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APPLICATION FOR KOSHER CERTIFICATION

SKS Shatz Kosher Services

ISRAEL Office: 16 Shamay St. ASHDOD ISRAEL, Tel: ++972-8-864-5535 Cell: ++972-52-523-1908 USA Office: 5902-14th Ave, Brooklyn N.Y. 11204 USA. Tel: +1-718-514-6711 Fax:+1-.718-514-6712 E mail: moskod@skskosher.com • http://www.skskosher.com/

Company Name

Company Registration Number:

Address:

City:

State:

Zip:

Country:

Phone:

Toll Free:

Fax:

Company Contact:

Title:

Phone:

Email:

Alternate Contact:

Title:

Phone:

Email:

Billing Contact:

Title:

Phone:

Email:

Marketing Contact:

Title:

Phone:

Email:

Company President/CEO:

Email:

Under which category of foods would you list the product(s) (e.g. snacks, baked goods, Ingredients Flavors, Vitamins, etc.)?

Have any of your Production Facilities or products ever been certified Kosher?

Yes No

If yes, by whom: Please attach a copy of the previous Kosher certificate:

Are any of them currently certified Kosher?

Yes No

If yes, by whom: Please attach a copy of the previous Kosher certificate:

How many plants are included in this application? (Attach a set of forms for each plant you can download the form from the bottom)

Are any of these products also produced in a plant not included in this application?

Yes No

Are any other products not listed in this application produced in this plant?

Yes No

Please provide the following information regarding products for which you are seeking certification (product form can be downloaded form the bottom)
I. Please list the name of each product for which you are seeking certification. Check the appropriate column(s) for Retail or Industrial/Institutional distribution. Please specify if you desire Passover certification
II. Please list each brand name for the product that you are seeking certification. Check the appropriate column(s) to indicate if the brand name is an In-House and / or Private Label
III. For Private Label brand name: Enter the name of the Private Label Company that owns the brand name. On the last page of this application, provide the company name, address and contact name

Fill the required fields and submit the full form with request (only required if you are not filling online)

PLEASE NOTE: The SKS symbol is a registered trademark of the Shatz Kosher Services. Its unauthorized use Is a violation of trademark laws. Our rights in this regard are enforced to the fullest extent of the law. The SKS symbol may not be used until a written contract has been executed with the SKS Shatz Kosher Services.

The SKS covenants and agrees that it will not communicate or divulge to, or use for the benefit of, any other person, partnership, association, or corporation, any of the trade secrets, formula, or secret processes, used or employed by the company in or about its business, that may be communicated to the SKS by virtue of this application. Submission and investigation of this application does not entail any commitment upon the part of the applicant or of the SKS in any way, until agreement for said purpose is duly entered into by both parties.

APPLICATION FOR KOSHER CERTIFICATION

SKS Shatz Kosher Services

ISRAEL Office: 16 Shamay St. ASHDOD ISRAEL, Tel: ++972-8-864-5535 Cell: ++972-52-523-1908 USA Office: 5902-14th Ave, Brooklyn N.Y. 11204 USA. Tel: +1-718-514-6711 Fax:+1-.718-514-6712 E mail: moskod@skskosher.com • http://www.skskosher.com/

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