/ WWF-INDONESIA
Application Form
SEAFOOD SAVERS
Name of Company: / Prepared by:
Niki Nofari
Last revision: / Page1of3
APPLICATION FORM

I, ….(signatory name)…., on behalf of …(company name)… hereby apply to become Seafood Savers member.

Applicant Information

Company Name / :
Company Website / :
SIGNATORY(Highest authority personnel in the company)
Name / :
Position / :
PRIMARY CONTACT
Name / :
Position / :
Email / :
Mobile number / :
Corresponding Address / :
Office Phone & Fax / :

Fisheries Unit to be registeredin Seafood Savers

No / Questions / Answers
1 / Name of fishery withlocation for fishery production / No / Species Name / Wild Caught/Aquaculture / Fishery location
Latin / Common / Indonesian
1
2
3
4
2 / Fishing Gear/Type of aquaculture (intensive/semi-intensive/traditional) / (for wild caught fisheries please also mention if you are using FishAggregating Devices such as rumpon)
3 / Fishing Efforts (Size and number of boats/ponds with number of fisherman/farmer) / Number and size of boats (wild caught):
Number and size of ponds (aquaculture):
Number of fishermen (wild caught):
Number of farmer (aquaculture):
4 / Products volume and type (provide data for each species) / Volume: ...... metric ton/year
Please specified on form of product:
WGGS
Steak
Fillet
Head on (for shrimp product)
Head less (for shrimp product)
Fresh
Live
Others, please identify (e.g.: loin, etc.)
5 / Market destination of the registered fisheries unit
(please mention name of country and buying company) / COUNTRY / BUYING COMPANY
6 / Company has been operating for / □ 5 years  5-10 years □ 10-20 years □ > 20 years
If less than 5 years, please specify on the actual time period: ......
7 / Fishing/farming activity has been operating for / □ 5 years  5-10 years □ 10-20 years □ > 20 years
If less than 5 years, please specify on the actual time period: ......
8 / Fishery certification the company is applying for / □ MSC □ ASC
9 / Does the company own a fishery that have received MSC, ASC or other fisheries certification?
If yes, please provide details of certified fisheries unit, type of certification,date of certification and the validity period / Fisherie unit (species, fishing gear/farming method, location):
Type of Certification: □ MSC □ ASC Others, please specify
Date of Certification:
Certification valid until:

By submitting this application, I shall abideby all terms stipulatedin the Seafood SaversInstitutional Guidelineestablished by WWF-Indonesia.

Submitted by,

(Signatory )

(Position)*

(Company Name)

*the person who is entitled to act before the law in representing the company.

Note:

This form serves to provide Seafood Savers Secretariat with generic information on the current fishery business and practices of the applicant company. The Seafood Savers is a bridging mechanism for fisheries companies wishing to pursue MSC and/or ASC certification.

All data and information retrieved during the process will be treated in compliance with Seafood Savers Confidentiality Disclosure Terms and Agreements. The document is provided separately. (template of the document is included as Appendix 2 in the Seafood Savers Institutional Guideline document)

Upon submission of the application form, the Seafood Savers applicant will receive written response within maximum 10 working days.

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