Name of certificate holder:
Certificate number:
Certified product standard(s):	☐ GOTS ☐ IVN
If applicable, name of supplier (producer, processor, etc.)
If applicable, name of certification body of supplier and number of certificate
Certificate shall be issued: (please refer to our fee-structure)	☐ within 5 working days ☐ within 2 working days
Payer of the certificate:

I have truthfully filled in all the information required and I have also enclosed:

☐ Filled out template of Transaction Certificate

☐ Invoice(s) No.

☐ B/L or AWB No.

☐ If relevant: Supplier transaction certificates

_____________________________	_______________________________________________

(Date)	(Stamp / Name, Address and Signature of Applicant)