AfriCert / Application for Rainforest Alliance Audit Services(Group)

Application Form for Rainforest Audit Services

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 r text there- it will be written in the right font. In tables use the empty lines and add additional table lines if necessary (table/add/lines). In the selection-boxes, simply click on your selection and an “X” will appear.
NB:Please fill out all the blank areas in the form. Complete this form in print, typed or in any other electronic format and send it to and Incomplete forms will be returned to the sender for proper filling.
  1. GENERAL INFORMATION ON THE ORGANIZATION SEEKING CERTIFICATION

Legal name of the organization seeking certification / Legal registration N
Legal mailing address / Email
Website
Postal Address / P.O box Fax
Postal Code Telephone
Trade name or d/b/a name (how the group is commonly known)
Preferred name to be used on the audit report and certificate
Legal Status (ownership)
Contact person for certification / Owner or legal representative signing legal agreements
Name / Name
Position / Position
Telephone / Telephone
Postal Addess / Postal Address
Email / Email
Sales representative (contact person for product traceability processes) / Contact person for the farmer cooperative representing group members / Group Administrator (if any) .
Name / Name
Position / Position
Telephone / Telephone
Postal Address / Postal Address
Email / Email
Name and address of Holding company*:
* If the applying company/group is a part of a holding company Legal mailing address / Address
Email
What type of entity will hold the group certificate? Check only one:
Membership groups or Private farm organization (e.g., cooperative or producer association)
Farm with product suppliers
Multiples farms of a single owner
Traders and Suppliers
Federation of groups, unions
Communal lands e.g. Ethnic or religious groups.
Local service provider
Government as a facilitator
How many member farms belong to the group, in total? / Number
Total number of owners of these farms: / Number
Total number of hectares (incl. production and other areas): / Number
How many of these member farms are to be included in the requested group certificate? / Number
Total number of hectares to be certified. / Number
How many of the group members that will be included in the certificate are there? How many are males and how are females? (This should reflect names recorded in the registry of group members.) / Number
# females / # males
Type of audit requested (select one): / Certification audit / Annual audit / Verification audit
Any Other (Specify)
Preferred audit date (Specify Month)
If the organization has been audited previously, have there been any changes since the last audit that affect the audit scope (i.e., changes in land area, crops, or group members)? / Yes (please specify): / No
Is the group certified or verified with any other organization? / Yes / No
If YES, please check all current valid certifications or verifications: / UTZ Certified / Organic / Global Gap
Fairtrade / 4C Association / Other (specify):
Has the group previously been Rainforest Alliance Certified TM ?
Yes / (If YES, provide the former Registration /certificate number and the time period during which the group was certified) and name of the certification body. / No
Does the organization administer other farms or groups not included in the scope of the audit?
Yes / (If YES, please specify) / No
  1. GROUP LOCATION

Town or city / Municipality / District
County / Province, State, or Department / Country
Physical address / Please provide the street address and directions to the group administrator office.
Location coordinates: coordinates must be taken at a point within the group of farms for which certification is requested. Please provide latitude and longitude coordinates in decimal degrees with five decimal places.
Latitude: / Longitude: / Altitude (meters):
Location of the reading: / Describe where this coordinate was recorded (e.g. main road through member farms)
Group area boundaries (not mandatory but strongly recommended to facilitate the audit process). Please provide a shapefile or KML file indicating the geographic extent of the member farms, i.e., a polygon surrounding member farms. / Provide link here, or e-mail file to the certification body
Group farm locations (not mandatory but strongly recommended to facilitate the audit process). Please provide a shapefile, KML file, or list of coordinates indicating the point locations of member farms. / Provide link here, or e-mail file to the certification body
  1. FARM AREAS AND LAND USES

Please provide the following information for the sum total of all areas within group member farms included in the certificate scope, plus any areas held in common by the group, such as processing areas or natural reserves.

