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For each allergenic food, derivative, and sensitizing agent please answer the questions:

• Does the material supplied contain peanuts and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with peanuts and products thereof?
  • Is the material supplied produced in the same factory with peanuts and products thereof?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain crustacea and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with crustacea and products thereof?
  • Is the material supplied produced in the same factory with crustacea and products thereof?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain fish and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with fish and products thereof?
  • Is the material supplied produced in the same factory with fish and products thereof?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain eggs and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with eggs and products thereof?
  • Is the material supplied produced in the same factory with eggs and products thereof?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain (tree) nuts and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with (tree) nuts and products thereof?
  • Is the material supplied produced in the same factory with (tree) nuts and products thereof?
  • Is there any cross-contact with the material supplied?
  • Type(s) of tree nut(s):
  • Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain milk and products thereof (including lactose)?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with milk and products thereof (including lactose)?
  • Is the material supplied produced in the same factory with milk and products thereof (including lactose)?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain soybeans and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with soybeans and products thereof?
  • Is the material supplied produced in the same factory with soybeans and products thereof?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain wheat and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with wheat and products thereof?
  • Is the material supplied produced in the same factory with wheat and products thereof?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain gluten (i.e., wheat, rye, barley, oats, spelt, or their hybridized strains) and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with cereals containing gluten and products thereof?
  • Is the material supplied produced in the same factory with cereals containing gluten and products thereof?
  • Is there any cross-contact with the material supplied?
  • Maximum amount of allergenic material present (in mg/kg, ml/l, or ppm):
  • Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain celery and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with celery and products thereof?
  • Is the material supplied produced in the same factory with celery and products thereof?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain sesame seeds and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with sesame seeds and products thereof?
  • Is the material supplied produced in the same factory with sesame seeds and products thereof?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain mustard and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with mustard and products thereof?
  • Is the material supplied produced in the same factory with mustard and products thereof?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain lupin and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with lupin and products thereof?
  • Is the material supplied produced in the same factory with lupin and products thereof?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain molluscs and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with molluscs and products thereof?
  • Is the material supplied produced in the same factory with molluscs and products thereof?
  • Is there any cross-contact with the material supplied?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain latex and products thereof?

  Answer
  Comment
  • Is the material supplied produced on the same equipment with latex and products thereof?
  • Is the material supplied produced in the same factory with latex and products thereof?
  • Is there any cross-contact with the material supplied?
  • Is there possible dermal exposure?
  • If any above is Yes: Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain sulfur dioxide and sulphites?

  Answer
  Comment
  • Maximum amount of allergenic material present (in mg/kg, ml/l, or ppm):
  • Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain carmine/cochineal?

  Answer
  Comment
  • Maximum amount of allergenic material present (in mg/kg, ml/l, or ppm):
  • Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain Yellow #5 (Tartrazine)?

  Answer
  Comment
  • Maximum amount of allergenic material present (in mg/kg, ml/l, or ppm):
  • Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain Yellow #6 (Sunset Yellow)?

  Answer
  Comment
  • Maximum amount of allergenic material present (in mg/kg, ml/l, or ppm):
  • Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):

• Does the material supplied contain materials of biological origin?

  Answer
  Comment
  • Maximum amount of allergenic material present (in mg/kg, ml/l, or ppm):
  • Describe the nature of the allergenic material present in the material supplied to the factory (e.g., hazelnuts, wheat maltodextrin, soya lecithin, state whether oils are refined or unrefined (distilled, decolorized and deodorized)):