Fomulir Pendataan Produk Halal
FORMULIR PENDATAAN
RUMAH POTONG HEWAN / UNGGAS
KECAMATAN :
KALASAN
1.
No Registrasi :
..................................
2.
Nama RPH/Unggas :
........................................................................................................
3.
Alamat :
.....................................................................................................
4.
Nama Pemilik :
......................................................................................................
5.
Alamat :
.....................................................................................................
6.
Tahun berdiri/Mulai Usaha :
...........................................................................................................
7.
Legalitas /ijin Usaha : Ada/belum ada bila
sudah : Nomor :................................
8.
Sertifikasi Halal : Ada/belum ada, bila sudah : Nomor
:...............................
9.
Jumlah Penyembelih :
..........................................................................................................
10.
Nama Penyembelih/Jagal :
............................................................................................................
11.
Binatang yang disembelih : ...........................................................................................................
12.
Jumlah disembelih : .................. (rata-rata
per hari)
13.
Sudahkan ada pembinaan : ............................................................................................................
14.
Bila telah dibina, oleh siapa? :
............................................................................................................
15.
Pembinaan yang dibutuhkan : ............................................................................................................
............................................................................................................
16.
Keterangan lain yang perlu : ............................................................................................................
.............................................................................................................
.............................................................................................................
............................................................................................................
Kalasan, ............................
Pemilik Usaha/Responden Petugas Pendata
............................... ...................................
