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Company Name

Application for QMS Registration to QMS, EMS or OHSAS(Please fill this form completely and return to AGSI-CPL by courier, fax

or e-mail)

Company

Name:

Standard &Accreditation applied for

( what isapplicable)::ISO 9001:2008 Std.(QMS) NABCBAccreditationDAC Accreditation(Dubai AccreditationCentre)

ISO 14001:2004 Std.(EMS)OHSAS 18001:2007

Std.

ScopeApplied forRegistratio

n:

Describe briefly the operations involved in the Production or Service provision(You may attach a flow-chart):

Details of processes outsourced, if any:

Relevant Legal (Statutory & Regulatory) Obligations applicable to product orservice provided:

PrimaryContactPerson-ISO:

Name: Designation:ProprietorTel.:Fax:e-mail:

AlternateContactPerson ISO:

Name: Designation:

Tel.:

Fax:e-mail:

LOCATION

ADDRESS DEPARTMENTS / FUNCTIONS

Office

Factory

Branch

Site (s)( Project)

Is the quality Management System (QMS) of your organization developed by a consultant? Yes NoIf Yes Please give following details:1) Name(s) of the Consultant(s):____________________________________________________ Form No.: F 9.31 Iss.: 01 Rev.: 06 Date: 01.01.2011 Page 1 of 2

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2) Name of the Consulting organization / Agency:______________________________________

Date of Implementationof

QMS

Initial Audit / Re-certification auditrequired in

(Month & Year)

(NOTE: Initial audit will be conducted in two stages. 1 st stage audit includes on/offsiteDocumentation Review,on-site Top Management and M.R. audits and assessment of adequacy of the system anddecide on the date(s) for the stage 2 certification - audit.)

Form No.: F 9.31 Iss.: 01 Rev.: 06 Date: 01.01.2011 Page 2 of 2

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Employee Details ** Note: The planning of the audit e.g. mandays, audit scheduling are based on thedetails as provided in this form]

(A) No. of Employees (include all employees permanent and alsotemporary/contract):

Dept. Function No. of

EmployeesTop Management:Marketing/ Sales:Purchase:H.R.:

Design andDevelopment:

Give category-wise split-up below:

PRODUCTION:(for manufacturingcompanies)

ORSERVICEPROVISION:(For serviceindustries)

CATEGORYNO. OF

EMPLOYEESManagement/

Supervisory

Operators

Helpers

Quality Control

CATEGORYNO. OF

EMPLOYEESManagement/Supervisory

Operators/ChemistsHelpers

Servicing/Installation/Commissioning:(where applicable)Stores andDispatch:(where applicable)Any other:(please specify):Any other:(please specify):

TOTAL:

(B) Is your organization working in Shifts (Yes/ No):___no_______

If yes, please give shift-wise split-up of the total no. of employees:

10General Shift: _____ I Shift: ______ II Shift: _____ III Shift: ____ Total

Employees =

(C ) Any other information you want to provide:

Form No.: F 9.31 Iss.: 01 Rev.: 06 Date: 01.01.2011 Page 3 of 2

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This Questioner filled by:

Name: Designation: Proprietor CompanyCompanySealSealSignatu

re:Date:

Form No.: F 9.31 Iss.: 01 Rev.: 06 Date: 01.01.2011 Page 4 of 2