Ingredient Allergen Declaration Request Form
Company Name
Contact Person
Email Address
Phone Number
Ingredient Name
Product/Item Code
Allergen Information
Gluten
Crustaceans
Eggs
Fish
Peanuts
Soybeans
Milk
Tree Nuts
Celery
Mustard
Sesame
Sulphites
Lupin
Molluscs
Other Allergens (if any)
Additional Comments