CARBON PROJECT
VALIDATION, VERIFICATION,
ASSESSMENT
APPLICATION
1. CONTACT INFORMATION
Company Legal Name:
dba*:
Date:
Jurisdiction of
Company:
Type of Legal Entity:
Primary Contact:
Title:
Mailing Address:
City:
State/
Prov:
Country:
Email(s):
Tel:
Post. Code:
Fax:
Website:
* ”doing business as” – for contracting purposes please ensure that your company’s full legal name is listed above.
2. PROJECT INFORMATION
Project Title:
Nearest City:
State:
Country:
Project Proponent:
Organization Type:
3. PROJECT DETAILS
Project Type(s):
Afforestation:
Reforestation:
Improved Forest Management
REDD / Avoided Conversion
Agricultural Land Management
Other:
Total Project Area:
Land Tenure:
Hectares
Acres
Number of Sites:
Private Company
Public Agency
Group or Co-operative
Community / Indigenous Land
Other:
Project Start Date:
Estimated total emissions reductions / sequestration:
Rainforest Alliance Carbon Application 01May12 (C-10)
Project Length:
tonnes CO2e per year
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tonnes CO2e over project life
Brief Description of Project:
4. SERVICE OF INTEREST FOR PROPOSAL
VCS = Verified Carbon Standard, CCBA = Climate, Community, Biodiversity Alliance, ACR = American Carbon Registry, CAR =
Climate Action Reserve
VCS Validation
Name of methodology used:
Is Methodology VCS approved:
Yes
No
Submitted for VCS
MAP
PDD Status:
Not started
In progress
Complete
Risk assessment and buffer
determination status:
Not started
In progress
Complete
Market leakage assessment (REDD or
IFM projects only)
Not started
In progress
Complete
VCS Methodology Approval Process
1st
Assessment requested:
2nd
If 2nd, state the 1st assessor:
VCS Verification
Name of methodology used:
Monitoring Report Status:
Not started
In progress
Complete
Not started
In progress
Complete
Not started
In progress
Complete
CCBA Validation
PDD Status:
CCBA Verification
Monitoring Report Status:
CAR Verification
Date project was submitted to the Reserve:
Initial site verification
Yes
No
Verification type:
Desk review
Site visit
CarbonFix Certification
Project status:
Not yet submitted
for pre-validation
Submitted for prevalidation
Pre-validation
complete
Plan Vivo Verification
Project status:
Validation
Rainforest Alliance Carbon Application 01May12 (C-10)
Project
Validation
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requested
undergoing validation
complete
Please detail the service requested:
ACR Verification
Project status:
Not yet submitted for eligibility
screening
Eligibility screening
completed
GHG Project Plan Status
Not started
In progress
Compete
GHG Assertion Status
Not started
In progress
Compete
Please detail the service requested:
Other carbon evaluation type
Please detail the service requested:
When would you be ready for evaluation?
Name:
Date:
5. CONFLICT OF INTEREST DISCLOSURE
It is the policy of the Rainforest Alliance to ensure that there is clear transparency and
independence in our carbon validation and verification program and decision-making
processes and to identify and address any actual or potential conflicts of interests
involving Rainforest Alliance and any party with whom we enter into an agreement. To
assist us in complying with this policy, please Identify any potential conflict of interest
regarding the requested services within this application1. If no known conflict of interest
is identified please indicate “No known conflict of interest”.
Potential or Real Conflict of Interest:
No known conflict of interest
1
Examples of potential conflict of interest would be any situation that would compromise Rainforest
Alliance’s ability to perform a wholly independent validation or verification of the requested service identified
in this application.
Rainforest Alliance Carbon Application 01May12 (C-10)
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- Application Contact Page Please use the following Rainforest Alliance Regional Office contact matrix for submitting your
application. Please use the location of your project site to select a regional office. Applications for
methodology reviews or multi-regional projects should be sent to the global address.
Region
Global
Africa
Asia, Australia, New
Zealand
Brazil
Canada
Central America,
CARICOM/Caribbean
Europe and Russia
Mexico
South America
(except Brazil)
United States of
America
Contact Details
jnunery@ra.org
Jared Nunery
Carbon Technical Specialist
Rainforest Alliance
65 Millet St., Suite 201
Richmond, VT 05477 USA
Tel: +1 802 - 434 - 8732
Fax: +1 802 - 434 - 3116
RACert.Africa@ra.org
RACert.AsiaPacific@ra.org
Pertokoan Griya Alamanda, Blok No. 17
Jl. Kapten Cokorde Agung Tresna, Lingkungan
Jayagiri, Kelurahan Dangin Puri Kelod, Kecamatan
Denpasar Timur
Denpasar – Bali INDONESIA 80234
Tel (+62) 361/256-689
Fax (+62) 361/256-634
Contact, Imaflora
Rua Chico Mendes 185, Caixa Postal 411
Piracicaba, Sao Paolo, BRASIL 13400-390
Tel/Fax (+55) 19/3414-4015
RACert.Canada@ra.org
3-929 Beach Blvd
Hamilton, ON L8H 6Z6
Phone: 647-899-7214
Fax: 866-438-1971
RACert.Mesoamerica@ra.org
8ª. Avenida 15-62, Zona 10
Guatemala City, GUATEMALA
Tel (+502) 2383 5757
Fax (+502) 2383 5788
Contact NEPCon
raswmesoamerica@ra.org
Margarita Maza de Juárez 422, Col.
Centro Oaxaca, Oaxaca,
MÉXICO CP 68000
Tel/Fax +52 (951) 502-6473 / 502-6532 / 132-8567
RACert.SouthAmerica@ra.org
Calle Manual Ignacio Salvatierra 359
(2˚ Piso)
Santa Cruz, BOLIVIA
Tel +591 3 332-5042
Fax +591 3 332-7451
RACert.US@ra.org
801 Highway 3 North, Suite 200
Northfield, MN 55057
Tel (507) 663-1115
Fax (507) 663-7771
Rainforest Alliance Carbon Application 01May12 (C-10)
Rainforest Alliance Regional Office /
Partner Organization
Headquarters
Africa Regional Office
Asia-Pacific Regional Office
Imaflora
Canada Regional Office
Mesoamerica Regional Office
NEPCon
Mesoamerica Regional Office – Mexico
South America Regional Office
US Regional Office
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