SUPPLIER ACCREDITATION FORM
Please write in PRINT. Put checkmark (/) on appropriate boxes. Put N/A on blank spaces if not applicable.
SAF No. Date Filled
A. SUPPLIER INFORMATION
Company Name ＧＪＡ ＰＲＯＣＥＳＳ ＦＩＴＴＩＮＧＳ ＴＲＡＤＩＮＧ
Company Address Ｐｈａｓｅ １ Ｂｌｏｃｋ ２７ Ｌｏｔ ３９ Ａｍａｒｉｓ Ｓｕｂｄｉｖｉｓｉｏｎ， Ｍｏｌｉｎｏ ＩＶ， Ｂａｃｏｏｒ Ｃｉｔｙ， Ｃａｖｉｔｅ
Facility/Plant Address
COMPANY REPRESENTATIVE
Department Name of Contact Person Telephone No Fax No Mobile No Email Address
Sales Ｊｏｎａ Ｍａｒｉｅ Ｆｏｒｍｅｌｏｚａ （０２） ８９７－８０２８ ０９９８－５８４－９８８６ ｓａｌｅｓｇｊａ８＠ｇｍａｉｌ．ｃｏｍ
Accounting Ａｂｍｅｌａｉｎｅ Ｐａｓｔｏｒｅｓ ０９１９０７４９２１１ ｇｊａｐｆｔａｃｃｔｇ＠ｇｍａｉｌ．ｃｏｍ
Safety
QA/Food Safety
TYPE OF BUSINESS ORGANIZATION
⭕ Single Proprietor ⭕ Partnership ⭕ Cooperative ⭕ Corporation ⭕ Other, Specify
TYPE OF BUSINESS OPERATION
⭕ Manufacturing ⭕ General Trading ⭕ Distributor ⭕ Other, Specify
PRODUCTS AND SERVICES
Supplies* Supplies Services Sub-contractor/Manpower
⭕ (Food/Non-Food Compounds) ⭕ (Facilities and Maintenance) ⭕ Calibration ⭕ Supply
⭕ Chemicals (Boiler/Steam/Water ⭕ Construction Materials ⭕ Fabrication (Precision/Metal) ⭕ Civil Works Electrical
Treatment
⭕ Electrical ⭕ Repair ⭕ Mechanical Works
⭕ Chemicals (Cleaning & Sanitizers)
⭕ Electronics ⭕ Rewinding ⭕ Plumbing/Sewage Works
⭕ Chemicals
⭕ Equipment ⭕ Rental
(Lubricants/Refrigerants)
⭕ Factory Supplies ⭕ Pest Control
⭕ Food Ingredients
⭕ HVAC ⭕ Food and Water Analysis
⭕ Food Packaging
⭕ Industrial Supply ⭕ Others
⭕ Food Safety Test Kits
⭕ IT
⭕ Food Contact Articles
⭕ Hand Gloves ⭕ Offices Supplies
⭕ Wax Paper
⭕ Others ⭕ PPES
⭕ Others ⭕ Pneumatics
⭕ Power Tools
Note: Food and Non-food ⭕ Waste Water Treatments
Compounds suppliers, please
answer Annex A, B and C ⭕ Others
SFI-PUR-FO-001 Rev01 19Aug2020
DELIVERY AND PAYMENT TERMS
Delivery Terms Ｕｐｏｎ ｒｅｃｅｉｐｔ ｏｆ Ｐ．Ｏ Currency (PHP)
Payment Terms ⭕ 30 Days ⭕ 60 Days ⭕ 90 Days ⭕ Others _____________
C. SUPPLIER INFORMATION
Type of Permit Permit/Registration Number Date Issued Expiration Date
⭕ Company Profile ________________________________________ ______________________________ _______________________________
⭕ SEC/DTI Registration ________________________________________
１７４８３７６ ______________________________
Ｊｕｎｅ １８， ２０２０ _______________________________
Ｊｕｎｅ １８， ２０２５
⭕ BIR Certificate of Registration ________________________________________
４５５－３２３－７３７－０００ ______________________________
Ｊａｎｕａｒｙ １２， ２０２１ _______________________________
Ｊａｎｕａｒｙ １２， ２０２５
⭕ Board of Investment ________________________________________ ______________________________ _______________________________
⭕ Business Permit from the Office ________________________________________
００３９８ ______________________________
Ｊａｎｕａｒｙ ６， ２０２２ _______________________________
Ｄｅｃｅｍｂｅｒ ３１，２０２２
of the City Mayor
⭕ VAT Registry Number (BIR 2303) ________________________________________
４５５－３２３－７３７－０００ ______________________________
Ｊａｎｕａｒｙ １２， ２０２１ _______________________________
Ｊａｎｕａｒｙ １２， ２０２５
⭕ FDA – License to Operate ________________________________________ ______________________________ _______________________________
⭕ Location Map ________________________________________ ______________________________ _______________________________
⭕ List of Products & Services ________________________________________ ______________________________ _______________________________
， ＳＳ３０４ ＆ ＳＳ３１６Ｌ Ｓａｎｉｔａｒｙ Ｐｉｐｅ Ｈｏｌｄｅｒｓ， ＳＳ３０４ ＆ ＳＳ３１６Ｌ Ｓａｎｉｔａｒｙ Ｓｐｒａｙ Ｂａｌｌｓ
Additional Requirements
Permit/Registration Number Date Issued Expiration Date
(For SUB-CONTRACTOR only):
⭕ DOLE Registration
⭕ PCAB License or Department order No. 174
⭕ Certified Bosh/COSH Safety Officer
⭕ Training Certificate of Skilled Workers
B. QUALITY SYSTEMS AND CERTIFICATION
QUALITY SYSTEMS
⭕ ISO 9000 ⭕ ISO 17025 ⭕ ISO 14000 ⭕ OSHAS 18001 ⭕ Others, Specify
Declaration: I certify that all information written herein is true and correct and written in good faith. I understand that the information will be
used in the evaluation process to assess the named organization’s suitability as a supplier. I understand that should any information change or
at the request of Sagrex Foods, Inc, I will notify and update our application.
Filled by Ｊｏｎａ Ｍａｒｉｅ Ｆｏｒｍｅｌｏｚａ Signature
Position Ｓａｌｅｓ Ｅｘｅｃｕｔｉｖｅ
Company Stamp
Date Ｆｅｂｒｕａｒｙ ０８，２０２２
Note: - Please send completed and signed documents to Sagrex Foods, Inc or email signed scanned documents to:
[email protected]; [email protected]. ; ddc@goldensaba
SFI-PUR-FO-001 Rev01 19Aug2020
SUPPLIERS ACCREDITATION STATUS
(TO BE FILLED IN BY SFI REPRESENTATIVE)
Status Remarks Reviewed & Recommended by Approved by Noted by
⭕ Approved ____________________
Production Manager
⭕ Not Approved
⭕ Conditionally Approved
____________________ ____________________ ____________________
⭕ Corrective Actions Department Head General Manager WHS Supervisor
PRODUCTS AND SERVICES
Item Description Purpose Application Other required documents, if any
1
2
3
4
5
ANNEX
To be filled in by Foods ingredients, Food Contact Articles and Non-Food compounds Suppliers Only
Annex A. QUALITY SYSTEMS AND CERTIFICATION (Please attach a copy of the certification)
QUALITY SYSTEMS Date Certified Validity Date Certification Body Remarks
⭕ BRC
⭕ FSSC
⭕ HALAL
⭕ HACCP/GMP
⭕ ISO 9000
⭕ ISO 17025
⭕ ISO 14000
⭕ KOSHER
⭕ OSHAS 18001
⭕ Others
SFI-PUR-FO-001 Rev01 19Aug2020
Annex B. FOOD SAFETY SECTION
Yes No N/A Remarks
1.0 Do you have a written food safety policy?
2.0 Has a food safety risk assessment been undertaken?
3.0 Do you have a food safety plan, product protection program, risk
management
4.0 Do you have Sanitation Standard Operating Procedures (SSOP’s)?
5.0 Do you have an employee hygiene program?
6.0 Are personnel trained in food hygiene and safety?
7.0 Do you have a pest control program?
8.0 Are cross-contamination risks controlled?
9.0 Do you have a recall program?
10.0 Do you have full traceability?
11.0 Do you have a system for handling customer complaints?
12.0 Do you allergens on-site (if, yes please fill in an Allergen Checklist)?
13.0 Do you have an allergen control program on-site?
14.0 Do you have a supplier approval program?
15.0 Are manufacturing instructions documented?
16.0 Do you carry out any auditing, either internal or external?
17.0 Do you carry liability insurance?
18.0 Do you have any other food safety controls in place?
19.0 Do you carry out any auditing, either internal or external?
Annex C. OTHER REQUIRED DOCUMENTS (Please tick box if applicable and attached a copy of document)
For Cleaning, Sanitizing, Machine
For Packaging and Food Contact
For Ingredients Lubricants and other non-food
Articles
compounds
⭕ Product Specification ⭕ Product Specification ⭕ Product Specification
⭕ Process Flow Chart ⭕ Process Flow Chart ⭕ MSDS/TDS
⭕ Microbiological Analysis * ⭕ Migration Test * ⭕ CPR
⭕ Chemical Analysis * ⭕ MSDS/TDS ⭕ NSF, EPA, OSHA, FDA Certification
(Heavy Metals, Pesticides, Mycotoxin and
⭕ Product Guarantee Certificate ⭕ Food Contact Grade Certificate
Food Additives)
⭕ HACCP Plan, if any ⭕ Others, Specify
⭕ Allergen Declaration and Result of Analysis
⭕ FDA Approved Certificate as food
⭕ Physico Chemical Analysis
Contact grade
⭕ Sample Certificate of Analysis (Internal)
⭕ Others, Specify
⭕ HACCP Plan, If any
* All test result must be externally test by an ISO * Migration test must be externally tested
17025 Accredited Laboratory/DENR Accredited by an ISO 17025 Accredited Laboratory
Laboratory
SFI-PUR-FO-001 Rev01 19Aug2020
