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THONG SIEK FOOD INDUSTRY PTE LTD 24.10.23

(Subsidiary of Thong Siek Global Pte Ltd) 1 of 9
22 SENOKO WAY, SINGAPORE 758044
Subject: Doc No: Rev:
SUPPLIER DECLARATION FORM F-HA22-1 02

I. GENERAL
INFORMATION LIABILITY, CONFIDENTIALITY
The Vendor shall provide Thong Siek Food Industry Pte Ltd with all elements (composition, origin,
type of manufacturing process and others supporting documents) required for meeting legal, labelling
and customs/export obligations related to the materials and Thong Siek Food Industry Pte Ltd finished
products.
The Vendor shall inform Thong Siek Food Industry Pte Ltd immediately of all problems related to the
materials sold to Thong Siek Food Industry Pte Ltd, and of all changes likely to affect the materials’
properties — especially changes of origin, composition, manufacturing process or any parameter that
may cause changes in the material quality & food safety parameters, functionality (including
nutritional), and/or regulatory compliance. The vendor shall inform if has been involved in a voluntary
withdrawal or mandatory recall in the last 5 years and share the documentation showing how it was
managed.

Each of the parties agree to keep confidential the information and/or documents (including this one)
that they may have exchanged or may exchange, relating to the other party and their activities. They
must agree not to use them for any purpose other than to ensure a smooth procurement operation. They
pledge to make all necessary arrangements with respect to their personnel and their subcontractors to
ensure that this obligation is fulfilled. The same obligations of confidentiality are also addressed to third
parties. If the parties have entered into a confidentiality agreement, then all such information and/or
documents shall be subject to the confidentiality agreement.

GENERAL REQUIREMENTS FOR MATERIALS

The Vendor must meet the requirements for the technical characteristics of the material as described in
the specification issued by Thong Siek Food Industry Pte Ltd. The Vendor shall refer Table 1:
Supporting Documents as a guideline and revert the necessary documents accordingly. The Vendor
shall fill in relevant information stated in this form (Section 1-Section 9). The materials sold to Thong
Siek Food Industry Pte Ltd must be fit for their purpose, authentic and produced without adulteration.
ASSESSMENT OF QUALITY & FOOD SAFETY MANAGEMENT SYSTEM
Vendor sites supplying materials and packaging to Thong Siek Food Industry Pte Ltd shall have a valid
certification to a GFSI-recognised programme. Traceability Program has to be provided if the
vendor does not have GFSl-benchmarked food safety programmes. Upon request, the Vendor must
provide the GFSI audit report to Thong Siek Food Industry Pte Ltd. The Vendor must notify Thong
Siek Food Industry Pte Ltd if a GFSI certification of a Vendor Site(s) against is withdrawn or suspended.
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SUPPLIER DECLARATION FORM F-HA22-1 02

Dear Valued Supplier,

Please provide all the relevant documents as listed below and submit them together with this
supplier declaration form.
Table 1: Supporting Documents
RAW MATERIAL (Eg: FISH, CHICKEN, MUTTON…) GFSI BENCHMARKED
SCHEMES

1. Business License/ Competent Authority Licenses / • Primus GFS

Import Licenses • Global Aquaculture
2. Food Safety Management System Certificate (FSMS): Alliance Seafood
such as HACCP, BRC, ISO, MSC, ASC etc. • Global Gap
• FSSC 22000
3. Traceability Program (*only if FSMS is not GFSI-
• Global Red Meat Standard
Recognized Certification)
• Canada gap
4. Halal Certificate/ Halal Questionnaire
• SQF
5. Product Specification • BRCGS Global Standard
• IFS International Featured
6. Process Flow Diagram
Standards
7. Health Certificate
• Japan Food Safety
8. Slaughtering Certificate (Applicable for chicken, mutton Management Association
and etc.)

