Annexure III

ALLERGEN CHECKLIST FOR RAW MATERIALS

Material name

Supplier name

Address

Contact person

Phone number/ email

Vendor code

Location & Facility

Filled by

Date

This template is designed to identify the Food Allergens present in any of raw materials
shipped to ITC limited.

These materials may be single or compounded ingredients, Additives, carriers,

solvents, diluents, sub-components, processing aids, Flavourings and other
components should be considered in mapping allergen and hyper sensitivities.
In the below checklist there are two options given (yes/ no),

If YES, indicate the concentration in the material and the source of the allergen

Important terms:
 Cross contamination includes raw material handling, storage, transport, personal
hygiene, cleaning, shared equipment/ lines, re- work, supply chain, packaging,
processing aids and other particulars in manufacturing area.

 Effective cleaning – is the cleaning verified, monitored and validated through

HACCP plan, suitable testing of allergen in NABL accredited labs etc.
Annexure III – page 1
 Present in Material
Concentration in
Part of recipe Cross – contact the material
Allergenic foods and derivatives Source (both part of the
recipe & cross
Yes No Yes no contact)(ppm)

Cereals containing gluten; i.e., wheat, rye, barley,

oats, spelt or their hybridized strains and products
of these
Crustacean shellfish (for example crab, lobster,
crayfish, shrimp, prawn) and their products
thereof
Eggs and egg products thereof
Fish and fish products thereof
Milk and milk products (lactose included) thereof
Peanuts and products thereof
Tree nuts (namely almonds, hazelnuts, walnuts,
cashews, pecans, brazils, pistachios, macadamia
nuts or Queensland nuts) and products thereof

Sesame seeds and products thereof

Soybeans and products thereof
Sulphite in concentration of maximum 10mg/kg

If the allergic material is present potentially in your factory but “No” has been ticked,
then please specify the action/ procedure taken to prevent/ control cross contact with
the material supplied to ITC. Kindly attach the relevant documents or additional
information related to allergen management that may help us understand better.

This worksheet highlights the presence/absence of potential

allergens/hypersensitivities in your facility. The completed template must be
returned to the ITC Limited. Any subsequent changes in allergen and sensitivities
status of the ingredients, materials (or changes in raw material source) must be
notified to The ITC limited immediately.

Annexure III – page 2

This template will be updated as and when the need may arise / any changes in
regulatory requirements for allergens and sensitivities. Accordingly, it need to be
completed submitted to ITC Ltd.

Signature: Name of the company

Company’s seal

Quality Assurance Manager or

Authorized Signatory

Accountability – Quality/ Procurement/ Product Development

Annexure III – page 3