Revision Date: April 13, 2023

Where Food Comes From, Inc.

866-395-5883
[email protected] Where Food Comes From, Inc.
Non-GMO Project Verification
Ingredient Disclosure
The Non-GMO Project (NGP) Standard requires Where Food Comes From (WFCF) to assess all
potential GMO risk ingredients in a product, including highly processed ingredients and sub-
ingredients. As a result, we ask that you complete this form with as much detail as possible to aid in
determining the risk status of your particular Ingredient and its possible sub-ingredients as they
relate to the enrolling Product. All information contained in this form will be treated as highly
confidential and maintained as such within the secure WFCF systems.

Completion Instructions: Please have the manufacturer of this ingredient complete, sign and return
this form to the NGP-enrolled Participant for submission to WFCF.

Ingredient Name: ____________________________________________________________________

Ingredient Manufacturer: _____________________________________________________________

Date of Completion^: ________________________

^The Non-GMO Project requires annual review and confirmation of all Non-GMO attestations.
As a result, this document will need to be reviewed and re-confirmed by the Manufacturer to
be accurate and true on an annual basis. These annual reviews are to be recorded below:
Date of Review & Confirmation: Reviewer Initials:
Date of Review & Confirmation: Reviewer Initials:
Date of Review & Confirmation: Reviewer Initials:

1. Is this Ingredient currently a Non-GMO Project Verified Product? YES NO

If NO, skip to Question # 2
If YES, please provide a copy of the current NGP Certificate of Verification for this Ingredient
with the return of this form and SKIP to the signature line on Page 4.

2. Is this Ingredient currently Certified Organic? YES NO

If YES, please provide a copy of the current Organic Certificate referencing this Ingredient with
the return of this form.

3. This Ingredient is made up of: (select and complete the best option)
Single/mono input
What is the raw material source? ___________________________________
-OR-

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© Where Food Comes From, Inc.

 Revision Date: April 13, 2023
Where Food Comes From, Inc.
866-395-5883
[email protected] Where Food Comes From, Inc.
Non-GMO Project Verification
Ingredient Disclosure
Multiple/compound inputs:
Please detail EACH ingredient input/sub-ingredient below to represent the
complete Ingredient formulation:
Sub-ingredient Name % in Sub-ingredient Raw Material Source Sub-
Formulation (i.e. corn, cane, citrus, canola, eggs, ingredient
meat, bee, algae, etc.) OR non- Country of
biological in origin? Origin

4. Is the Ingredient or any of its sub-ingredients listed above derived from the following? (mark
all that apply)
Alfalfa Apple Canola Corn Cotton Eggplant
Papaya Pineapple Potato Soy Sugar Beets
Zucchini Yellow Summer Squash Microorganisms Animal-derivatives

If these crop sources are in use, please be sure you have listed them in the above table in the
Sub-ingredient Raw Material Source column associated to the relevant ingredient(s).

5. Is this Ingredient or any of its sub-ingredients a genetically modified organism (GMO)* (*see
Page 4 for a complete definition)? YES NO
If YES, please explain and/or detail which sub-ingredients this applies to:

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© Where Food Comes From, Inc.

 Revision Date: April 13, 2023
Where Food Comes From, Inc.
866-395-5883
[email protected] Where Food Comes From, Inc.
Non-GMO Project Verification
Ingredient Disclosure
6. Is this Ingredient or any of its sub-ingredients a product of Synthetic Biology***/synthetic
biology1
(***see Page 4 for a complete definition) YES NO

If YES, please explain and/or detail which sub-ingredients this applies to:

7. Does the Ingredient or any of its sub-ingredients contain processing aids present at .5% or
more that are not detailed in the above formulation? YES NO
If YES, please list those below:

8. Is the Ingredient or any of its sub-ingredients (including the inputs/substrates used to

produce them) a microorganism or derived from a microorganism (including enzymes)?
YES NO
If YES, please list all applicable ingredients:

