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IMI Global, International Certification Services, Sterling Solutions and Validus are divisions of Where Food Comes From, Inc. Visit www.wherefoodcomesfrom.com to learn more.
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Document No: NGP Questionnaire Version 3.0 Revision Date: 11‐17‐16
Where Food Comes From, Inc.Non‐GMO Project Verification Questionnaire
ORGANIZATION INFORMATION Legal Name of Company/ Brand Owner
Company’s primary Contact for Non‐GMO Verification
Telephone
Fax
Mailing Address
* Physical address of each location where your product to be verified will be handled, processed or distributed in or from. (Ex: farms, feed mills, processing facilities, co‐packer/contracted manufacturer.)
Do you manufacture/process your own products (yes/no)? ___________ If no, please list names of all facilities involved above* What is the number of products you wish to verify? ___________
If you have additional Brands or Private Labels (not owned by you, the Brand Owner) that also need verification, please indicate the total number of additional products in addition to what is listed above: ______________
Will your products be sold in countries out of the U.S. and Canada (please list all countries)?
_____________________________________________________________________________________________
Please submit all product labels with ingredient statements and product specification sheets that include ingredient declarations. This will ensure that we are aware of all possible ingredients so that
we can provide you with an accurate cost assessment. **You cannot receive a cost assessment without these items**
IMI Global, International Certification Services, Sterling Solutions and Validus are divisions of Where Food Comes From, Inc. Visit www.wherefoodcomesfrom.com to learn more.
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Document No: NGP Questionnaire Version 3.0 Revision Date: 11‐17‐16
Where Food Comes From, Inc.Non‐GMO Project Verification Questionnaire
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VERIFICATION INFORMATION Have you ever applied for Non‐GMO Project Verification or been verified as a Non‐GMO operator in the past? Yes _____No _____ If yes, which technical administrator (T.A.) have you used? ____________________________________________
When is your next renewal date? __________________________________ **If yes to the above, please submit a copy of your most recent certificate from your previous technical administrator.
1. Are any or all products currently certified organic? Yes _____ **If yes, please submit a copy of your most recent certificate
2. Are any of your ingredients currently certified Non‐GMO? Yes ____ No ____ **If yes, please submit a copy of the most recent certificate(s) 3. Does your manufacturing or packaging facilities have Identity Preservation Systems in place (i.e. Organic, SQF, BRC, etc.)? Yes______ No______ If yes, please list the system and each location in which it is used.: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ **If yes, please submit a copy of the most recent certificate(s) 4. Does your product contain High‐risk ingredients? Yes _____ No _____
Please select all high risk crops and inputs listed below: High Risk Crops:
___ Alfalfa ___ Canola ___ Corn ___ Papaya
___ Soy ___ Sugar Beets ___ Cotton
___ Zucchini ___ Honey ___ Summer Squash
High Risk Inputs: ___ Animal Derivatives (eggs, dairy, meat, etc.) ___ Livestock Production Inputs ___ Microbes and Microbial products
___ Ingredients derived from high‐risk crops (referenced above) ___ Ingredients derived from livestock/animal products
AND/OR any of the following Additives:
___ Amino Acids ___ Aspartame ___ Ascorbic Acid ___ Sodium Ascorbate ___ Vitamin C ___ Citric Acid ___ Sodium Citrate ___ Ethanol ___ Flavorings (“natural” & “artificial”) ___ High‐Fructose Corn Syrup ___ Hydrolyzed Vegetable Protein ___ Lactic Acid
___ Maltodextrins ___ Molasses ___ Monosodium Glutamate ___ Sucrose ___ Textured Vegetable Protein (TVP) ___ Xanthan Gum ___ Vitamins ___ Yeast Product
IMI Global, International Certification Services, Sterling Solutions and Validus are divisions of Where Food Comes From, Inc. Visit www.wherefoodcomesfrom.com to learn more.
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Document No: NGP Questionnaire Version 2.5 Revision Date: 08.17.16
Where Food Comes From, Inc.Non‐GMO Project Verification Questionnaire
5. Are any of the high risk ingredients also being processed in both verified and non‐verified products at either your facilityor a contracted manufacturer? Yes ____ No ____
6. Please let us know if you would like additional information about other certification programs offered by Where FoodComes From, Inc. that can be bundled with your Non‐GMO Project Verification (check all that apply):
____ Organic Certification ____ Food Alliance Certified ____ Global Animal Partnership (GAP) 5‐Step
Animal Welfare Rating ____ Grass‐fed
____ Food Safety (SQF) ____ Gluten‐Free Certification ____ Non‐GMO Testing SOP Development/Consulting ____ Where Food Comes From Source Verified® label ____ Other ____________________________________
Let’s see how you did! Check off each item as you’ve collected them. Once you have all relevant boxes checked, your Questionnaire is ready to be submitted!
____ Completed Questionnaire ____ Product Labels with Ingredient Statements ____ Product Specification Sheets with Ingredient Declarations ____ Most recent Non‐GMO Certificate of Approval for these products (if applicable) ____ Most recent Non‐GMO Certificate of Approval for individual ingredients (if applicable) ____ Most recent Organic Certificate of Approval for these products (if applicable) ____ Certificate(s) demonstrating Identity Preservation Systems at your manufacturer or
packaging facility(ies) (if applicable)
Please return completed applications to: Where Food Comes From 202 6th Street, STE 400 Castle Rock, CO 80104 Office: (866) 395‐5883 Fax: (877) 258‐4535
Email: [email protected]
