SKC002 – CERTIFIED KERNEL USERS FSQM SKC002 - CERTIFIED KERNEL USERS FSQM VER: 3.0 You are advised to scroll through the list to ensure everything is available before starting. If you need to stop halfway, feel free to save and come back, but please sign off at the bottom of the partially filled form before submitting. This is required because you will have to start a new list when coming back, upon which you can leave blank what you've filled before. Required fields are marked with *. Are you in a position to sign this document for your company* By ticking this box, I confirm that I am authorised and knowledgeable to supply the information below on behalf of the company named below, and that I will do so to the best of my ability, and that I would rather leave a field blank if I have doubt about what that field pertains to. I also understand and accept that it is my responsibility to inform MSM, by email to info@macsm.org, if any of the information that I provide changes. Full Legal Name of Company * Please fill in all fields as they are required annually for FSQM assurance. Physical Address where Cracking Happens In addition to selling from this company, do you plan on buying product from the MSM platform through this company or an affiliated company? Yes No Key Contact Name for FSQM Queries: Key Contact Cell/Tell Number: Key Contact Email Address: FOOD SAFETY COMPLIANCE Detailed signed Product Specification per Product: You will have to provide samples and CoA's for every consignment. Please provide an example of a previous CoA: Certificate of acceptability (R638) or applicable local certification: Product flow diagram: Latest valid safety certifications(multiple files in one go): Kosher Certification: Halal Certification: Organic Certification: FDA Certification: GACC Certification: GMO Free/BE Free Certification: Do you have a pest control program? Yes No Do you use contract cleaners? Yes No Do you use an X-ray machine? Yes No Do you use a Metal detector? Yes No SIGN-OFF Full Name and Surname* Date of Signing* Please sign in the block by drawing your signature with your finger or mouse* Submit