No: RACS/REC/18/XX

Date:

General information

Please fill in the information (Please add N/A if not applicable)

Client ID
Name of Organization
Address:
Email:	Telephone:
Contact Person:	Date of Application:
Date of Evaluation:	Date of Certification:

Type of Certification	Facility Product
Sector (Product/ Group)	Chemical Halal Products Food Electrical
Scope of Certification	Cosmetics Detergents Perfumes Tobacco (Cigarettes, Moassel, Dokha) Children Toys Oxo-Biodegradation of Plastic Bags and Other disposable plastic object. Petroleum (Diesel, Lubricant Oils) Retreaded Tires Liquefied Petroleum Gas Cylinder (LPG) Food Contact Material Halal Food Halal Cosmetics Halal Slaughtering Houses Paint Pesticides Organic Foods Energy Drinks Water Electrical & Gas Appliances Others, please specify.

Scope of appeal/review

Please tick below which evaluation/certification decision you wish to challenge:
Decertification
Suspension
Immediate suspension after audit
Application denied
Decision not to grant initial certification
Detected non-conformities
Required corrective measures
Required objective evidences
Others (please specify):

Details of appeal/review

No.	Standard Requirement concerned by appeal/review	Compliance Criteria concerned by appeal/review	Certification or Evaluation Decision concerned by appeal/review (e.g. non-conformity, corrective measure)	Explanation of reasons/ justification for appeal/review	Additional evidence supplied	Response of RACS Operations Department

To be filled by the appellant or RACS	To be filled by the appellant	To be filled by the appellant	To be filled by the appellant	Please list the additional documentary evidence attached to the appeal/review	To be filled by RACS
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General remarks of the client:

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Customer Signature