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FORMULIR PENGAJUAN SERTIFIKAT HALAL

Data Pemilik Usaha


Nama : ..................................................................................................................
Alamat Lengkap : ..................................................................................................................
No HP : ..................................................................................................................

Data Usaha
Nama Usaha / Merk : ………………………………………………………………………………………………………….
Nama Produk : ..................................................................................................................
Alamat Usaha/Outlet : ..................................................................................................................
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Deskripsi Produk : ..................................................................................................................
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Bahan – Bahan Produk : ..................................................................................................................
( beserta merk bahan ) ..................................................................................................................
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Alat Pengolahan : ..................................................................................................................
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Cara Pembuatan : ..................................................................................................................
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Lampiran
 Foto KTP ( dikirim via whatsapp )
 Foto Produk ( dikirim via whatsapp )
 Foto Tempat Usaha (d ikirim via whastapp )
 NIB ( jika sudah punya ) : .....................................................................................................

Jika sudah di isi semua bisa mengubungi nomer di bawah

0813 2802 5290 ( Lilik Adi Raharja )


0895 4244 87418 ( Arfan )

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