MAD

Nestlé Major Allergen Declaration (MAD) Version 10.1, Nov. 2022 MAD to be updated latest by: Fill info in cell B60

In order for Nestlé to be able to understand the allergen profile (allergen by-Nature and cross-contact) and to correctly label its products,
we request that you fill in the following table until all blue background color has disappeared.
à Please read the embedded MAD vendor instructions carefully before filling the MAD. MAD Vendor Instructions Nov2022.pdf

The present declaration must be updated each time there is a change in your raw materials, processes or product portfolio, which impacts the allergen information provided.
Any amendments must be notified to and approved in writing by Nestlé in advance of such change taking place.

If you are supplying any of the following countries: NORTH AMERICA (USA, CANADA), BRAZIL, HONG KONG, JAPAN, SOUTH KOREA, TAIWAN, or if requested,
please fill in the additional NORTH AMERICA/BRAZIL/ASIA respective tab(s).

For Nestlé Nutrition materials, please fill in the 3 additional NORTH AMERICA/BRAZIL/ASIA tabs.

1. Vendor Information 1a. Nestlé IT / SAP information - Complete information when available
Vendor Site ID SAP Material Name Pasta Fideos Sin Huevo 1ton
Vendor Site Name SAP Material Number
Vendor Material Name
SAP Raw Material Purchasing Specification Number
Vendor Material Number
Vendor Site: Street & Nr, City, Country SAP Vendor Number 100447317
Vendor Site Contact: Name, E-mail, Phone

2.
Indicate if material
supplied contains
allergen
By-Nature
Answer Yes/No
Allergenic foods and derivatives
CC from production line shared with the
• Indicate allergenic foods
intentionally added to the
material supplied
transportation/fields/your supplier's For full list, see MAD Vendor Instructions - Annex 1
4.
3. Qualify 5. 7.
Indicate if there is Nature of allergenic material present as CC Input Indicate
Potential DIRECT in the material supplied CC QUANTITATIVE data if the ALLERGEN CC RISK
Cross-Contact (CC) [mg (allergen) proteins/kg of the material supplied
with the material supplied or mg gluten/kg*] , is UNDER CONTROL
OR 6.
Answer Yes/No INHOMOGENEOUS CC if not available, Answer Yes/No
Indicate
E.g. Pieces - indicate NO if the VENDOR SITE is part of a 8.
whole hazelnuts, soybean grits, meringue pieces,…
GFSI-recognised certification FINAL ASSESSMENT
Do NOT use "<" or ">" signs programme:
E.g. If <20, state 19.9 Nestlé internal use
HOMOGENEOUS CC If >20, state 20.1 E.g. AsiaGAP, FSSC, BRCGS, SQF, only
E.g. liquid, powder or puree - IFS, Global G.A.P., … with Allergen
• Potential DIRECT CC includes: soybean flour, skim milk powder, unrefined sesame oil, … • YES
Management Programme in place
Control measures are in place to mitigate the
material supplied allergen CC hazard
AND/OR
Potential CC from NON-SIGNIFICANT CC • NO
*For sulphites, Control measures are in place BUT the allergen
facilities E.g. Refined [allergen] oil, lactose, butter fat, fish gelatin, use CC hazard CANNOT be mitigated
soy/egg lecithin,wheat starch, barley malt, hydrolysed [mg SO2/kg]
plant proteins,…

CELERY and products thereof Provide missing answers

CEREALS cont. GLUTEN and prod. thereof Provide answer for all Provide answer for all cereals below Provide missing answers
cereals below

Barley

Rye
Provide missing answers
Oat

Wheat (such as triticale, spelt, khorazan wheat)

CRUSTACEANS and products thereof Provide missing answers

EGGS and products thereof Provide missing answers

FISH and products thereof Provide missing answers

LUPIN and products thereof Provide missing answers

MILK and products thereof (excl. lactose) Provide missing answers

LACTOSE

MOLLUSCS and products thereof Provide missing answers

MUSTARD and products thereof Provide missing answers

PEANUTS and products thereof Provide missing answers

SESAME seeds and products thereof Provide missing answers

SOYBEAN and products thereof Provide missing answers

Provide answer for all

(Tree) NUTS and products thereof Provide answer for all tree nuts below Provide missing answers
tree nuts below

