Annex

Section A: General information

Purpose of this form

Information provided in this form will be assessed and used to determine the risk of the product and the import conditions that will be applied to the import permit.

Questionnaire requirements

• It is the responsibility of the MANUFACTURER of the product(s) intended for export to Australia to complete this questionnaire.
• Please submit this questionnaire with the application for a permit to import food products.
• A separate questionnaire is to be completed for each product intended for export to Australia.
• Commercial-in-confidence information should be marked as such by the manufacturer and the questionnaire returned directly to the Animal and Biological Imports Branch.

What you must know

• It is the responsibility of the owner and importer to be aware of relevant Australian state, territory and Commonwealth laws.
• In accordance with Biosecurity legislation, Biosecurity officers may decide to suspend, vary or revoke your import permit.
• The Department of Agriculture may contact overseas government competent authorities to verify any information provided in this questionnaire.
• It is a criminal offence under the Criminal Code Act 1995 to knowingly give false or misleading information to a Commonwealth officer exercising powers under Commonwealth law. This offence carries a potential penalty of 12 months' imprisonment.

To complete this form

Enter data in all relevant fields, expand text boxes if space is insufficient, save the document and ensure to include with BICON permit application. If you have any questions please contact

Department of Agriculture, Fisheries and Forestry Animal and Biological Imports Branch
Phone: 1800 900 090 or Email imports@awe.gov.au.

Importer company name

Import permit application number (if known)

Previous import permit number for this product (if applicable)

Name of manufacturer

Street address

City

Country

Phone

Fax

Email

Administrative office

Street address

City

Country

Phone

Fax

Email

Product name

Package type

Package size

End use

E.g. Ricotta and tomato pasta sauce

Glass Jar

400g

Human Consumption

Ingredients

Please list all ingredients below, including added water. Please include percentages adding up to 100%

%

Sub–ingredients

Please include percentages adding up to the same % as the ingredient they form.

Species of origin

(animal/plant) or

Genus and species

(fungi / microbial)

Country of origin

Required for animal derived material only. The country in which the animals resided at the time of collection. Please note: the EU is not a country.

Processing

Please include:

- Pasteurisation parameters must be provided for all dairy/egg ingredients.

- heat treatments applied to the core of the meat, egg or baked goods.

- any additional heat treatments applied.

e.g. Chopped tomatoes

44%

Not applicable

90⁰C for 30 seconds

e.g. Ricotta cheese

25%

Whey

Bovine (cow)

Italy, Austria, Germany

Pasteurisation parameters: 72⁰C for 15 seconds

Cream

Bovine (cow)

Italy

Pasteurisation parameters: 72⁰C for 15 seconds

Milk

Bovine (cow)

Not required for plant ingredients

Pasteurisation parameters: 72⁰C for 15 seconds

Salt

e.g. Onion

5.5%

e.g. Sunflower seed oil

5.5%

Maltodextrin 2%

Not required

Not required for highly processed ingredients

Not required

e.g. Beef extract

11%

Bovine

Australia

100⁰C for 30 minutes

e.g. Flavouring:

Tomato Flavour

9%

Natural flavouring

Substances 35-45%

Flavourings preparations <2%

Maltodextrin 50-60%

Silicon dioxide E551 5%

Arabic gum E414 <2%

Vegetable oils <2%

Vegetable

Yeast extracts (Saccharomyces spp.)

Potato (Solanum tuberosum)

Synthetic

Acacia spp.

Palm (Elaesis guineensis)

Please insert here (electronically) either a manufacturing flow chart or a robust description of the manufacture of this product.

Check if Commercial-in-confidence information

Please provide an overview of how the above ingredients are combined to form the final product. Please include any additional treatments that the product is exposed to as part of the manufacturing process, for example:

• Cooking - including minimum temperature held (in Celsius) and the minimum time held at this temperature
• pH treatments - including pH value and minimum time held at this pH
• Sterilisation - including thermocouple data gathered during the retort process

Has the dairy or meat passed through any additional countries (other than the above specified country of origin and country of manufacture):

no

yes

If yes, please provide details:

e.g. The ‘Whey Powder’ was processed in Croatia using milk collected from animals which resided in the USA.
The ‘Sweet Way’ was processed in the USA and then stored in Germany prior to being manufactured into the ‘Happy Infant Formula’.

Date of Retort

Weight of product

Machine type

Pressure

e.g. 26 December 2013

e.g. 400 gram glass jar

e.g. Hydrostatic steriliser

Are any microorganisms used in the manufacture of the product:

no

yes

If yes, please provide details:

e.g. The Flavourings preparations are derived from Yeast extracts (Saccharomyces spp.)

Are there any enzymes are used in the manufacture of the product?

no

yes

If yes, please list enzyme/s used, % in final product and species of origin:

e.g. Product contains 0.1% lactase derived from bovine (cow).

Signature

Date (dd/mm/yyyy)

Full Name

Email

Position