AfriCert
Application for SAN Climate Module Verification
Application Form for SAN Climate Module Verification for Groups
How to fill in the form:
If you see a grey field after the title or text, such as this one
, please click with the mouse on this grey field and
write you text there- it will be written in the right font . In tables please use simply the empty lines and add additional table
lines if necessary (table/add/lines). In the selection-boxes, simply click or on your selection and an “X” will appear.
Complete this form in print, typed or any other electronic format and send it to applications@africertlimited.co.ke and
info@africertlimited.co.ke Incomplete forms will be returned to the sender for proper filling.
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Name of the Farmer group:
Contact Person
Name
Relationship to farmer group/
Position:
Type of Process:
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Product(s):
Scenario of verification:
Cell:
Email:
Initial Verification
Annual Verification
Desk Verification
Re-Verification
Scenario 1: Inclusion of all certified member farms in the group
Total Number of Farmers:
Total hectares:
Scenario 2: Inclusion of predetermined number of certified member farms
Total Number of Farmers:
Farmers to be included in the SAN Climate Scope:
Hectares to be included in the SAN Climate Scope:
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Traceability
Non-certified product is not handled at the facility and all members farms
will be included in the scope of the SAN Climate Module
All member farms are certified, but Scenario 2 will apply and just a
percentage of them will become SAN Climate Module verified.
Certified and non-certified product is handled in the facility. Scenario 1 will
apply and from the certified farmers, 100% will be verified with the SAN
Climate Module
Certified and non-certified product is handled in the facility and scenario 2
will apply, since not all member farmers will be included in the verification
scope of the SAN Climate Module.
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Have you included plans for
Yes
No
mitigation and adaptation to climate
change in the Social and
Please describe briefly:
Environmental Management Policy?
Has the Group Administrator or a
member farm conducted and/or
participated in training events on this
subject?
Has the Group Administrator
identified the main sources of
Yes
No
greenhouse gas emissions in the
member farms and in its own
If so, please describe the list of components included ( i.e., fuels, fertilizers):
Form No.
Written by/date
Authorized by/date
Revision date (yymmdd)
Page
AC 01h
FM/ 2015
CM/ 2015
150703
1 of 3
AfriCert
Application for SAN Climate Module Verification
operations?
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What actions has the Group
Yes
No
Administrator promoted to reduce
emissions in its own operations and
Please describe briefly:
member farms?
Has the Group Administrator
If so, please briefly describe the methodology used for member farms and
conducted annual greenhouse gas
specific operations for that crop
inventories?
Has the Group Administrator
Yes
No
measured carbon reservoirs in the
group member farms?
Please briefly describe the methodology used:
Has the Group Administrator done an
Yes
No
inventory of the forestry component
in the group member farms?
Please indicate the date of the last inventory:
Do the Group Administrator and
Yes
No
member farms have residual water
treatment systems?
Please briefly describe the system used:
Do member farms keep records of
Yes
No
nitrogen fertilizer application?
Please describe briefly:
Is soil carbon stocks in soil
Yes
No
promoted in the group’s member
farms?
Please describe some of these practices:
Does the Group Administrator or
Yes
No
group member farms use irrigation
systems?
Please describe briefly:
Do the Group Administrator and/or
Yes
No
group member farms use machinery,
keeping record of fuel and/or energy
Please describe briefly:
use?
Do the Group Administrator and
Yes
No
group member farms implement
energy reduction measures and/or
Please describe:
use alternative sources?
Disclosure of information:
With the consent of the CB, a client’s general information can be availed in the CB’s website.
Avail information publically? Yes
No
Note: Operator applying for certification must have access to the applicable standards (this can be downloaded
free of charge from www.sanstandards.org
Or obtained from the information pack from AfriCert Ltd (delivery and printing cost charged to the client).
Date:
Name (Authorised Signatory):
Signature: __________________________
Company stamp:
FOR AFRICERT’S USE ONLY:
Form No.
Written by/date
Authorized by/date
Revision date (yymmdd)
Page
AC 01h
FM/ 2015
CM/ 2015
150703
2 of 3
AfriCert
Application for SAN Climate Module Verification
Application reviewed and approved by:
Date of final review and approval:
Form No.
Written by/date
Authorized by/date
Revision date (yymmdd)
Page
AC 01h
FM/ 2015
CM/ 2015
150703
3 of 3