MAD

Nestlé Major Allergen Declaration (MAD) Version 9, Jan. 2018 MAD valid until: Fill info in cell B58

In order for Nestlé to be able to understand allergen cross-contact and to correctly label its products, we request that you fill in the following table until all blue background color has disappeared.
à Please read the embedded MAD vendor instructions carefully before filling the MAD.
The present declaration must be updated each time there is a change in your raw materials, processes or product portfolio, which impacts the allergen information provided.
Any amendments must be notified to and approved in writing by Nestlé in advance of such change taking place.

1. Vendor Information 1a. GLOBE information - Complete if available

Vendor Site ID GLOBE Material Name
Vendor Site Name GLOBE Material Number
Vendor Material Name GLOBE Purchasing Specification
Vendor Material Number Number

Vendor Site: Street & Nr, City, Country GLOBE Vendor Code

Vendor Site Contact: Name, E-mail, Phone

4. If "Yes" is ticked in Column 3, please

specify, by adding a X mark, the origin of 5. Nature of allergenic material present as CC in
2. By-Nature 2a. Nature of the CC the material supplied 6. Max. amount of homogeneous
3. Potential
constituent of the allergenic material allergenic material present by CC
material supplied present by-Nature in Cross-Contact
(CC) with the [mg (allergen) proteins/kg
(i.e. intentionally the material • For oils, specify if unrefined or highly refined or mg gluten/kg]
material supplied (refined, bleached and deodorized)
added) supplied or
• For CC of (tree) nuts with another (tree) nut, specify
the type(s) of (tree) nuts. Maximum amount of SO2 7. The allergen CC risk of
[mg SO2/kg] present by-Nature the material supplied is
Allergenic foods and derivatives From the fields, in under control and below
From A. Homogeneous
supplier's From the material supplied limits provided
facilities or production production (e.g. liquid, powder or B. Inhomogeneous
• Provide info facility (excl. (e.g. pieces)
during line puree)
(e.g. wheat prod. line)
• Provide info • Provide info transportation
maltodextrin, celery oil,
( Yes/ No) (Yes/No) • Provide info • Provide info
soy lecithin, lactose
powder,...) (e.g. soybean flour, skim (e.g. whole hazelnuts, • Provide numeric value
milk powder, highly soybean grits,meringue (e.g. 1, 23, 152,…)
refined sesame oil, …) pieces,…)

Is the CC<2mg celery

Celery and product thereof proteins/kg?
Provide answer Provide answer Provide missing Is the CC<20mg
Cereals cont. gluten and prod. thereof for all cereals for all cereals Provide missing value(s)
below below answer(s) gluten/kg?

Barley
Rye
Oat
Wheat (such as.spelt, khorazan wheat)
Is the CC<100mg
Crustacean and products thereof
crustacean proteins/kg?
Is the CC<0.3mg egg
Eggs and products thereof proteins/kg?
Is the CC<1mg fish
Fish and products thereof
proteins/kg?
Is the CC<40mg lupin
Lupin and products thereof
proteins/kg?
Is the CC<1mg milk
Milk and products thereof (excl. lactose)
proteins/kg?
Lactose
Is the CC<3mg mollusc
Molluscs and products thereof
proteins/kg?
Is the CC<0.5mg mustard
Mustard and products thereof
proteins/kg?
Is the CC<2mg peanut
Peanuts and products thereof proteins/kg?
Is the CC<2mg sesame
Sesame seeds and products thereof
proteins/kg?
Is the CC<10mg soybeans
Soybean and products thereof
proteins/kg?
Provide answer Provide answer Provide missing Is the CC<1 mg (tree) nut
(Tree) nuts and products thereof for all tree nuts for all tree nuts Provide missing value(s)
below below answer(s) proteins/kg?