Total area within the scope of the requested certificate / Area (ha)
Total area designated for agricultural crops / Area (ha)
Total area designated for conservation management (land dedicated to conservation or environmental protection on a long-term basis, including conservation set-asides and environmentally sensitive areas that have been kept out of production such as steep slopes and riparian buffers) / Area (ha)
How many hectares designated for conservation management are under strict preservation (i.e., no harvesting or other activities)? / Area (ha)
How many hectares designated for conservation management are being managed for restoration? / Area (ha)
Do you have records of farm land use or changes to farm land use from 1999 to the present time? / Yes / No
Have any natural ecosystems been altered or cleared on member farms after November 1999? / Yes / No / Unknown
Land holdings of group member farms: Please indicate the number of member farms within the certificate scope that fall into each of the following farm size categories. This information should be based on the registry of group members.
Less than 1 hectare / Number of group members
1 - 1.99 hectares / Number of group members
2 - 4.99 hectares / Number of group members
5 - 9.99 hectares / Number of group members
10 - 99.99 hectares / Number of group members
100 hectares or larger / Number of group members
Land area under cultivation within group member farms: Please summarize land area under cultivation on member farms by indicating the number of member farms within the certificate scope that fall into each of the following categories. This information should be based on the registry of group members.
Less than 1 hectare / Number of group members
1 - 1.99 hectares / Number of group members
2 - 4.99 hectares / Number of group members
5 - 9.99 hectares / Number of group members
10 - 99.99 hectares / Number of group members
100 hectares or larger / Number of group members
Please fill in the group farmers list with the following headings.
No or code / Farm name / Owner name / Address / Location / Region / Product / Total Farm size (Ha) / Production Ha / Production of the farm (final product e.g. green coffee, in Kg)
Detailed information about the group
Specify the infrastructure at the farm (mark all the options that apply)
Facility Number(s)
Office(s)
Plant nursery
Warehouse
Laboratory
Workshop for vehicles
Store
Processing area /factory
Health care center / hospital / Facility Number(s)
Employee’s dining room
Boilers
Gasoline or diesel storage
Housing for workers
Waste treatment area
Airport (AirStrip for loading fertilizer)
Irrigation system
Pumping station /hydro electric
Specify the types of water resources present in the farm (mark all the options that apply) / Rivers / Streams
Dams
  1. FARM CROPS AND PRODUCTION LEVELS

Please indicate recent and anticipated production levels by completing a separate row of the following table for every crop that is included in the scope of the requested certificate. Land areas and quantities harvested should reflect the sum total for all group member farms within the certificate scope. For “total quantity harvested,” please enter actual quantities for prior time periods and estimated quantities for future time periods, for each year within the three-year duration of the certificate. For instance, when applying for a new certificate, please provide estimated quantities for all three years. When applying for an annual audit in the second year of the certification cycle, please provide actual quantities harvested in the first year of the certification cycle and estimated quantities for the second and third years.

Crops to be certified. Refer to the SAN List of Authorized Crops for Certification.

Crop (common & scientific names.) / Variety or varieties / Total area planted of this crop (hectares) / Harvest period / Total quantity harvested in each 12-month period / Kg per Ha / Units (kg or other unit for quantity harvested) / Product type (see instructions)
Year 1 / Year 2 / Year 3
  1. PRODUCT HANDLING, SALES, PROCESSING, AND LABELING

Types of sales: How does the group sell its products? Please check all that apply:
The group sells raw materials (un-processed agricultural products) / Yes / No
The group sells processed or dried raw materials (e.g., fermented cocoa or roasted coffee beans) / Yes / No
The group processes raw materials into value-added products / Yes / No
If YES, what finished products does the operation produce?
The group retails finished products / Yes / No
Product handling and processing
Does the group buy products from non-certified farms or groups? / Yes / No
If YES, please describe:
Does the group receive certified and non-certified products in the same facilities? / Yes / No
If YES, please describe:
Does group mix, split, or repackage Rainforest Alliance CertifiedTM products with non-certified products, or does the group intend to do so? / Yes / No
If YES, please describe:
Does the group receive products at more than one site (e.g., more than one mill, factory, or processing facility)? / Yes / No
If YES, please describe:
Does your group use the Rainforest Alliance Certified Seal on product or off-product? / Yes / No
If YES, please describe:
Product flow (traceability) – Kindly fill in details under the following headings. Add more rows if required.
Name of first buyer of your crop / Location (city, country) / Contact details (name and email) / Annual quantity (tons, kg or boxes)
  1. LABOR