Is the microorganism used a GMO*? YES NO

Is the microorganism used produced via Synthetic Biology***? YES NO
2
Is the microorganism used detectable in the final Ingredient? YES NO
If YES, is the microorganism or its derivative viable or functional in the final Ingredient?
YES NO
If NO, what process renders the microorganism or its derivative non-viable/functional
(ie. heat, etc.):

9. Is the Ingredient or any of its sub-ingredients an enzyme derived from plants/animals (i.e.,
papain from papaya, bromelain from pineapple, rennet from ruminants, etc.)
YES NO
If YES, please list all applicable ingredients:

If YES, what is the plant or animal source?

If plant sourced, is the source plant a GMO*? YES NO
If animal sourced, please answer #10 below.

1 The terms “Synthetic Biology” (uppercase as defined in Appendix A of the Non-GMO Project Standard V16.1 (“Standard”) and “synthetic biology”

(lowercase) are referenced intentionally. As there is no universally accepted definition for synthetic biology, the term “synthetic biology” (lowercase)
includes usage of that tern (and comparable terms) by industry even if such terms are not necessarily in full alignment with the Standard’s definition.
2 Genetic material is detectable via standardized DNA testing methodology. Please note that a microorganism affidavit may be required in this case.

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© Where Food Comes From, Inc.

 Revision Date: April 13, 2023
Where Food Comes From, Inc.
866-395-5883
[email protected] Where Food Comes From, Inc.
Non-GMO Project Verification
Ingredient Disclosure
10. Is the Ingredient or any of its sub-ingredients animal-derived (i.e. dairy, eggs, meat, bee
products, seafood, etc.)? YES NO
If YES, are the source animals GM, including those that are cloned? YES NO
3
If YES, was rBST/rBGH administered? YES NO
If seafood, is the product wild harvested or farmed?

Definitions

*Genetically Modified Organism (GMO): An organism to which Biotechnology** has been applied and
derivatives of such an organism; cloned animals are included within this definition.

** Biotechnology: The application of:

a. in vitro nucleic acid techniques, including recombinant deoxyribonucleic acid (DNA) and the
direct injection of nucleic acid into cells or organelles; or
b. fusion of cells beyond the taxonomic family, that overcame natural physiological, reproductive,
or recombination barriers and that are not techniques used in traditional breeding and selection.

***Synthetic Biology: the development of novel, artificial nucleic acid sequences, biological pathways,
organisms, or devices or the redesign of existing natural biological systems.

I hereby acknowledge that the information provided above is true and correct and, furthermore, that
I have the authority and knowledge to attest to the accuracy of this information. In addition, I
understand that the Non-GMO Project and the Technical Administrator (i.e., WFCF) are relying on the
truthfulness, accuracy, completeness, and correctness of such statements in evaluating the above-
named input/ingredient for compliance with the Non-GMO Project Standard.

Signature: ________________________________________________________________________
Printed Name: _____________________________________________________________________
Company: ________________________________________________________________________
Title: _________________________________________________________Date: _______________

IF WE BECOME AWARE THAT ANY OF THE STATEMENTS ABOVE ARE INACCURATE, FALSE, INCOMPLETE, INCORRECT, OR BASED ON
HYPOTHESIS OR OPINION, WE RESERVE THE RIGHT TO (A) DEEM THE ABOVE-NAMED INPUT/INGREDIENT NON-COMPLIANT WITH THE
STANDARD AND, THEREFORE, PROHIBITED FROM BEING USED IN OR AS A, “NON-GMO PROJECT VERIFIED” PRODUCT, AND/OR
TERMINATE FROM THE PRODUCT VERIFICATION PROGRAM ALL PRODUCTS THAT USE THIS INPUT/INGREDIENT.

3 Recombinant bovine growth hormone (rBGH) is also known as recombinant bovine somatotropin (rBST). rBST/rBGH is a prohibited input.
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© Where Food Comes From, Inc.