FSC®[1]CHAINOFCUSTODY (CoC)CERTIFICATION

APPLICATION

1.CONTACT INFORMATION

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

* “doing business as” – for contracting purposes please ensure the full legal name of the entity applying for certification is listed above and include any dba name(s) as applicable.

** Contract signatory must have legal authority to represent the organization.

2. BUSINESS BACKGROUND

Help us create a profile of your business to plan for your chainofcustody (CoC) assessment

a) BUSINESS TYPE

Please state the nature of your enterprise:

Primary manufacturing
(using roundwood logs as inputs) / Secondary manufacturing
(all other manufacturing) / Broker / Trader / Agent
(no physical possession of products)
Distribution / Wholesale
(physical possession but no change to product) / Retailer (sell to end user) / Converter of Paper Products
Other / Printers and Paper Merchants: Please complete the separate CoC applicationfor this category.

b) ORGANIZATIONFACILITIES

Briefly specify type and number of facilities (e.g., factory, sawmill, warehouse, shop) and addresses if different from your principal address above:

Total number of organizationfacilities:
Number of facilities to be included in the CoC certificate:

Facility name/ type:

(e.g., sawmill, warehouse) Physical Address:

c) FSCCERTIFIED PRODUCTION

If you are a manufacturer, please choose the CoC scheme, if known:
We will process FSC inputs separately from all other material: / We would like to manufacture FSC products that use both certified and non-certified inputs:

Please briefly describe what you are planning to do in terms of FSC certification, including inputs and outputs.

3. SIZE CLASS OF CERTIFICATE HOLDER(This will be confirmed during the audit)

Note: size class is based on all wood / wood fiber based products for FSC Accreditation Administration Fee (AAF) purposes. The AAF is determined each year based on the current FSC AAF policy.
Check / AAF Size Class / Annual Turnover ($USD)
Class 1 / < 200,000
Class 2 / 200,000 – 1,000,000
Class 3 / > 1 – 5 Million
Class 4 / > 5 – 25 Million
Class 5 / > 25 – 100 Million
Class 6 / > 100 – 500 Million
Class 7 / > 500 – 1,000 Million
Class 8 / > 1,000 – 2,000 Million
Class 9 / > 2,000 – 3,000 Million
Class 10 / > 3,000 – 5,000 Million
Class 10 + / > 5,000 Million
Group/Multi-site with Traders and Processors
Comments:
AAF size class has changed since last audit
Comments:

4. Planned Certificate Scope

This information will be requested by theRainforest Allianceprior to providing a cost proposal; please fill in to the best of your knowledge.

a) FSC-CERTIFIED INPUTS (current or potential)N/A

Please specify FSC-certified material inputs (e.g., logs, sawn timber, paper, board products).

b) NON-CERTIFIED VIRGININPUTSN/A

Please specify non-certified material inputs you would like use in FSC products (may be for FSC Mix and/or FSC Controlled Wood products).
Note: non-certified, virgin inputs shall comply with FSC Controlled Wood requirements (FSC-STD-40-005 or FSC-STD-30-010*).

c) NON-CERTIFIED RECLAIMEDINPUTSN/A

Please specify reclaimed (post & pre-consumer/post-industrial) material inputs (may be for FSC Mix or FSC Recycled products). Note: non-certified, reclaimed inputs shall comply withFSC requirements for reclaimed material inputs (FSC-STD-40-007*).

d) FSC CERTIFIED PRODUCTSN/A

Please specify products you plan to sell as FSCcertified.

e) FSC CONTROLLED WOOD PRODUCTSN/A

Please specify non-certified products that you plan to sell as FSC Controlled Wood. Note: FSC CW sales shall only be made to other FSC CoC certified companies.

f) OUTSOURCINGN/A

Please specify if you plan to outsource any part of FSC certified handling and/or production to subcontracted facilities (include a description of potential outsourced activities and number of subcontractors to be used).

g) MULTI-SITE CERTIFICATION Are you seeking multi-site CoC certification? Yes No

(If yes please complete supplemental CoC Application Appendix A)

h) GROUP CERTIFICATION

Are you seeking group CoC certification? Yes No

(If yes please complete supplemental CoC Application Appendix A)

* For more information regarding FSC ChainofCustody Certification and the standard requirements, please visit:

5. CHAINOFCUSTODY PLANNING

Are there companies in your supply chain that may want to become certified? / Yes No
If yes, please list company names:
Has your organization held an FSC certificate in the past? / Yes No
Name of certification body:
Certificate code:

By signing below, I acknowledge that the information included on application is true and correct.