Please answer the following questions by indicating the sum total of workers employed, including:

a)Workers on all group member farms employing at least five individuals each. This includes employees involved in planting, tending, and harvesting crops; crop processing; and farm administration and management.

b)Workers employed by the group administrator as managers or office workers, trainers or technical staff, factory or processing workers, or similar occupations.

Please include all workers that were employed at any time during the past 12 months, including seasonal workers.

Summary of full-time, year-round workers: / Number of full-time year-round female workers: / Number of full-time year-round male workers:
Summary of part-time, year-round workers: / Number of part-time year-round female workers: / Number of part-time year-round male workers:
Summary of seasonal or temporary workers (includes both full-time and part-time): / Number of temporary and seasonal female workers: / Number of temporary and seasonal male workers:
Total number of workers employed by the group administrator and all member farms (should equal the sum of the six numbers above): / Total number of workers:
At peak harvest time, the temporary workforce is about how many people?
Are there labour organizations or unions active at the farm? Please describe.
If there is a labour or union active, please specify contact details.
How many members does the labour organization or the union have?
Farm labor: Please estimate the percentage of member farms that use each of these labor models. Percentages should sum to 100%.
Predominately family labor / Number of member farms
Family labor supplemented by seasonal paid labor / Number of member farms
Family labor supplemented by year-round paid labor / Number of member farms
Paid labor is the primary source of labor / Number of member farms
Mechanization: Please estimate the percentage of member farms with each level of mechanization. Percentages should sum to 100%.
Un-mechanized: farms rely almost exclusively on hand tools or draft animals / Number of member farms
Semi-mechanized: farms supplement hand tools with some motorized farm implements (e.g., rent or hire a tractor to plow or weed on a seasonal basis) / Number of member farms
Mechanized: motorized farm implements are used throughout the farming cycle / Number of member farms
Sub-contracted Activities
List all companies or persons that you have sub-contracted activities e.g. Crop protection product application).
Company/person name / Contact details / Activity
  1. TRAINING

Did group members or their employees receive training or support during the past year? / Yes / No

If YES, please complete the following table to summarize training or support provided to individual farmers (i.e., group member farmers). If your group certificate includes larger farms that employ five or more workers each, please also include training or support provided to farm workers on these larger farms. Do not include training of group administrator employees or workers in processing operations. Training or support includes classroom training, field demonstrations, farmer field schools, and other forms of hands-on learning and support. Please complete one row for each topic on which training or support was provided. To fill in the first three columns, please use the categories listed below.

Training topic (see categories below) / Who provided the training? (see categories below) / Who received the training? (see categories below) / What crop was the primary focus of the training? / How many people were trained?
females / males
Categories for the “training topic” column (please use the corresponding number in the table above) / Categories for the “who provided training” column (please use the corresponding number in the table above) / Categories for the “who received training” column
Environmental /
  1. Ecosystem conservation or wildlife protection
  2. Water quality protection (including water treatment)
  3. Integrated waste management
  4. Climate change adaptation or mitigation
/ Organization staff or representative /
  1. Group administrator staff or representatives, such as extension workers or trainers
  2. Lead farmers
  3. Plantation technical staff (e.g., staff agronomists or foremen)
/
  1. Hired workers
  2. Individual farmers (typically group members within group certificates)

Social /
  1. Fair treatment of workers (e.g., hiring practices, labor practices, discrimination)
  2. Occupational health and safety
  3. Community relations
/ SAN member /
  1. CEFCA (Côte d’Ivoire)
  2. FIIT (Guatemala)
  3. Fundación Natura (Colombia)
  4. ICADE (Honduras)
  5. Imaflora (Brazil)
  6. ProNatura Sur (Mexico)
  7. Rainforest Alliance
  8. RSPB
  9. SalvaNatura (El Salvador)
  10. Other SAN member