9. Catch Certificate (If available)

10. Certificate of Analysis (COA)

11. Declaration of Absence of Partially Hydrogenated Oils

(Applicable to product that contain oil as a key ingredient)

12. Product Photo [Packaging (Front & Back), Carton]

13. Nutrition Info Panel (If available)
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SUPPLIER DECLARATION FORM F-HA22-1 02

INGREDIENT GFSI BENCHMARKED

SCHEMES

1. Business License/ Competent Authority Licenses / • Primus GFS

Import Licenses • Global Aquaculture
2. Food Safety Management System Certificate (FSMS): Alliance Seafood
such as HACCP, BRC, ISO, MSC, ASC etc. • Global Gap
• FSSC 22000
3. Traceability Program (*only if FSMS is not GFSI-
• Global Red Meat
Recognised Certification)
Standard
4. Halal Certificate/ Halal Questionnaire
• Canada gap
5. Product Specification • SQF
• BRCGS Global Standard
6. Process Flow Diagram
• IFS International Featured
7. Certificate of Analysis (COA)
8. GMO Analysis Certification (Applicable to Soy, Corn, Standards
• Japan Food Safety
Wheat Products)
9. Declaration of Absence of Partially Hydrogenated Oils Management Association

(Applicable to product that contain oil as a key ingredient)

10. Health Certificate (For animal origin/animal by product
ingredient eg. Cheese, milk, egg, honey etc)

11. Product Photo [Packaging (Front & Back), Carton]

12. Nutrition Info Panel (If available)
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SUPPLIER DECLARATION FORM F-HA22-1 02

PACKAGING GFSI BENCHMARKED

SCHEMES

1. Business License/ Competent Authority Licenses / Import • Primus GFS

Licenses
• Global Aquaculture Alliance
2. Food Safety Management System Certificate (FSMS): such Seafood
as HACCP, BRC, ISO, MSC, ASC etc. • Global Gap

3. Traceability Program (*only if FSMS is not GFSI- • FSSC 22000

Recognized Certification) • Global Red Meat Standard

4. Product Specification • Canada gap

5. Process Flow Diagram • SQF

6. Material Safety Data Sheet (MSDS) • BRCGS Global Standard

7. Certificate of Analysis (COA) (If available) • IFS International Featured

8. Packaging Artwork Standards

9. Certificate of Conformance / Food Grade Declaration • Japan Food Safety Management

Association
(applicable for Primary Packaging)
10. ** Migration Test: Overall and Specific Migration
(applicable for Primary Packaging)
11. **EU Compliance Declaration (applicable for Primary
Packaging)
** Refer to Commission Regulation (EU) No 10/2011 of 14 January
2011 on plastic materials and articles intended to come into contact
with food

OTHERS (e.g. CHEMICALS, LUBRICANTS, GLOVES, etc) Fill up these section

1. Business License/ Competent Authority Licenses / Import Section 1, 2, 3, 4, 5, 6 and
Licenses
Section 9.
2. Product Specification
3. Material Safety Data Sheet
4. Quality Management System Certificate (QMS): such as
ISO, cGMP, etc.
5. Food Safe / Food Grade Declaration (If applicable)
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SUPPLIER DECLARATION FORM F-HA22-1 02

Section 1: Supplier Information

1.1 Company Name: Univa Aromatics Pte Ltd

1.2 Company Address: 89, Kaki Bukit Industrial Terrace, Singapore 416169

Tel No: (+65) 6749 5210 Fax No: (+65) 6742 1609

1.3 Business Type:

☒ Manufacturer/ Processor ☐ Packer ☐ Others: ___________

☐ Importer ☐ Trader/ Wholesaler /Distributor

Section 2: Manufacturer Information

2.1 Manufacturer Name: Univa Aromatics Pte Ltd

Manufacturing Address: 153, Kampong Ampat #06-04, Junjie Building, Singapore 368326

Tel No: (+65) 6749 5210 Fax No: (+65) 6742 1609
2.2 What is the quality system that your company is certified? If your company is in the process to certify,
please specify the achievable target date.
Specify target date /
FSMS / QMS Yes No Remarks
(If applicable)
BRC
FSSC ✓
ISO
HACCP
HALAL ✓
EU Approval Establishment Number
(List your approval code)
Other Certification:

(If answer “Yes” to any above-mentioned food quality certification, please attach the relevant certificate.)
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SUPPLIER DECLARATION FORM F-HA22-1 02

2.3 Does manufacturer have the following in-house quality control programme?

QA/QC Department ☐ No ☒ Yes

Internal Lab Testing ☐ No ☒ Yes,

Nature of tests: __Specific Gravity and____
Refractive Index .
Foreign Matter Detection ☐ No ☒ Yes,
Type of control: _CCP Control (Sieve) .
_____________________________________

Product Traceability ☐ No ☒ Yes,

Detail of system: __Attached as product .
tracebility declaration .