Optional input for global tree nut homogeneous CC

Almonds

Brazil nuts

Cashews

Hazelnuts Provide missing answers

Macadamia or Queensland nuts

Pecans

Pistachio nuts

Walnuts

SULPHUR DIOXIDE and SULPHITES

(total of SO2 added and naturally present)

Naturally present Provide missing answers

Added sulphites

Y
9. Procedures in place to prevent or control the ABOVE MENTIONED potential cross-contacts:

Validated cleaning procedure(s) Ye

If "YES" appears in cell H52, Specify the procedures in place to prevent/control potential CCs here below and attach documents describing these procedures to the MAD, otherwise leave blank.
Please attach documents describing these procedures to the MAD
Provide above missing answer(s)
0
Specific production scheduling
Raw materials segregation
✘
Y
es
Ye
Please attach documents describing these procedures to the MAD
Please attach documents describing these procedures to the MAD
0
0
Dedicated equipment / production areas
Y
es
Please attach documents describing these procedures to the MAD 0
Other
s
ses
Please describe in cell E55 and attach documents describing these procedures to the MAD: 0 0

10. Final Sign-off 11. Comments (e.g. max. allergen homogeneous CC amounts are derived from ELISA kit detection limits, name of GFSI-recognised certification programme)
Date (DD/MM/YY)
Signature
Last Name and First Name of Signatory
Position
Phone number
E-mail address

Note: Numbers in boxes refer to steps in Major Allergen Declaration (MAD) Guidelines - Instructions to vendors, Guidelines are attached in this document.
MAD Version 10.1 / CO-QM / Oct. 2022 Replaces Version 10, Nov. 2019
 Add. NORTH AMERICA allergens

Nestlé Major Allergen Declaration (MAD) Version 10.1 NORTH AMERICA (USA, Canada) additional information required
1. Vendor Information
Vendor Site ID 0 1a. Nestlé IT / SAP information - Complete information when available
Vendor Site Name 0 SAP Material Name Pasta Fideos Sin Huevo 1ton
Vendor Material Name 0 SAP Material Number 0
Vendor Material Number 0
SAP Raw Material Purchasing Specification Number 0
Vendor Site: Street & Nr, City, Country 0
Vendor Site Contact: Name, E-mail, Phone 0 SAP Vendor Number 100447317

4.
2. 3. Qualify 7.
Indicate if material Indicate if there is Nature of allergenic material present as CC Indicate
supplied contains Potential DIRECT in the material supplied if the ALLERGEN CC RISK
allergen Cross-Contact (CC) of the material supplied
By-Nature with the material supplied 5. is UNDER CONTROL
INHOMOGENEOUS CC
E.g. Pieces - Input 6.
Answer Yes/No Answer Yes/No CC QUANTITATIVE data Indicate Answer Yes/No
whole hazelnuts, soybean grits, meringue pieces,…
[mg (allergen) proteins/kg if the VENDOR SITE is part of a
or mg gluten/kg*] , GFSI-recognised certification 8.
FINAL ASSESSMENT
HOMOGENEOUS CC OR programme:
Allergenic foods and derivatives if not available,
E.g. liquid, powder or puree - Nestlé internal use
soybean flour, skim milk powder, unrefined sesame indicate NO E.g. AsiaGAP, FSSC, BRCGS, SQF,
only
• Potential DIRECT CC includes: oil, … IFS, Global G.A.P., … with • YES
CC from production line shared with the Do NOT use "<" or ">" signs Allergen Management Programme Control measures are in place to mitigate
• Indicate allergenic foods material supplied E.g. If <20, state 19.9 in place the allergen CC hazard
intentionallz added to the AND/OR If >20, state 20.1
material supplied Potential CC from NON-SIGNIFICANT CC • NO
transportation/fields/your supplier's For full list, see MAD Vendor Instructions - Annex 1 Control measures are in place BUT the
facilities E.g. Refined [allergen] oil, lactose, butter fat, fish allergen CC hazard CANNOT be mitigated
gelatin, soy/egg lecithin,wheat starch, barley malt,
hydrolysed plant proteins,…

