VERIFICATION SERVICESVerification of Legal Origin/Compliance (VLO/VLC)

APPLICATION

1. ORGANIZATON CONTACT INFORMATION[1]

Legal Name: / dba*:
Date: / Jurisdiction of Company:
Type of Legal Entity:
Primary Contact: / Title:
Contract Signer**: / Title:
Mailing Address:
City: / State/Prov: / Country:
Email(s): / Post. Code:
Tel: / Fax: / Website:

*”doing business as” – for contracting purposes please ensure that your company’s full legal name is listed above.

**The contract signer must have sufficient legal rights to represent the organization.

2. TYPE OF VERIFICATION REQUESTED

Verification of Legal Origin (VLO):
Verification of Legal Compliance (VLC):
Are you applying for multi-site verification? / Yes No
Is there a specific date when you want to have your verification completed by? / Date:

3. BUSINESS BACKGROUND(Help us create a profile of your business to plan for your legality verification)

3a. BUSINESS TYPE(check all thatapply)

Please state the nature of your enterprise:

Primary manufacturing / Import / Export / Forest Manager
Secondary manufacturing / Broker / Trader / Agent / Distribution / Wholesale
Converter of Paper Products / Retailer / Other

3b. SITES (PROCESSING FACILITIES) AND PRODUCTS (to be included in the scope)

Briefly specify type and number of sites (e.g., factory, sawmill, warehouse, shop or Forest Management Enterprise – FME) and addresses if different from your principal address above:

Number of sites/FMEs to be included in the verification scope:
Site name / Address: / Type of entity (e.g., FME, sawmill, molding facility):

3c. FME INFORMATION (list the FMEs included in Scope)

FME Name: / Address: / Area of FME (ha): / Species harvested: / Type of FME:
(natural forest concession, plantation, community forest etc.)

3d. VERIFIED PRODUCTS TO BE INCLUDED IN THE SCOPE

Application is for ALL or SOME of the forest products your business produces or sells.

Product Type: / Species: / Annual Quantities (m3):

- Application Contact Page -

Please use the following Rainforest Alliance Regional Office contact matrix for submitting your application based on the location of your Organization’s main office for the division applying for verification.

Region / Contact Details / Rainforest Alliance Regional Office / Partner Organization
Africa / / Africa Regional Office
Asia, Australia, New Zealand /
Pertokoan Griya Alamanda,
Blok No. 17
Jl. Kapten Cokorde Agung Tresna, Lingkungan Jayagiri, Kelurahan Dangin Puri Kelod, Kecamatan
Denpasar Timur, Bali, Indonesia
Tel (+62) 361/224-356
Fax (+62) 361/235-875 / Asia-Pacific Regional Office
Brazil / Contact Imaflora
Rua Chico Mendes 185, Caixa Postal 411
Piracicaba, Sao Paolo,
BRASIL 13400-390
Tel/Fax (+55) 19/3414-4015 / Imaflora
Canada / Box 1771, Chelsea, QC, Canada, J9B 1A1
Tel (819) 827-8278
Fax (866) 438-1971 / Canada Regional Office
Central America, CARICOM/Caribbean / 8ª. Avenida 15-62, Zona 10
Guatemala City, GUATEMALA
Tel (+502) 2383 5757
Fax (+502) 2383 5788 / Mesoamerica Regional Office
Europe, Russia / Contact NEPCon / NEPCon
Mexico / Margarita Maza de Juárez 422, Col.
Centro Oaxaca, Oaxaca,
MÉXICO CP 68000
Tel/Fax +52 (951) 502-6473 / 502-6532 / 132-8567 / Mesoamerica Regional Office – Mexico
South America
(except Brazil) /
Calle Manual Ignacio Salvatierra 359
(2˚ Piso)
Santa Cruz, BOLIVIA
Tel +591 3 332-5042
Fax +591 3 332-7451 / South America Regional Office
United States of America /
801 Highway 3 North, Suite 200
Northfield, MN 55057
Tel (507) 663-1115
Fax (507) 663-7771 / US Regional Office

Appendix: Verification Application

Notes

1. ORGANIZATIONCONTACT INFORMATION

The Organization making the application should be the same Organization to whom the Verification Statement will be issued. The Organization may consist of several entities (such as a forest source and processing facilities) which can be included in the scope of the verification. Information on these is given in section 3b and 3c. In case of multiple sites covered under the scope of the same verification Statement the assessment will be carried out as a multi-site verification.

2. TYPE OF VERIFICATION REQUIRED

There are two types of legality verification offered:

  1. Verification of Legal Origin (VLO) focuses on the possession of mandatory approvals, permits, and documents required by the specific permitting framework of the country involved.
  2. Verification of Legal Compliance (VLC) expands upon the basic component of legal origin and encompasses a more comprehensive selection of laws relating to environmental protection, wildlife, water and soil conservation, harvesting rules and practices, worker health and safety, and fairness to communities.

Note: Timber producers and all downstream entities wishing to be verified must have in place a robust Chain of Custody system to allow tracking of material back to a verified source. If you are not sure of which service to request then please contact the Rainforest Alliance Regional Representative or the Regional Office for advice.

3. BUSINESS BACKGROUND

Please check all business-type boxes in section 3a applicable to the Organization making the application, even if there are some Organization facilities that will not be included in the scope of the assessment. The Organizationsites and products that will be included in the verification scope should be listed in sections 3d.

There may be other companies in your supply chain (either upstream or downstream) that you wish to have verified. If so, list these in section 3b. These siteswill be assessed as part of a multi-site arrangement with your Organization, or as separate organizations who will receive their own Verification Statements.

If the scope of the verification includes forest management enterprises (FMEs), please fill in the required information in section 3c.

NEXT STEP

Thank you for taking the time to complete the Application. The information you provided will help us provide you with an effective and efficient verification service. If you should have any queries on the Application or Rainforest Allianceverification services please contact your local Rainforest Alliance representative or the Regional Office.

VLO/VLC Application 01May12 (VER-02)Page 1 of 4

[1] See Appendix at end of document for application instructions