Almonds
Brazil nuts
Cashews
Hazelnuts
Macadamia nuts
Pecans
Pistachio nuts
Walnuts
Sulphur dioxide and sulphites
(total of SO2 added and naturally present)
Naturally present
Added sulphites

8. Procedures in place to prevent or control the ABOVE MENTIONED potential cross-contacts:

If "YES" appears in cell K50, Specify the procedures in place to prevent/control potential CCs here below and attach documents describing these procedures to the MAD, otherwise leave blank. Provide above missing
answer(s)
Validated cleaning procedure(s) ✘ Please attach documents describing these procedures to the MAD 0
Specific production scheduling
Raw materials segregation
Y Please attach documents describing these procedures to the MAD
Please attach documents describing these procedures to the MAD
0
0
Dedicated equipment / production areas e Please attach documents describing these procedures to the MAD 0
Other Please describe in cell I55 and attach documents describing these procedures to the MAD: 0
s
9. Final Sign-of
Date (DD/MM/YY)
Signature
Last Name and First Name of Signatory
Position
Phone number
E-mail address

On specific market request, additional USA/BRA/Asian tab(s) may also need to be filled in. Thank you.

Note: Numbers in boxes refer to steps in Major Allergen Declaration (MAD) Guidelines - Instructions to vendors, Guidelines are attached in this document.
MAD Version 9/CO-QM/Jan. 2018 Replaces Version 8, Sept. 2016
 Add. USA allergens

1. Vendor Information
Vendor Site ID 0 1a. GLOBE information - Complete if available
Vendor Site Name 0 GLOBE Material Name 0
Vendor Material Name 0 GLOBE Material Number 0
Vendor Material Number 0
GLOBE Purchasing Specification Number 0
Vendor Site: Street & Nr, City, Country 0
Vendor Site Contact: Name, E-mail, Phone 0 GLOBE Vendor Code 0

4. If "Yes" is ticked in Column 3, please

specify, by adding a X mark, the origin of 5. Nature of allergenic material present in the
2a. Nature of material supplied as CC
3. Potential the CC
2. By-Nature allergenic material
constituent of the present by-Nature Cross-Contact 6. Max. amount of
material supplied in the material (CC) with the • For oils, specify if unrefined or highly refined (refined, homogeneous allergenic
material supplied bleached and deodorized) material present by CC
supplied
• For CC of (tree) nuts with another (tree) nut, specify the [mg (allergen) proteins/kg] 7. The allergen CC risk
type(s) of (tree) nuts. in of the material
Allergenic foods and derivatives the material supplied supplied is under
From the fields,
supplier's From
From control and below
production A. Homogeneous B. Inhomogeneous limits provided
facilities or production (e.g. liquid, powder or
during line facility (excl. (e.g. pieces)
• Provide info prod. line) puree)
transportation
• Provide info (e.g. wheat • Provide info
( Yes/ No) maltodextrin, celery (Yes/No)
oil, soy lecithin, ...) • Provide info • Provide info
(e.g. soybean flour, skim milk (e.g. whole hazelnuts, • Provide numeric value
powder, highly refined sesame soybean grits,meringue (e.g. 1, 23, 152,…)
oil, …) pieces,…)

USA
Is the GLOBAL CC<1
GLOBAL (USA + GI-31.006) Provide answer Provide answer Provide missing answer(s) Provide missing value(s) mg (tree) nut
Tree nuts and products thereof for all tree nuts for all tree nuts proteins/kg?

Provide answer Provide answer

USA - (Tree) nuts and products thereof for all tree nuts for all tree nuts Provide missing answer(s) Provide missing value(s) Is the CC<1 mg (tree)
nut proteins/kg?
below below

Beech nut
Butternut
Chestnut
Chinquapin
Coconut
Ginko nut
Hickory nut
Lichee nut
Pine nut / Pinon nut
Pili nut
Sheanut

8. Procedures in place to prevent or control the USA SPECIFIC ABOVE MENTIONED potential cross-contacts:
Provide above missing
If "YES" appears in cell K30, Specify the procedures in place to prevent/control potential CCs here below and attach documents describing these procedures to the MAD, otherwise leave blank.
answer
Validated cleaning procedure(s) Please attach documents describing these procedures to the MAD 0