USA, CANADA

GLOBAL (NORTH AMERICA + mandatory MAD) Provide answer for all 0

Provide answer for all tree nuts Provide missing answers Provide missing answer Provide missing answers
(Tree) NUTS and products thereof tree nuts

Provide answer for all Provide answer for all tree nuts
NORTH AMERICA - (Tree) nuts and products thereof tree nuts below below Provide missing answers

Optional input for global tree nut homogeneous CC

Beech nut

Butternut

Chestnut

Chinquapin

Coconut

0 Provide missing answers

Ginko nut

Hickory nut

Lichee nut

Pine nut / Pinon nut

Pili nut

Sheanut

For oils: Is the oil Refined, Bleached, Deodorized?

For Fish, Crustaceans, Mollusks : specify the species for by-Nature and cross-contact materials.

See FDA Seafood list: https://www.cfsanappsexternal.fda.gov/scripts/fdcc/index.cfm?set=SeafoodList

8. Procedures in place to prevent or control the USA SPECIFIC ABOVE MENTIONED potential cross-contacts:

If "YES" appears in cell H37, Specify the procedures in place to prevent/control potential CCs here below and attach documents describing these procedures to the MAD, otherwise leave blank. Provide above missing answer(s)

Validated cleaning procedure(s)

Y Please attach documents describing these procedures to the MAD 0
Specific production scheduling
Raw materials segregation
✘
Ye
e Please attach documents describing these procedures to the MAD
Please attach documents describing these procedures to the MAD
0
0

sYe
Yses
Dedicated equipment / production areas Please attach documents describing these procedures to the MAD 0
Other Please describe in cell E36 and attach documents describing these procedures to the MAD: 0 1

s
10. Final Sign-off 11. Comments (e.g. max. allergen homogeneous CC amounts are derived from ELISA kit detection limits, name of GFSI-recognised certification programme)
Date (DD/MM/YY) 30/12/1899
Signature 0
Last Name and First Name of Signatory 0
Position 0
Phone number 0
E-mail address 0

The 'MAD' Tab must be filled out. On specific market request, additional BRAZIL/ASIA tab(s) may also need to be filled in. Thank you.

Note: Numbers in boxes refer to steps in Major Allergen Declaration (MAD) Guidelines - Instructions to vendors, Guidelines are attached in this document.
MAD Version 10.1 / CO-QM /Oct. 2022 Replaces Version 10, Nov. 2019
 Add. BRAZIL allergens

Nestlé Major Allergen Declaration (MAD) Version 10.1 BRAZIL additional information required
1. Vendor Information
Vendor Site ID 0 1a. Nestlé IT / SAP information - Complete information when available
Vendor Site Name 0 SAP Material Name Pasta Fideos Sin Huevo 1ton
Vendor Material Name 0 SAP Material Number 0
Vendor Material Number 0
SAP Raw Material Purchasing Specification Number 0
Vendor Site: Street & Nr, City, Country 0
Vendor Site Contact: Name, E-mail, Phone 0 SAP Vendor Number 100447317

