HMA Application Form Butcher

HMA APPLICATION FOR BUTCHERS
Business Name in Full:*
Full Legal/Corporate Name*
Contact Person:*
Trading Name/Business Name *
(if different from above)
Jurisdiction of Registration (Ontario/Federal): *
Corporation No/ Business Registration No.:*
Current Proprietor established since:*
Registered Office Address:*
Post Code:*
Physical Address:*
Post Code:*
Office Telephone:*
Mobile Contact:*
Website Address*
E-Mail Address:*

Please indicate your day and time of business operation:

	MON	TUES	WEDS	THURS	FRI	SAT	SUN
Time of Operation

Please list all fresh meat / poultry products supplied or sold:*

	PRODUCT	QUANTITY PER DAY	QUANTITY PER WEEK	DELIVERIES PER WEEK
1
2
3
4

- I / We** understand that by virtue of this application, I must return the completed application form together with a non-refundable application fee of $200.00+HST to HMA.
- I / We** understand that this is only an application to use the HMA’s Halal Certification Mark and the attached application fee of $200.00+HST does not constitute an approval by the HMA.
- I / We** accept liability for the reasonable travel and administration costs of a preliminary inspection by HMA.
- I / We** understand that an initial audit inspection will only be undertaken by the HMA provided the ‘Initial Audit Authorization Form’ is completed
  and submitted to the HMA (see form below).
- I / We** understand that after the initial audit, a security deposit of any amount not exceeding $3,000.00 may be required to further process the application. The amount will be decided by the HMA board.
- I / We** understand and accept that the HMA may cancel this application at any time without being required to provide an explanation.
- I / We** understand that by virtue of this application I / we** duly authorize HMA where necessary and in their sole discretion to approach other recognized Muslim Authorities or any supplier or manufacturer of any equipment or other peripherals used by the applicant to verify its conformity with the CRITERIA set by HMA.
Please note that no applicant is authorized to use and display the HMA name and/or logo at their outlet, website, advertising and marketing material prior to obtaining the HMA certification. HMA is a registered trademark. The HMA reserves the right to pursue legal action for trademark infringement.
Name:*
Position:*
Signed:*

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Date*

MonthDayYear
For and on behalf of:
Strictly Confidential:
HMA, undertakes to treat all information supplied by or obtained from the application in respect of its processes, trade secrets, prices and operations in the strictest confidence and will not divulge such information for the benefit of any other person or company.
INITIAL AUDIT INSPECTION AUTHORIZATION FORM

HMA will only consider approving products and conducting an initial audit inspection ofthe applicant’s facility/s, if the applicant is prepared to abide by the following HMAStandards:
Butcher Shop

▪ Retailer will only buy HMA certified products from HMA approved facilities/ suppliers.
▪ Retailer will display HMA certificate in a clear and visible area for the customers
▪ No contamination with non HMA certified products
▪ Allow HMA inspectors / supervisors unfettered access at facility for inspections on a daily basis
Company Name:*
Name of Person Authorizing Audit Inspection:*
Phone Number:*
Email*
Acknowledgement

The above stated company agrees to firstly complete an application, pay the HMA $200.00 (application fee) and reasonable travel expense for the audit inspection, if outside the Greater Toronto Area.

HMA will contact you to arrange payment of the fees.
Signature (Draw your signature below)*

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Date*

MonthDayYear
Signature Name (for verification)*
Full Name
HMA (Halal Monitoring Authority of CCMT)

	Ingredient/Raw Materiel	Product Code	Supplier	Contact Person	Telephone	Manufacturer (if different from the supplier)
1
2
3
4
5
6
7
8
9

Additional Notes:
Please verify you are not a robot*
Should be Empty:

HMA APPLICATION FOR BUTCHERS

INITIAL AUDIT INSPECTION AUTHORIZATION FORM

HMA (Halal Monitoring Authority of CCMT)