Section 3: Product Information

Product Name Sweetness Modifier Flavour FL1723

Brand (If any)

Product Composition/
Refer to ingredient declaration
Ingredient (In descending
order & specify E number
for additive used)

Country of Origin Singapore

Non-Halal / Halal / Not Applicable

Halal Status
(If Halal certified, please provide certificate)
GMO Free Yes / No / Not Applicable (If yes, please provide certificate)

Section 4: Packaging Information

Primary Packaging
30L HDPE JERRYCAN
(dimension, material)
Secondary Packaging
NIL
(dimension, material)
Net Weight (per pack) 25kg
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SUPPLIER DECLARATION FORM F-HA22-1 02

Date Coding Format DD/MM/YYYY

Section 5: Storage Information, Conditions and Distribution Mode

Shelf life 12 months from manufacturing date

In a sealed original container, protected from heat and light at an ambient
Storage Conditions
temperature of 15 - 30°C, relative humidity <70%
Distribution Method Land Transport

Section 6: Additive Declaration

Are the following additives added? (If yes, specify type and concentration in % or ppm)
Type:
Preservatives Yes / No
Conc:
Type:
Colouring Agents Yes / No
Conc:
Type:
Emulsifiers / Stabilizers Yes / No
Conc:
Type:
Others: ____________________ Yes / No
Conc:
Section 7: Allergen Declaration
In same
In same In Product (If yes, specify causing ingredient
Allergens Status Production
Facility and concentration in % or ppm)
Line
Ingred:
Contain soya and by-products? Y/N Y/N Y/N
Conc:
Contain cereal and by-products
Ingred:
(particularly gluten): List out the Y/N Y/N Y/N
Conc:
source of gluten
Ingred:
Contain milk and by-products Y/N Y/N Y/N
Conc:
Ingred:
Contain egg and by-products Y/N Y/N Y/N
Conc:
Contain crustaceans (List out the Ingred:
Y/N Y/N Y/N
species used / Source) Conc:
Contain molluscs (List out the Ingred:
Y/N Y/N Y/N
species used / Source) Conc:
Y/N Ingred:
Contain lupin Y/N Y/N
Conc:
Contain fish (List out the species Ingred:
Y/N Y/N Y/N
used / Source) Conc:
Ingred:
Contain peanut Y/N Y/N Y/N
Conc:
Ingred:
Contain sesame Y/N Y/N Y/N
Conc:
Y/N Ingred:
Contain sulphur dioxide Y/N Y/N
Conc:
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SUPPLIER DECLARATION FORM F-HA22-1 02

Ingred:
Contain mustard Y/N Y/N Y/N
Conc:
Ingred:
Contain celery Y/N Y/N Y/N
Conc:
Contain tree-nuts (List out the Ingred:
Y/N Y/N Y/N
source of Nuts used) Conc:
Ingred:
Contain aspartame Y/N Y/N Y/N
Conc:
Ingred:
Contain royal jelly Y/N Y/N Y/N
Conc:
Ingred:
Contain bee pollen/propolis Y/N Y/N Y/N
Conc:
Ingred:
Contain buckwheat Y/N Y/N Y/N
Conc:
Packaging contains latex and by- Ingred:
Y/N Y/N Y/N
products Conc:

Section 8: Laboratory/ Analytical Standards

Parameter Tested Acceptable Limit
As per micro declaration

Microbiological Standards
(Specify parameter & acceptable
limit)

Specific Gravity @20°C 1.0500 – 1.0600

Refractive Index @20°C 1.3690 – 1.3790
Physical Standards Clear pale yellow to yellowish brown
Colour
(Specify parameter & acceptable liquid
limit) Odour Sugary, sweet

As per heavy metal declaration

Heavy Metals & Other
Chemicals Standards (Specify
parameter & acceptable limit)
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22 SENOKO WAY, SINGAPORE 758044
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SUPPLIER DECLARATION FORM F-HA22-1 02

Section 9: Agreement

This is to certify and acknowledge that:

1. All the above information provided are true and correct.

2. All the items supplied are complying to Legislative Requirements.
3. It is the supplier’s responsibility to inform Thong Siek Global Pte Ltd (TSG) on any modifications that
may occur.

Representative Name:

Bu Bing Cong

Designation:

Quality Executive Management

Signature:

Company Stamp

Date: 09 JAN 2023