Application No:______
Received Date: ______
LOW-CARBON OFFICE OPERATION PROGRAMME (LOOP)
APPLICATION FOR REGISTRATION AS REGISTERED LOOP VERIFIER
Notes for the Applicant:
1. Please complete the form from Part I to Part III.
2. For details of the requirements on registration as a registered LOOP verifier, please refer to the document titled “Low-carbon Office Operation Programme: Guide to Registration as Registered LOOP Verifiers” which is available on the official website http://www.wwf.org.hk/loop of the Low-carbon Office Operation Programme (the Programme) under Verification Service.
3. Please ensure that all relevant parts of this form are completed and the information is accurate. If there is insufficient space, please give details on separate sheets and attach the sheets to this form.
4. Please return the completed form attaching the necessary supporting document i.e. staff experience records, job references, training records, etc. to the Secretariat of the Programme at the address listed on Page 1 of this form.
5. This is a registration of Registered LOOP Verifiers ONLY and there is NO contractual relationship between the Applicant as one party and the Secretariat of the Programme at WWF Hong Kong as the other party. The Secretariat of the Programme at WWF Hong Kong bears no responsibilities on any liability and cost incurred by the Applicant in connection with the activities related to this registration.
6. Valid Business Registration Certificate issued by competent authorities.
7. The information provided in this form will be used for processing the application for Registration as a Registered LOOP Verifier under the Programme.
8. The Secretariat of the Programme has adopted a Privacy Policy. Information about the policy is available at the official website http://www.wwf.org.hk/loop of the Programme.
If you do not want to receive promotional materials from WWF Hong Kong, please mark a “x“ in the box on the left.
LOW-CARBON OFFICE OPERATION PROGRAMME (LOOP)
APPLICATION FOR REGISTRATION AS REGISTERED LOOP VERIFIER
/ For Official Use Only /PART I: Particulars of the Applicant
1. Company Name
2. Company Address / (Building)
(Street)
(District)
(City)
(Postcode)
3. Contact Person / Mr Ms
4. Position
5. Telephone / ( )
6. Fax / ( )
7. Email
8. Website (if any)
9. Year of Establishment
10.Business Registration Number (see note 6)
11. Number of Employees in Hong Kong
12. Number of Employees Outside Hong Kong (Please specify location)
/ Part I
PART II: Particulars of Staff Member to be registered as LOOP Verifier
1. / Name / Mr Ms
Position
Tel. / ( )
Curriculum Vitae
Job Reference
2. / Name / Mr Ms
Position
Tel. / ( )
Curriculum Vitae
Job Reference
3. / Name / Mr Ms
Position
Tel. / ( )
Curriculum Vitae
Job Reference
4. / Name / Mr Ms
Position
Tel. / ( )
Curriculum Vitae
Job Reference
Please add new lines here for particulars of more staff members
/ Part II
1.
2.
3.
4.
PART III: Supporting Documents to be Enclosed with this Application
Please check the boxes below for supporting documents attached to the application form:
1. General
Copy of Business Registration Certificate (see note 6).
2. Registration as a Registered LOOP Verifier
Relevant job references of the company/organization in Hong Kong with track records in practical consulting experience in projects related to carbon accounting and energy management, environmental and sustainability management, or equivalent.
Information of a maximum of three completed projects in Hong Kong including contact information of the clients of these projects. Such information of projects and client contacts will be made available to the public upon registration of the organization as a Registered LOOP Verifier. / Part II
1.
Part II
2.
PART IV: Declaration
I/We, the undersigned,
(a) confirm that the information given in this application as well as the accompanying information is true and correct that reflects the status of affairs as at the date of submission. I/We understand that any inaccurate/incomplete information supplied in this application will delay my/our application for registration as a Registered LOOP Verifier under the Low-carbon Office Operation Programme (the Programme). I/We shall inform the Secretariat of the Programme immediately if there are any subsequent changes to the information provided in this application; and
(b) agree that when my/our company is registered as a Registered LOOP Verifier, I/we will issue a code of conduct for my/our staff involved in the verification/assessment using the methodology of the Labelling Scheme of the Programme.
(c) have obtained consent from our clients of those project experiences attached to this application to release their contact information for reference by the public upon registration of my/our company as a Registered LOOP Verifier.
Authorized Signature of Applicant
with Company Seal :
Name (IN BLOCK LETTER) :
Position :
Date :
- END - / Part III
/ Part III
1.
Part III
2.
For Official Use Only
Remarks:
Recommendations:
Registration accepted
Registration Reference:
Further information required (please specify):
Registration declined (please specify the reasons):
Checked by: The LOOP SecretariatDate:
(3 April 2012) / Page n°: / 4 of 5
Document: / Registered LOOP Verifiers Application Form 20120326 / Revision n°: / 2