Form C
Food Label Name of Dish: _______________________________________
Country of Origin: __________________________________
Please tick:
Halal
Peanuts
Milk
Vegetarian
Tree nuts
Eggs
Soy
Fish
Wheat (Flour)
Shellfish
Any other ingredients you would like to mention: ___________________________________
-------------------------------------------------Please Cut---------------------------------------------------
Food Label Name of Dish: _______________________________________
Country of Origin: __________________________________
Please tick:
Halal
Peanuts
Milk
Soy
Fish
Vegetarian
Tree nuts
Eggs
Wheat
Shellfish
Any other ingredients you would like to mention: ___________________________________