Registration Form-
Cocoa |
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Account Information
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Fields marked with an asterik (*) are required to complete the form. |
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Mailing address
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Visiting address
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Address Line 1
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Address Line 1
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Address Line 2
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Address Line 2
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City
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City
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Postal Code
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Postal Code
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State :
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State :
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Country
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Country
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Fax Number
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Website
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Fiscal Number / VAT Number
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Hide Company in Member Directory
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Primary Contact
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Contact Person Information
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Contact Type
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Is this the primary contact? (A primary contact can manage member information and user settings)
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First Name
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Last Name
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Title *:
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E-mail *:
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Position
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Member Information
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Estimation of annual buying volume in cocoa bean equivalent
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MT
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Do you buy or sell pure cocoa products?
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Products to Certify
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Activities
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When are you planning to get certified?:
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Expected Certification Date (if available)
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Preferred Certification Body
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Name
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Address
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Phone
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E-mail
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Other Certification Scheme(s) Certified
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Not applicable
Organic certification
Rainforest Alliance
Fairtrade
Other
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Please Indicate
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Certification Option
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Average harvest quantity in the last 4 years:
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Approximate number of workers
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Number of workers living on the farm:
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Number of family members living on farm on permanent basis(not including temporary employees)
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Pre Certification Information
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Did you receive any training or workshop on UTZ?
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Yes, training on UTZ program in (indicate country / year/month) by UTZ.
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Country
Year
Month
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Yes, training on UTZ program in (indicate country/year/month) by external person (name of person if possible).
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External Person
Country
Year
Month
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No, did not receive any trainings or workshops on UTZ
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Before participating in the UTZ program:
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Did producers have access to training on farm rehabilitation and good sanitation practices on the farms (e.g. pruning and removal of diseased plant material)?
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Did producers have access to technical advice or training on fertilizer use and dosages?
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Did producers have access to training on good harvest and post harvest practices?
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Did producers have access to training on safe use, storage and transportation of agrochemicals and packaging?
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Which of the following environmental conservation practices did you apply?
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Protection of water streams
Forest Protection and Conservation
Reforestation
Not applicable
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Did the producers receive information on child labor and the importance of school attendance?
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Did you have a system in place to document cocoa revenues and communicate them to the group members?
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Did persons that apply hazardous crop protection products receive training?
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Did persons that apply hazardous crop protection products use adequate protective clothing?
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Were there first aid kits and/or people trained on first aid and emergency procedures available on central locations of the cooperative?
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Name of parent company:
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Main Brands
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Brand 1
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Brand 2
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Brand 3
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What Countries Do You Buy From?
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To Which Countries Do You Sell?
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Do you intend to sell products with an UTZ claim?
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Do you approve that we use your company name for our marketing activities?
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Serving UTZ product to employees? (via caterer, restaurant, coffee machines)
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Serving UTZ in Shops?
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Serving UTZ to Customers/visitors?
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Who is your supplier?
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Interested in in-company communication?
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Remarks
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Terms and Conditions
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Select Signing Person
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Thank you for registering with UTZ. Your information has been successfully submitted and is now being processed. You will receive a confirmation email with your login details for the Good Inside Portal within three working days. If you have any questions, please contact techsupport@utz.org
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