CHAIN OF CUSTODY CERTIFICATION APPLICATION

1. CONTACT INFORMATION

Organization Legal dba**: Name*: Date: Jurisdiction of Organization***: Type of Legal Entity: Primary Contact: Title: Mailing Address: City: State/ Country: Prov: Email(s): Post. Code: Tel: Fax: Website: * For contracting purposes please ensure that your organization’s full legal name is listed above. ** ”doing business as”; i.e., trading name(s) *** jurisdiction (country/state/province) under whose law the entity is legally registered

2. BUSINESS DESCRIPTION Help us create a profile of your business to plan for your Chain of Custody certification audit. a) BUSINESS TYPE Please state the nature of your enterprise: Secondary producer Primary producer Broker / Trader / Agent (all other processing/ (farm or group administrator) (no physical possession of products) manufacturing) Distribution / Wholesale (physical possession but no Retailer (sell to end user) Other change to product) b) GENERAL DESCRIPTION Please provide general description of business operation, including details on the purchase, production and sale of Rainforest Alliance CertifiedTM products.

Please attach flowchart of materials originating from Flowchart submitted with application. certified farms, identifying all processing and critical Flowchart not available at time of application. mixing points. c) ORGANIZATION AND/OR SUPPLY CHAIN FACILITIES Briefly specify type and number of sites (e.g., factory, warehouse, shop) and addresses of sites to be included in the CoC certificate, if different from your principal address above:

SAN/RA CoC Application 1May12 (CoC-72) Page 1 Number of sites to be included in the Chain of Custody certificate:

Business Type (e.g., Site/Organization Name warehouse) Physical Address

3. RAINFOREST ALLIANCE CERTIFIED PRODUCTS This information will be requested by the Certification or Inspection Body prior to providing a cost proposal; please complete to the best of your knowledge. a) MARKETPLACE REGISTRATION Is organization registered on If yes, when did Yes On or before 1 Feb 2012 Rainforest Alliance Certified organization register on No After 1 Feb 2012 Marketplace? Marketplace? If registered AFTER 1 Feb 12 please provide date: b) RAINFOREST ALLIANCE CERTIFIED INPUTS and PRODUCTS N/A Please use the table below to describe all Rainforest Alliance Certified inputs and products purchased, handled, processed and/or sold through facilities included on application (See examples in first 2 rows):

INPUTS to RAC PRODUCTS products (Incoming Origin of the produced/sold by Type of site material/ingredients) input site Destination EXAMPLE 1: Storage Green coffee  Dry mill YY  Green coffee in 100  Exporting warehouse  Farm x2 pound sacks  Roasting and  Farm x3  Green coffee packed grinding in factory in 1 pound bags ZZ  Local consumption – supermarkets EXAMPLE 2: Bananas  Farm B1  Banana puree  Exporting Processing and  Farm B2  Local consumption packing plant

c) OUTSOURCING N/A Please specify if you plan to outsource any part of Rainforest Alliance Certified product handling and/or production to contracted facilities (include a description of potential outsourced activities and number of contractors to be used).

Please use attached RAINFOREST ALLIANCE REGIONAL OFFICE CONTACT MATRIX for submitting your application based on the location of Organization’s main office. By signing below, I acknowledge that the information included on application is true and correct. Signed: Name: Date: Title:

SAN/RA CoC Application 1May12 (CoC-72) Page 2 APPLICATION CONTACT PAGE FOR SAN/RA CHAIN OF CUSTODY CERTIFICATION

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.

Rainforest Alliance Regional Office / Region Contact Details Partner Organization Africa, Turkey [email protected] Africa Regional Office 36 Abotsi Street, East Legon; Accra, Ghana Tel: +233(0)302 50221 Asia, Australia, New [email protected] Asia-Pacific Regional Office Zealand, India 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 Canada [email protected] Canada Regional Office Box 1771, Chelsea, QC, Canada, J9B 1A1 Tel (819) 827-8278 Fax (866) 438-1971 Costa Rica, Nicaragua, [email protected] Mesoamerica Regional Office Panama and 8ª. Avenida 15-62, Zona 10 Caribbean Guatemala City, GUATEMALA Tel (+502) 2383 5757 Fax (+502) 2383 5788 Europe, Turkey, Russia Contact NEPCon: [email protected] NEPCon and Israel Peru and Bolivia [email protected] South America Regional Office Calle Manual Ignacio Salvatierra 359 (2˚ Piso) Santa Cruz, BOLIVIA Tel +591 3 332-5042 Fax +591 3 332-7451 United States of [email protected] US Regional Office America 801 Highway 3 North, Suite 200 Northfield, MN 55057 Tel (507) 663-1115 Fax (507) 663-7771

SAN/RA CoC Application 1May12 (CoC-72) Page 3