Ys
Specific production scheduling ✘ Please attach documents describing these procedures to the MAD 0
Raw materials segregation Please attach documents describing these procedures to the MAD 0
Dedicated equipment / production areas
e Please attach documents describing these procedures to the MAD 0
Other Please describe in cell H27 and attach documents describing these procedures to the MAD: 0
s
9. Final Sign-of
Date (DD/MM/YY) 30/12/1899
Signature 0
Last Name and First Name of Signatory 0
Position 0
Phone number 0
E-mail address 0

The 'MAD' Tab must be filled out. On specific market request, additional BRA/Asian tab(s) may also need to be filled in. Thank you.

Note: Numbers in boxes refer to steps in Major Allergen Declaration (MAD) Guidelines - Instructions to vendors, Guidelines are attached in this document.
MAD Version 9/CO-QM/Jan. 2018 Replaces Version 8, Sept. 2016
 Add. BRA allergens

1. Vendor Information
Vendor Site ID 0 1a. GLOBE information - Complete if available
Vendor Site Name 0 GLOBE Material Name 0
Vendor Material Name 0 GLOBE Material Number 0
Vendor Material Number 0
GLOBE Purchasing Specification Number 0
Vendor Site: Street & Nr, City, Country 0
Vendor Site Contact: Name, E-mail, Phone 0 GLOBE Vendor Code 0

4. If "Yes" is ticked in Column 3, please

specify, by adding a X mark, the origin of 5. Nature of allergenic material present in the
2a. Nature of material supplied as CC
3. Potential the CC
2. By-Nature allergenic material
Cross-Contact 6. Max. amount of
constituent of the present by-Nature (CC) with the
material supplied in the material • For oils, specify if unrefined or highly refined (refined, homogeneous allergenic
supplied material supplied bleached and deodorized) material present by CC
• For CC of (tree) nuts with another (tree) nut, specify the [mg (allergen) proteins/kg] 7. The allergen CC risk
type(s) of (tree) nuts. in of the material
Allergenic foods and derivatives the material supplied supplied is under
From the fields,
supplier's From
From A. Homogeneous control and below
production (e.g. liquid, powder or B. Inhomogeneous limits provided
facilities or production facility (excl. (e.g. pieces)
• Provide info during line prod. line)
puree)
• Provide info (e.g. wheat • Provide info transportation
( Yes/ No) maltodextrin, celery (Yes/No) • Provide info • Provide info
oil, soy lecithin, ...) (e.g. soybean flour, skim milk (e.g. whole hazelnuts, • Provide numeric value
powder, highly refined sesame soybean grits,meringue (e.g. 1, 23, 152,…)
oil, …) pieces,…)

BRAZIL
Is the GLOBAL CC<1
GLOBAL BRA + GI-31.006) Provide answer Provide answer Provide missing answer(s) Provide missing value(s) mg (tree) nut
Tree nuts and products thereof for all tree nuts for all tree nuts proteins/kg?

BRA - Pine nuts Is the CC< 1mg pine

nut proteins/kg?

BRA - Latex and products thereof Is the CC< 0mg latex

proteins/kg?

8. Procedures in place to prevent or control the BRA SPECIFIC ABOVE MENTIONED potential cross-contacts:

If "YES" appears in cell K20, Specify the procedures in place to prevent/control potential CCs here below and attach documents describing these procedures to the MAD, otherwise leave blank. Provide above missing
answer
Validated cleaning procedure(s) Please attach documents describing these procedures to the MAD 0
Specific production scheduling
Ys
✘ Please attach documents describing these procedures to the MAD 0
Raw materials segregation Please attach documents describing these procedures to the MAD 0
Dedicated equipment / production areas
e Please attach documents describing these procedures to the MAD 0
Other Please describe in cell H27 and attach documents describing these procedures to the MAD: 0
s
9. Final Sign-of
Date (DD/MM/YY) 12/30/1899
Signature 0
Last Name and First Name of Signatory 0
Position 0
Phone number 0
E-mail address 0

The 'MAD' Tab must be filled out. On specific market request, additional USA/Asian tab(s) may also need to be filled in. Thank you.