Agronomic /
  1. Crop selection, rehabilitation or replanting
  2. Integrated pest management
  3. Pesticide selection, storage, safety, or record-keeping
  4. Water management (including irrigation)
  5. Nutrient management or soil fertility management
  6. Soil conservation (e.g., erosion control)
  7. Product quality, hygiene, or food safety
  8. Livestock management

Other organization /
  1. Other non-governmental organization, research center, or university
  2. National or local government extension service
  3. Representative or technical staff of a trader, buyer, or retailer
  4. Representative or technical staff of a farm input or equipment company (e.g., pesticide company)
  5. Private consultant
  6. Other

Farm systems /
  1. Farm planning, record-keeping, or social/environmental management systems
  2. Farm business management (including financing and financial book-keeping)

  1. ADDITIONAL DETAILS

Indicator collection
This information is helpful for making a quote but not a requirement at this point.
Once you agree that we conduct an audit you will be asked to fill out this table with specific indicators about your group. Rainforest Alliance has the objective to measure the social, environmental and economic impact of its work to better demonstrate its benefits to farmers and buyers of certified products. The collected data are used on a confidential basis and farmers and the public in general will be informed of the results once available.
Water consumed (Liters/month)
Wastewater treated (Liters/month)
Pesticides / Class I / Class II / Class III
Others
Strict reserve area (hectares)
Conservation area (hectares)
Species identified on the farm / flora / fauna
Stream sides and water bodies (km)
Local workers / male / female
full-time
part-time
Non-local workers / male / female
full-time
part-time
Employees / total
Minors benefited with education
Do workers have access to potable water? / Yes / No
Do full-time workers earn at least $2/day? / Yes / No
Number of serious accidents
Amount of certified product (kg, L or units) / produced / sold as certified
Markets the certified products is sold to: (kg, L or units) / domestic / international
%
enter text.% / .%
  1. STATEMENT AND SIGNATURES

  • I attest that the information provided in this application is accurate and complete, to the best of my knowledge.
  • I have read and understood the current versions of the Sustainable Agriculture Network Standard for Sustainable Agriculture and Standard for Sustainable Cattle Production Systems (if applicable).
  • I have read and understood and I am committed to comply with the certification requirements.
  • I acknowledge that [Certification Body] may subcontract auditors to carry out the service requested.
  • I will provide all necessary information to auditors in order to evaluate the member farms, the group administrator, and all facilities and activities within the certificate scope.
  • I will keep a record of all claims presented to my organization in relation to product compliance with the relevant standards and will make these records available to [Certification Body]. I shall take adequate actions in regard to such claims as well as to any deficiency of products or services which may affect compliance with certification requirements. I shall document actions taken.
  • I will make certification claims only in relation to the certification scope.
  • I shall not employ the certified product in a way that [Certification Body] loses prestige and will not include any declaration of certified product which may be considered as erroneous or unauthorized by [Certification Body].
  • Upon suspension or cancellation of certification, I will discontinue use of all public affairs that contain any reference to certification, and return all certification documents that [Certification Body] may request.
  • I will use certification only to indicate that certified products are in conformity with specific standards.
  • I will make an effort to guarantee that neither the certificate nor the report, nor any parts of these, are employed in a misleading manner.
  • I will comply with [Certification Body]’s requirements when mentioning product certification in media such as documents, brochures or publicity.
  • I acknowledge, without limitation, the decision of [Certification Body] regarding processing of this application.

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 SAN standards and policies (this can be downloaded free of charge from as well as the current Use of Seal Guidelines or obtained from the information pack from AfriCert Ltd (delivery and printing cost charged to the client).
Approved in representation of: / Name of organization seeking certification
Date: / Indicate date
Full name of the client representative authorized to sign this Statement: / Indicate name
Client representative’s signature and Company stamp.

FOR AFRICERT’S USE ONLY: