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Declaration Letter: (Please Give Chemical and Trade/product Name)

This declaration letter states the following: 1. The letter declares the composition of products YP 1176 CT and YP 1177 TT supplied to PT. SUPARMA. 2. The products do not have halal certification and do not contain any raw materials or additives derived from animals. 3. Priyanto Hari Purnomo signs as the Director to confirm the information provided in the letter.

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2K views2 pages

Declaration Letter: (Please Give Chemical and Trade/product Name)

This declaration letter states the following: 1. The letter declares the composition of products YP 1176 CT and YP 1177 TT supplied to PT. SUPARMA. 2. The products do not have halal certification and do not contain any raw materials or additives derived from animals. 3. Priyanto Hari Purnomo signs as the Director to confirm the information provided in the letter.

Uploaded by

RnDLab TSJ
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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F-TSJ-QHSE-04/R01

DECLARATION LETTER

1. We declare that the composition of our products


(please give chemical and trade/product name) :
YP 1176 CT and YP 1177 TT

2. Which we supply to :
Name : PT. SUPARMA
Address : Jl. Raya Mastrip No. 856
Karang Pilang, Surabaya
Ph : (031) 7666666
Fax : 031 766 3287
(Please answer the questions by give tick on appropriate box )
Does the products have Halal Certification? Tick appropriate box

( If the material does not has Halal Yes X No


Certificate please answer the question
Company
below) : PT. TRIMITRA SEJATI JAYA
Address : Komplek Pergudangan dan Industri
Does the products
Permata inGedangan
the raw materials
Blok ADorNo.1
in
process using materials ( additive, anti
Bohar Taman, Sidoarjo Yes X No
oxidant, stabilizer, oil/grease, etc. )61257
derived
from animals?Ph. : +62 31 8549555 (Hunting)
Fax : +62 31 8551082
Name ( If yes, please answerHari
: Priyanto the Purnomo
question below)
Tittle / Position : Director
Date What kind: 2th
animal are 2021
February used in the raw Pig and its derivatives ( Porcine )
material?
Signature
animal corpse

Others : ............................................

What kind animal are used in the process Pig and its derivatives ( Porcine )
production?

animal corpse

Others : ............................................

Does the products in the raw materials or in


process using ethanol derived from X No
Yes
Khamr( Liquor / Rhum / Wine ) ?

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