Note: Numbers in boxes refer to steps in Major Allergen Declaration (MAD) Guidelines - Instructions to vendors, Guidelines are attached in this document.
MAD Version 9/CO-QM/Jan. 2018 Replaces Version 8, Sept. 2016
 Add. Asian allergens

1. Vendor Information
Vendor Site ID 0 1a. GLOBE information - Complete if available
Vendor Site Name 0 GLOBE Material Name 0
Vendor Material Name 0 GLOBE Material Number 0
Vendor Material Number 0
GLOBE Purchasing Specification Number 0
Vendor Site: Street & Nr, City, Country 0
Vendor Site Contact: Name, E-mail, Phone 0 GLOBE Vendor Code 0

4. If "Yes" is ticked in Column 3, please

specify, by adding a X mark, the origin of 5. Nature of allergenic material present in the
2a. Nature of material supplied as CC
3. Potential the CC
2. By-Nature allergenic material Cross-Contact
constituent of the present by-Nature 6. Max. amount of
material supplied in the material (CC) with the • For oils, specify if unrefined or highly refined (refined, homogeneous allergenic
material supplied bleached and deodorized) material present by CC
supplied
• For CC of (tree) nuts with another (tree) nut, specify the [mg (allergen) proteins/kg] 7. The allergen CC risk
type(s) of (tree) nuts. in of the material
Allergenic foods and derivatives the material supplied supplied is under
From the fields,
supplier's From
From
A. Homogeneous control and below
facilities or production production B. Inhomogeneous limits provided
facility (excl. (e.g. liquid, powder or
during line puree) (e.g. pieces)
• Provide info transportation prod. line)
• Provide info (e.g. wheat • Provide info
( Yes/ No) maltodextrin, celery (Yes/No)
oil, soy lecithin, ...) • Provide info • Provide info
(e.g. soybean flour, skim milk (e.g. whole hazelnuts, • Provide numeric value
powder, highly refined sesame soybean grits,meringue (e.g. 1, 23, 152,…)
oil, …) pieces,…)

JAPAN, TAIWAN, SOUTH KOREA

Is the CC<10mg
Buckwheat and product thereof buckwheat
proteins/kg?

Provide answer
Fruits and products thereof
for all fruits below

Orange
Kiwi
Banana
Peach
Apple
Mango
Tomato
Provide answer
Meat and products thereof for all meats
below
Beef
Chicken
Pork
Matsutake mushroom
Yam
Gelatin

8. Procedures in place to prevent or control the ABOVE MENTIONED potential cross-contacts:

If "YES" appears in cell K30, Specify the procedures in place to prevent/control potential CCs here below and attach documents describing these procedures to the MAD, otherwise leave blank. Provide above missing
answer
Validated cleaning procedure(s) Please attach documents describing these procedures to the MAD 0
Specific production scheduling 0
Ys
✘ Please attach documents describing these procedures to the MAD
Raw materials segregation Please attach documents describing these procedures to the MAD 0
Dedicated equipment / production areas
e Please attach documents describing these procedures to the MAD 0
Other Please describe in cell I30 and attach documents describing these procedures to the MAD: 0
s
9. Final Sign-of
Date (DD/MM/YY) 12/30/1899
Signature 0
Last Name and First Name of Signatory 0
Position 0
Phone number 0
E-mail address 0

The 'MAD' Tab must be filled out. On specific market request, additional USA/BRA tab(s) may also need to be filled in. Thank you.

Note: Numbers in boxes refer to steps in Major Allergen Declaration (MAD) Guidelines - Instructions to vendors, Guidelines are attached in this document.
MAD Version 9/CO-QM/Jan. 2018 Replaces Version 8, Sept. 2016