JCM_MV_F_Vrf_Rep_ver021.0

JCM Verification Report Form
A. Summary of verification
A.1. General Information
Title of the project
Reference number
Monitoring period
Date of completion of the monitoring report
Third-party entity (TPE)
Project participant contracting the TPE
Date of completion of this report
A.2 Conclusion of verification and level of assurance
Overall verification opinion

Positive
Negative

Unqualified opinion

Based on the process and procedure conducted, XXX(TPE’s name) provides reasonable assurance that theemission reductions for YYYY (project name)Are free of material errors and are a fairrepresentation of the GHG data and information, and

Are prepared in line with the related JCM rules,
procedure, guidelines, forms and other relevant
documents(If overall verification opinion is <State the reasons>negative, please check below andstate its reasons.)
Qualified Opinion
Adverse opinion
Disclaimer
A.3. Overview of the verification results
Item

Verification requirements

No CAR or CL
remainingThe
project The TPE determines the conformity of the actual
implementation with project and its operation with the eligibility criteria ofthe eligibility criteria the applied methodology.
oftheappliedmethodology
Theproject The TPE assesses the status of the actual project and1

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Item

Verification requirements

No CAR or CL
remaining

implementation
its operation with the registered/validated PDD or any
against the registered approved revised PDD.
PDD or any approved
revised PDD
Calibration frequency If monitoring Option C is selected, the TPEand correction of determines whether the measuring equipments havemeasured values with been properly calibrated in line with the monitoring
related requirements plan and whether measured values are properlycorrected, where necessary, to calculate emission
reductions in line with the PDD and Monitoring
Guidelines.
Data and calculation The TPE assesses the data and calculations of GHGof GHG emission emission reductions achieved by/resulting from thereductions
project by the application of the selected approved
methodology.
Avoidance of double The TPE determines whether the project is notregistered under other international climate mitigation
registration
mechanisms.
Post
registration The TPE determines whether there are postchangesregistration changes from the registered PDD and/or
methodology which prevent the use of the applied
methodology.
Authorised signatory:Mr.

Last name:Title:First name:Specimen signature:

Ms.

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B. Verification team and other experts

NameCompany

Function*

Schemecompetence*

Technicalcompetence*On-site visit

Mr.
Ms.
Mr.
Ms.
Mr.
Ms.
Mr.
Ms.
Please specify the following for each item.
* Function: Indicate the role of the personnel in the validation activity such as team leader,team member, technical expert, or internal reviewer.
* Scheme competence: Check the boxes if the personnel have sufficient knowledge on the JCM.
* Technical competence: Indicate if the personnel have sufficient technical competence related
to the project under validation.

C. Means of verification, findings and conclusions based on reporting requirements
C.1. Compliance of the project implementation and operation with the eligibility criteria of theapplied methodology<Means of verification><Findings>
Please state if CARs, CLs, or FARs are raised, and how they are resolved.
<Conclusion based on reporting requirements>
Please state conclusion based on reporting requirements.

C.2. Assessment of the project implementation against the registered PDD or any approved
revised PDD<Means of verification><Findings>
Please state if CARs, CLs, or FARs are raised, and how they are resolved.

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JCM_MV_F_Vrf_Rep_ver021.0<Conclusion based on reporting requirements>
Please state conclusion based on reporting requirements.

C.3. Compliance of calibration frequency and correction of measured values with related
requirements<Means of verification><Findings>
Please state if CARs, CLs, or FARs are raised, and how they are resolved.
<Conclusion based on reporting requirements>
Please state conclusion based on reporting requirements.

C.4. Assessment of data and calculation of GHG emission reductions<Means of verification>

Parameters

Monitored

Method to check values in the monitoring report withvalues

sources<Findings>
Please state if CARs, CLs, or FARs are raised, and how they are resolved.
<Conclusion based on reporting requirements>
Please state conclusion based on reporting requirements.

C.5. Assessment of avoidance of double registration<Means of verification>4

JCM_MV_F_Vrf_Rep_ver021.0<Findings>
Please state if CARs, CLs, or FARs are raised, and how they are resolved.
<Conclusion based on reporting requirements>
Please state conclusion based on reporting requirements.

C.6. Post registration changes<Means of verification><Findings>
Please state if CARs, CLs, or FARs are raised, and how they are resolved.
<Conclusion based on reporting requirements>
Please state conclusion based on reporting requirements.

D. Assessment of response to remaining issues
An assessment of response to the remaining issues including FARs from the validation and/or
previous verification period, if appropriate

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E. Verified amount of emission reductions achieved
Year

Verified
Reference Verified
Project VerifiedEmission
Emissions (tCO2e)
Emissions (tCO2e)
Reductions (tCO2e)

2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Total(tCO2e)
Total (tCO2e)

F. List of interviewees and documents received
F.1. List of interviewees

F.2. List of documents received6

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Annex Certificates or curricula vitae of TPE’s verification team members, technicalexperts and internal technical reviewers
Please attach certificates or curricula vitae of TPE’s validation team members, technicalexperts and internal technical reviewers.

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