______

Signature of authorized representativeDate

Rainforest Alliance CoC Application 18Oct16 (CoC-05)Page 1

- 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 certification.

Region / Rainforest Alliance Regional Office / Partner Organization
Contact Details
Africa / Contact Rainforest Alliance Africa Regional Office:

36 Abotsi Street, East Legon, PMB CT 435,
Cantonments, Accra, Ghana
Tel: +233 0207 50 22 10
Asia, Australia / Contact Rainforest Alliance Asia-Pacific Regional Office:

Jl. Tantular Barat No. 88 Yang Batu Kauh
Dangin Puri Klod, Denpasar Timur
Denpasar, Bali – Indonesia 80114
Tel: (62-361) 4723499
Fax: (62-361) 4723498
Brazil / Contact: IMAFLORA
Instituto de Manejo e Certificação Florestal e Agrícola
Estrada Chico Mendes, 185
Piracicaba - SP | Brazil
CEP 13426-420
Tel: +55 (19) 3429 0800
Imaflora
Delivering certification services in association with the Rainforest Alliance
Canada / Contact Rainforest Alliance Canada Regional Office:

PO Box 1771
Chelsea, Quebec J8V3B2, CANADA
Central America, CARICOM/Caribbean / Contact Rainforest Alliance Mesoamerica Regional Office:
8a. Avenida 15-62, Zona 10
Ciudad Guatemala, Guatemala
Tel: (502) 2300-6800
Fax: (502) 2383-5777
China / Contact: China Standard Conformity Assessment CO., LTD.
E-mail:
No.33 Zengguang Road, Haidian District,
Beijing P.R.CHINA 10004
Tel: +86(0)1068718768
Fax: +86(0)10 68437171
China Standard Conformity Assessment CO., LTD (CSCA)
Delivering certification services in association with the Rainforest Alliance
India,Bangladesh, Pakistan, Sri Lanka, UAE and Gulf Countries / Contact: Wood Certification Pvt. Ltd.
DSM-365, DLF TOWERS,
15, SHIVAJI MARG, MOTI NAGAR,
NEW DELHI-110015. INDIA
Tel: +91-11-45500485
Wood Certification Pvt. Ltd
Delivering certification services in association with the Rainforest Alliance
Japan / Contact: BSI Group Japan K.K.
Aoyama Building 5F, 2-12-28 Kita-aoyama, Minato-ku,
Tokyo, 107-0061, JAPAN
Tel: +81 3 6890 1172
Fax: +81 3 6890 1181
BSI Group Japan K.K.
Delivering certification services in association with the Rainforest Alliance
Mexico / Contact Rainforest Alliance Mesoamerica Regional Office - Mexico:

Privada Reforma #103
C.P. 34260
Colonia Porfirio Diaz
Durango, DGO, Mexico
Tel: +52 (618) 817-2050
New Zealand / Contact: AsureQuality
Email:
Level 1, 7a Pacific Rise
Mt Wellington, Auckland 1060, NEW ZEALAND
Tel: +64 9 573-8000Fax: +64 9 573-8001
AsureQuality
Delivering certification services in association with the Rainforest Alliance
South America
(except Brazil) / Contact Rainforest Alliance South America Regional Office:
Calle Asunción # 180 (esquina Libertad)
Edificio Copy Color, departamento 3A
Santa Cruz - Bolivia
Tel: +591 3 332-5042
Fax: +591 3 332-7451
United States of America / Contact Rainforest Alliance United States Regional Office:

19 Bridge Square
Northfield, MN 55057, USA
Tel: (507) 663-1115
Fax: (507) 663-7771

Rainforest Alliance CoC Application 18Oct16 (CoC-05)Page 1

[1]Rainforest Alliance is an FSC accredited certifier FSC® A000520