4.
2. 3. Qualify 7.
Indicate if material Indicate if there is Nature of allergenic material present as CC Indicate
supplied contains Potential DIRECT in the material supplied if the ALLERGEN CC RISK
allergen Cross-Contact (CC) 5. of the material supplied
By-Nature with the material supplied Input is UNDER CONTROL
INHOMOGENEOUS CC 6.
CC QUANTITATIVE data
Answer Yes/No Answer Yes/No E.g. Pieces - [mg (allergen) proteins/kg Indicate Answer Yes/No
whole hazelnuts, soybean grits, meringue pieces,… if the VENDOR SITE is part of a 8.
or mg gluten/kg] , GFSI-recognised certification FINAL ASSESSMENT
OR
Allergenic foods and derivatives if not available, programme:
Nestlé internal use
HOMOGENEOUS CC indicate NO E.g. AsiaGAP, FSSC, BRCGS, SQF, only
• Potential DIRECT CC includes: E.g. liquid, powder or puree - IFS, Global G.A.P., … with Allergen • YES
CC from production line shared with the soybean flour, skim milk powder, unrefined sesame oil, … Do NOT use "<" or ">" signs
Management Programme in place Control measures are in place to mitigate the
• Indicate allergenic foods material supplied E.g. If <20, state 19.9 allergen CC hazard
intentionally added to the AND/OR If >20, state 20.1
material supplied Potential CC from NON-SIGNIFICANT CC • NO
transportation/fields/your supplier's For full list, see MAD Vendor Instructions - Annex 1 Control measures are in place BUT the allergen
facilities E.g. Refined [allergen] oil, lactose, butter fat, fish gelatin, CC hazard CANNOT be mitigated
soy/egg lecithin,wheat starch, barley malt, hydrolysed
plant proteins,…

BRAZIL

GLOBAL (BRAZIL + mandatory MAD) Provide answer for all 0

(Tree) NUTS and products thereof tree nuts Provide answer for all tree nuts Provide missing answers Provide missing answer Provide missing answers

BRAZIL - (Tree) NUTS and products thereof Provide answer for all Provide answer for all tree nuts Provide missing answers
tree nuts below below

Chestnut
Provide missing answers
Pine nuts
0

Latex and products thereof Provide missing answers

8. Procedures in place to prevent or control the BRA SPECIFIC ABOVE MENTIONED potential cross-contacts:

If "YES" appears in cell H24, Specify the procedures in place to prevent/control potential CCs here below and attach documents describing these procedures to the MAD, otherwise leave blank. Provide above missing answer(s)
Y
Validated cleaning procedure(s)
Y Please attach documents describing these procedures to the MAD 0
Specific production scheduling ✘
Yees Please attach documents describing these procedures to the MAD 0

eses
Raw materials segregation Please attach documents describing these procedures to the MAD 0
Dedicated equipment / production areas
Other YYe
s Please attach documents describing these procedures to the MAD
Please describe in cell E25 and attach documents describing these procedures to the MAD:
0
0 1

s
10. Final Sign-off 11. Comments (e.g. max. allergen homogeneous CC amounts are derived from ELISA kit detection limits, name of GFSI-recognised certification programme)
Date (DD/MM/YY) 30/12/1899
Signature 0
Last Name and First Name of Signatory 0
Position 0
Phone number 0
E-mail address 0

The 'MAD' Tab must be filled out. On specific market request, additional NORTH AMERICA/ASIA tab(s) may also need to be filled in. Thank you.

Note: Numbers in boxes refer to steps in Major Allergen Declaration (MAD) Guidelines - Instructions to vendors, Guidelines are attached in this document.
MAD Version 10.1 / CO-QM / Oct. 2022 Replaces Version 10, Nov. 2019
 Add. ASIA allergens

Nestlé Major Allergen Declaration (MAD) Version 10.1 ASIA (Hong Kong, Japan, South Korea, Taiwan) additional information required
1. Vendor Information
Vendor Site ID 0 1a. Nestlé IT / SAP information - Complete information when available
Vendor Site Name 0 SAP Material Name Pasta Fideos Sin Huevo 1ton
Vendor Material Name 0 SAP Material Number 0
Vendor Material Number 0
SAP Raw Material Purchasing Specification Number 0
Vendor Site: Street & Nr, City, Country 0
Vendor Site Contact: Name, E-mail, Phone 0 SAP Vendor Number 100447317

