Muslim American Food Council - Global Halal

A Halal Certification Organization

Sunday, June 29, 2014

Posted by TAA at 3:18 PM

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Halal Certification Application

MUSLIM AMERICAN FOOD COUNCIL

Global Halal

HALAL CERTIFICATION APPLICATION FORM

This is a multipurpose form please complete only those areas which pertain to your operation

1. Name:____________________________

Address:_________________________

City:____________________________

State:___________________________

Zip Code:________________________ of the place where you process Halal Products- indicate which product(s) you process:

Beef___/ __poultry / Lamb___/;

2. Month:_________Day:_________Year:_______

You began slaughtering, processing and/or

Distributing Halal products;

3. Which day of the week do you process Halal

Beef: M T WED TH F SAT SUN (circle one)

What time of the day do you process Halal Beef: ______AM/PM

4. Which day of the week do you process Halal

Chicken: M T WED TH F SAT SUN (circle one)

5. What time of the day do you process Halal

Chicken: ______AM/PM

6. How many pounds of Halal Beef do you process

Weekly:___________________________

7. How many pounds of Halal Chicken do you process weekly:___________________________

8. If you have had prior certification indicate Which Islamic organization certified your plant or slaughter location as compliant with Halal;

Organization Name:________________________________

Address:__________________________________________

City______________________________________________

State:____________________________________________

Zip Code:_________________________________________

Telephone Number: ( ) _ _ _ - _ _ _ _

9. What is the number of people that slaughter Halal Beef at your plant or Location:___________

Name:_______________________________________

Address:____________________________________

Telephone:__________________________________

Name:_______________________________________

Address:____________________________________

Telephone:__________________________________

Name:_______________________________________

Address:____________________________________

Telephone:__________________________________

10. What is the number of people that slaughter Halal

Chicken at your plant or Location:___________

Name:_______________________________________

Address:____________________________________

Telephone:__________________________________

Name:_______________________________________

Address:____________________________________

Telephone:__________________________________

Name:_______________________________________

Address:____________________________________

Telephone:__________________________________

11. What is the number of people that slaughter Halal

Lamb at your plant or Location:___________

Name:_______________________________________

Address:____________________________________

Telephone:__________________________________

Name:_______________________________________

Address:____________________________________

Telephone:__________________________________

Name:_______________________________________

Address:____________________________________

Telephone:__________________________________

12. What is the number of people that slaughter Halal

Goat at your plant or Location:___________

Name:_______________________________________

Address:____________________________________

Telephone:__________________________________

Name:_______________________________________

Address:____________________________________

Telephone:__________________________________

13. Do you use any form of “stunning” on your

Animals: [Yes____] [No___]

14. Do you feed your Beef any animal by-products:

[Yes__][No___]

15. Do you feed your Beef any pork or any substance

That originates in or is derived from Pork:

[Yes__][No__]

16. Does your beef receive hormones at anytime:

[Yes___][No___]

17. Does your beef receive steroids at anytime:

[Yes___][No___]

18. Do you feed your chicken any animal by-products:

[Yes__][No___]

19. Do you feed your chicken any pork or any

Substance that originates in or is derived from

Pork: [Yes__][No__]

20. Do your chickens receive hormones at anytime:

[Yes___][No___]

21. Do your chicken receive steroids at anytime:

[Yes___][No___]

22. Do you wash any of your Halal products with Tri-

Sodium Phosphate (TSP) [Yes___][No___]

23. Do you wash any of your Halal products with any

Chemical: [Yes___][No___]

*If yes please state the name and concentration

Of the chemical used:_________________

24. Please indicate your Chicken feed provider:

Name: ____________________________________

Address: _________________________________

Telephone: _______________________________

25. Please indicate your Beef feed provider:

Name: _________________________________

Address: ______________________________

Telephone: ____________________________

26. Please indicate your Lamb feed provider:

Name: _________________________________

Address: ______________________________

Telephone: ____________________________

27. Is your chicken, Beef, Lamb or Goat USDA

inspected:

[Yes___][No___] (If you answer yes)

28. Name of USDA Inspector:___________________

29. Identification Number of Current USDA

Inspector:_________

Name of person completing this Form:

_________________________

(Please Print)

_______________________________

Position of person completing this Form:

MAFC-HCA-Form- Revised 2009

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