transport, slaughter or sale of animals or produce.

Please do not submit an application unless you have fully read the RSPCA standards and believe you meet full compliance with them.

I agree to abide by the NSF Certification UK Scheme regulations and requirements of the Freedom Food Sch eme. Signed by the applicant or authorised signatory on membership application :

Signed: ______Position: ______Date: ______

Duck Section A Issue 6 PLEASE RETURN TO FREEDOM FOOD HO WITH PAYMENT FREEDOM FOOD CHARGES PLEASE ENCLOSE PAYMENT WITH APPLICATION : VAT @ 20.0% TOTAL JOINING FEE £30 £6.00 £36.00 Up to 30,000 birds £119 £23.80 £142.80 Additional multiples of 30,001 up to 60,000 birds £176 £35.20 £211.20 Additional multiples of 60,001 up to 90,000 birds £233 £46.60 £279.60 Additional multiples of 90,001 up to 120,000 birds £290 £58.00 £348.00 Additional multiples of 120,001 up to 150,000 birds £347 £69.40 £416.40 Additional multiples of 150,001 up to 180,000 birds £404 £80.80 £484.80

CHEQUE ENCL £ OSED

If you would prefer to pay by BACS, our account details are:

Sort code: 60 11 17 Account number: 69595259 Account name: Freedom Food Limited

Note: A receipted invoice will be sent by return

FOR OFFICE USE ONLY

PAID (incl VAT) Part of Group? Folder To DC Assessor Date Sent requested?

YES / NO YES / NO YES / NO

APPLICATION REVIEW SECTION – OFFICE USE ONLY

…………………………………………………………………………………………………………………………………………. Signature Name Date

Authorised by approved application reviewer

Duck Section A Issue 6 PLEASE RETURN TO FREEDOM FOOD HO WITH PAYMENT