NASAA Certified Organic - NCO Certified Organic
NAME OF APPLICANT:CERTIFICATION NUMBER:TRADING AS:DEROGATION REQUESTED FOR:Tick Derogation RequiredNon-organic seeds - specify purpose below: ?? Pasture ? Cropping ? Horticulture ? Green manure ? Hay/SilageNon-organic seedlings/plant propagation material?Livestock non-organic feed?Use of non-natural vitamins/feed supplements?Use of non-organic mushroom spawn?Other –specify the relevant Standard & derogation clause:APPLICANT INFORMATION SUPPORTING REQUEST FOR DEROGATIONIdentify reason(s) for derogation request and why it is required for your operation:Input material not available in: ? Sufficient quantity ? Sufficient quality ? Required variety/type ? Other reason (specify below):Indicate effort made to obtain an organic supply of the input:(Note: at least two certified organic suppliers of the required input must be approached)1.2.Indicate supplier and conventional input details:SUPPLIERPRODUCT/NAME/VARIETYQUANTITY/AMOUNTFor the input(s) listed above, indicate how the risk of potential contamination from prohibited substances including GMOs and/or GMO derivatives is managed.Note –post harvest chemical treatment of conventional seed and planting material is not permitted under the IFOAM Program unless prescribed by law for phytosanitary purposes.For livestock feed, indicate % of the livestock diet calculated on both a daily and annual basis, and indicate period over which feed is required.% on daily basis:% on annual basis:Time period or stock age when feed is required:Operator Signature: Date:PLEASE SUBMIT YOUR DEROGATION REQUEST FORM TO THE NCO OFFICE: Email: info@.auNCO RESPONSEDecision:? APPROVED ? NOT APPROVEDIf Approved - Date Derogation Period Ends:Program(s) approved for:Indicate Any Conditions Attached:Name of NCO Officer:Date: ................
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