Please complete:

Name of Client
Address/Country
Contact person
E-Mail to confirm and/or respond to feedback
Local contact office of Kiwa BCS, if any
Local contact-office of KBCS already informed about your feedback?	No ☐ Yes ☐, on
Feedback related to which Certification-program?	EU ☐ NOP ☐ JAS ☐ GOTS ☐ Other ☐
Did you submit feedback with the same issue in the last 12 months?	No ☐ Yes ☐, on
Feedback - please specify as follows:	Annexes or References Please, mention, if any
Cause of feedback: please specify briefly the reason for your feedback (what kind of circumstance has triggered your need for feedback)
Objective (expectation): please specify briefly what you expect from Kiwa BCS and how you justify your expectation
Date	Client´s signature