4.
2. 3. Qualify 7.
Indicate if material Indicate if there is Nature of allergenic material present as CC Indicate
supplied contains Potential DIRECT in the material supplied if the ALLERGEN CC RISK
allergen Cross-Contact (CC) of the material supplied
By-Nature with the material supplied 5. is UNDER CONTROL
INHOMOGENEOUS CC Input 6.
Answer Yes/No Answer Yes/No E.g. Pieces - CC QUANTITATIVE data Answer Yes/No
Indicate
whole hazelnuts, soybean grits, meringue pieces,… [mg (allergen) proteins/kg
or mg gluten/kg*] , if the VENDOR SITE is part of a 8.
GFSI-recognised certification FINAL ASSESSMENT
Allergenic foods and derivatives OR
HOMOGENEOUS CC if not available, programme:
E.g. liquid, powder or puree - Nestlé internal use
indicate NO
• Potential DIRECT CC includes: soybean flour, skim milk powder, unrefined sesame oil, … E.g. AsiaGAP, FSSC, BRCGS, SQF, • YES only
CC from production line shared with the IFS, Global G.A.P., … with Allergen Control measures are in place to mitigate the
Do NOT use "<" or ">" signs
• Indicate allergenic foods material supplied Management Programme in place allergen CC hazard
intentionally added to the AND/OR E.g. If <20, state 19.9
NON-SIGNIFICANT CC If >20, state 20.1
material supplied Potential CC from • NO
transportation/fields/your supplier's For full list, see MAD Vendor Instructions - Annex 1 Control measures are in place BUT the allergen
facilities E.g. Refined [allergen] oil, lactose, butter fat, fish gelatin, CC hazard CANNOT be mitigated
soy/egg lecithin,wheat starch, barley malt, hydrolysed
plant proteins,…

HONG KONG, JAPAN, SOUTH KOREA, TAIWAN

Buckwheat and product thereof Provide missing answers

0
GLOBAL (TAIWAN + mandatory MAD) Provide answer for all Provide answer for all tree nuts Provide missing answers Provide missing answers
(Tree) NUTS and products thereof tree nuts

Provide answer for all Provide answer for all tree nuts
(Tree) nuts and products thereof Provide missing answers
tree nuts below below

Coconut Provide missing answers

Chestnut

Pine nuts Provide missing answers

Shea nut

Fruits and products thereof

Orange Provide missing answers

Kiwi Provide missing answers

0
Banana Provide missing answers

Peach Provide missing answers

Apple Provide missing answers

Mango Provide missing answers

Tomato Provide missing answers

Meat and products thereof

Beef Provide missing answers

Chicken Provide missing answers

Pork Provide missing answers

Matsutake mushroom Provide missing answers

Yam Provide missing answers

Gelatin Provide missing answers

For oils: Is the oil Refined, Bleached, Deodorized?

8. Procedures in place to prevent or control the ABOVE MENTIONED potential cross-contacts:

If "YES" appears in cell H43, Specify the procedures in place to prevent/control potential CCs here below and attach documents describing these procedures to the MAD, otherwise leave blank. Provide above missing answer(s)

Validated cleaning procedure(s)

Ye Please attach documents describing these procedures to the MAD 0
Specific production scheduling ✘
Ye Please attach documents describing these procedures to the MAD 0

s
Raw materials segregation Please attach documents describing these procedures to the MAD 0
Dedicated equipment / production areas
Other YsYe
es Please attach documents describing these procedures to the MAD
Please describe in cell E38 and attach documents describing these procedures to the MAD:
0
0

s
10. Final Sign-off 11. Comments (e.g. max. allergen homogeneous CC amounts are derived from ELISA kit detection limits, name of GFSI-recognised certification programme)
Date (DD/MM/YY) 30/12/1899
Signature 0
Last Name and First Name of Signatory 0
Position 0
Phone number 0
E-mail address 0

The 'MAD' Tab must be filled out. On specific market request, additional NORTH AMERICA/BRAZIL tab(s) may also need to be filled in. Thank you.

Note: Numbers in boxes refer to steps in Major Allergen Declaration (MAD) Guidelines - Instructions to vendors, Guidelines are attached in this document.
MAD Version 10.1/CO-QM/Oct. 2022 Replaces Version 10, Nov. 2019