Application Form Global Organic Latex Standard

GOLS Program Manual
GOLSAPPL.F01(05) :2021-05-10

NAME OF COMPANY APPLYING AND LEGAL STATUS

(please use full name of company with e.g. Ltd., Inc, SAC, SA, SARL, BV)
ADDRESS OF COMPANY ADDRESS OF COMPANY
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
COMPANY’S LEGAL REPRESENTATIVE

(name of person)
COMPANY’S CONTACT PERSON

(complete if different from Legal Representative)
FUNCTION WITHIN THE COMPANY
TELEPHONE / FAX NUMBER
EMAIL
Website
VAT/SVAT NUMBER (for proper tax exemption)
(cross the applicable one)

(cross the applicable one) Applying for the first time Indicate changes (if you are already a CU client)
1. Products

Please describe below the products you want to have certified. If it concerns changes mention all the products and indicate which one is changed, added or withdrawn.
Product Category

Product Category Centrifuged Latex Mattress and Bedding Rubberized Coir Products Rubber Toys Rubber Moulded products (Solid) Condoms Gloves Other Other
Detail description of the product

- Ex: Mattress made with >95% Certified Organic

- Ex: Rubberized Coir sheet made with >95% Certified Organic
Name and Scope Certificate number of the supplier

- Centrifuged Latex - Ex: Name and scope certificate number of rubber plantation(s)

- Mattress and Bedding - Ex: Name and scope certificate number of centrifuging unit(s)
2. Processing units

Please describe below the activities of all processing units, including the central administration office. If it concerns changes mention all the units and indicate which one is changed, added or withdrawn.
Name and address of unit
Process(es)

Process(es) Latex Collection Unit Centrifuging Process Manufacturing of Mattress and Bedding products Assembling of Mattress and Bedding Products Manufacturing of Rubberized Coir product Manufacturing of Rubber Toys Manufacturing of Rubber Moulded Products (Solid) Manufacturing of Gloves Manufacturing of Condoms Export and Administration Trading Warehousing Other Other
LATEX COLLECTION UNIT: Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
CENTRIFUGING PROCESS: Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
MANUFACTURING OF MATTRESS AND BEDDING PRODUCTS: Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
ASSEMBLING OF MATTRESS AND BEDDING PRODUCTS:
Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
MANUFACTERING OF RUBBERIZED COIR PRODUCT:
Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
MANUFACTURING OF RUBBER TOYS: Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
MANUFACTURING OF RUBBER MOULDED PRODUCTS (SOLID): Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
MANUFACTURING OF GLOVES: Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
MANUFACTURING OF CONDOMS: Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
EXPORT AND ADMINISTRATION: Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
TRADING: Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
WAREHOUSING: Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
OTHER: Site Name
- - - - -
Use the stripes if you have multiple Site Names. Each stripe stands for a new site.
Adress(es) of the Site Name(s)
- - - - -
Mention: Street Address, City, Postal / Zip Code, State/Province/Region, Country
Number of employees
- -
(Excluding the Management)
Added/withdrawn

(if applicable). Ex: Newly added/Removed
3. Please describe the location of the production/processing units

e.g. travel time between the different units, if applicable
Travel time between units, if applicable estimated time needed for travelling from nearest international airport etc.
4. List of other certifications obtained by the company
EU/NOP SMETA/ETI/BSCI/SA8000 ISO 90001 ISO 14001 FSC Other Other
4.1. Please send the copy of your company registration at the Chamber of Commerce along with this document (Applicable for companies which are applying for the first time only).

Attach Files
Undersigned declares to have completed this Application Form truthfully
NAME COMPANY
LEGAL REPRESENTATIVE

(The person of the company, accepted by the Chamber of Commerce registration as assignment authorized.)
Date Date / MM / DD YYYY
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Application Form Global Organic Latex Standard

Application Form Global Organic Latex Standard

1. Products

2. Processing units

Name and address of unit

3. Please describe the location of the production/processing units

4. List of other certifications obtained by the company

Undersigned declares to have completed this Application Form truthfully