JCM_ID_F_MoC_ver01.0

Section 3: Third-party entity (TPE)
Name of the TPE that conducts validation Japan Quality Assurance Organization(and verification) for the project:
Address (incl. postcode): 1-25, Kandasudacho, Chiyoda-ku, Tokyo 101-8555, Japan
Contact person:

Mr.

Ms.

Last name: Motokawa

First name: Hiroshi

Title: Director
Department: Global Environment Department
E-mail:global_environment@jqa.jp

Telephone: +81-3-4560-5600

Section 4: List of project participants other than nominated focal point entity(ies)(1)

Name of project participant
PT Nikawa Textile Industry(2)
(3)
(4)
(5)
(6)
*Rows may be added, as needed*Contact information of each participant is indicated in Section 5.

2JCヽ 11 1D F ⅣIoC ver01.0

JCⅣI WIodalities of Corll■ unication Statement Form
△NNEXlThis anncx isto be used by the nominatcd focal point(s)tO request changestoprttectparticipant
status and contact details offocal point entity(ies)f0110Wing prttcCt registration.

Section l:Project details
Title ofthc prtteCt

Introduction of lngh Efflciency Looms in Weaving MillCountry

The Republic oflndonesia

PrtteCt rcference numbcri

ID020

Dttc of Submission

19 Fcb 2021

Section 2:Addition/change ofname ofa prttect participant□ Add pr筍 eCt pttiOpant□ Change name ofprttect paH滝 ゃant(ifSelccted,indictte former name bebw)
The following cntity is hereby added as a prttect participant or is newiシ

named in rcspect ofthe above prttecto By pro宙 ding a spccimen signature beloヽ 嶋the prttcct pahicipant conittills

its acceptance ofthe curentrnodahtics ofcommunication.

Name ofentity:
Address(incl・ POStCOde):

Former name of project participant(if applicable):

Telephone:

Fax:

mail:

Website:E…

Prilnary authorised signatory:Mr.□

Last name:First name:Ms。 □Title:

Date:dd/maLけ 刀げSpeciHnen sigmature:

Alternate authorised signatory:Mr.□

Last name:First name:Ms。

□Title:Date:dd/mm/̲SpeciHnen signature:

ContAct persom:

Mr,□

Last name:First name:Title:

Depart】 ment:

6Ms.□

JCⅢ 生 ID F MoC vcr01.0

Mobile:Direct tel.:

E― mail:

Direct fax:

Signature of the noHlinated focal point:

Name:

Date:dd/mm/̲Specimen signature:

Section 3:Voluntary withdrawal of project participantsThc following entity is registcred as a prttect pahicipant in thc above pr筍 ect and hereby
confittnis itS VOluntary conscnt to be removed.

Name of emtity:

Ms,□

□

Name of authorised signatory:

Mr。

LASt name:First name:Title:

Date:dd/mm/̲Specilnen signature:*Ro、 vs mav be addedぅ as needed

Signature ofthe noHlinated focaI POinti

Name:
Date:dd/mm/yyyy

SpeciH■ en signature:

Section 4i Change of contact details(prOject participants or lbcal point entity(ies))
The following entity is an e適 sing prttect pahicipant/focal point cntity in respect ofthe above
prttCCt and hcrcby requests the fol10Wing changes to its contact dctails:□ Pttect panicゃ ant
匪で Focal point

Name of entity:△ ddress(inCI・

Nisshinbo Textile lnc.

POStCOde):2‑4‐ 2,KitElkyuhoji― Imachi,Chuo― ku,OsakEL 541‑0057,Japan

1 Fax:+81‑6‑6267… 5667

Telephone:+81‑6‑6267‐ 5513

1 wvebsite:

E― mail:ohnomasatsu8u@nisShinbo.co」 p

https://wv内 慟ηv.niSShinbo―

l textileocottp

図Ms。 □Prilnary authorised sigilatory:

I Mr。

LASt name:Ohnoi First mame:Masatsugu

Title:Senior ⅣIanager

Date:19/Fcb/2021

SpeciHnen signature:

7

JCⅣI ID F ⅣIoC ver01.0

Aiternate authorised signatory:

Mr.図Last name:Kameshima

First name:Yoshiharu

Ms。 □Title:Manager
Date:19/Feb/2021

Speci】 men sigmature:

Contact persoHl:

Mr.図

Last name:KamcshinlaFirst name:Yoshiharu

Ms。 □Title:Manager
Departlment:Production contorol departmemt
E)irect tel.:+81‐ 6‐ 6267‑5552

WIobile:NAE― mail:y―Direct fax:+81‑6‑6267‐ 5670

kameshima@niSShinbo.cojp*Rows lnav be addedぅ as needed

Signature ofthe nominated focal point:

Name:Ktto Tomoml
Date:19/Feb/2021

Specilnen signature:

DISCLAIMER:Any new representat抒 e for a focal point entity is recognized to hold he sameauthority designated to him/her by the entity as hat held by he previous signatory.
Ifa change to a prttect pahiCipant requested in this section is also applicable to a focal point
entitt it iS recognttcd that the prttect pahidpant and the foc』 point are the same le8Л enti転ejurisdiction.

with the same legal registtation in thc respect抒8

JCM ID F MoC vcr01.0

JCWE ⅢIodalities of CoH11■ unication Statement Form

ANNEX lThis anncx isto be used by thc nominated focal point(s)tO request changesto pr筍

ect participant

status and contact dctails offocal point cntity(ies)fOl10Wing prttect registration.

Section l:Project details
Title ofthe prtteCt

Introduction of卜 ngh Efficicncy Loomsin Weaving MiH

Countリ

The Republic oflndonesia

PrtteCt reference numberi

ID020

Datc of Submission

13 Dec 2022

Section 2:Addition/change of name ofa proiect paHicipant□ Add prttcct participant匠]Change name ofprttect participant(if sClected,indicatc foAlller name below)
The following entity is hereby added as a prttcct pahicipant or is newly named in respcct ofthc above prttect・ By providing a specimen signature below,the prttcct panicipant conil11ls

its acceptancc ofthe curcnt rnodalities ofcommunication

Name of entity:
Address(incI・ POStCOde):

Former name ofpЮ ject participant(if applicable):

Telephone:
E― mElil:

Fax:
WebSite:PriRmary authorised signatory:Mr.□

Last name:First name:Ms。

□Title:Date:dd/mm/)切Specil■ en signature:

Altermate authorised signatory:

Mr.□

LAst name:First name:Ms.□

Title:

Date:dd/mm/̲SpeCi14en Signature:

Contact person:

Mr.回

Last name:First name:Title:

Department

6Ms.□

JCM ID F MoC ver01.0

Mobile:Direct tel.:

E― mail:

Direct fax:

Signature of the noHlinated aocal point:

Name:
Date:dd/mm/y別SpeciHnen signature:

Section 3:Woluntatt withdrawal of project patticipants
The following entity is rcgistered as a prttect patticipant in the above prtteCt and hercby
conilllls its voluntalE,/conSentto be removed.

Name oFentity:

Ms.□□Name of authorised sigmatory:

Mr。

Last nElmeiFirst name:Title:

Date:dd/mm/̲Specil■ en sigmature:*Rows may bc added,as needed

Signature ofthe noHlinated focal point:

NAme:

Date:dd/mm/̲Specilnen signature:

Section 4i Change of contact details(proiect pattiCipants or focal point entity(ies))
The following entity is an e対 sting pro」 ect pahicipant/fOcal p9int entity in respect ofhe above
prtteCt and hereby requests the following changes to its contact details:□ Pttect pahicゃ ant
図 FocЛ poht
Name of entity:

Nisshinbo Textile lnc.

Address(ind・ pOStcode):2‑4‑2,Kitakyuhoii― machi,Chuo― ku,Osaka 541‑0057,Japan

Telephone:+81‑6‑6267‑5513

Fax:+81‑6‑6267‑5667. Website:

E― mail:ohnomasatsugu@niSShinbo.co」 p

https://、 Tttw.misshinbo―

l textileocottp

Ms.□

PriHmary authorised sigmatory:

Mr.図Last name:Ohno

First name:Masatsugu

Title:Senior managOr
Date:13/12/2022

Speci】 nen signature

7

JCⅢ l:ID F MoC ver01.0

Mr.図Ms.□First name:Last name:Yamamoto
Titlo:

Date:13/12/2022

SPoci】 men signMi図Ms.

tname:KatsuyukiFi▼ 襦Title:

Depart二 nent,Production cOntorol departlnent

Mobile:NADirect tel.:キ 81‐ 6と 6267‑5552

E― mail:

Direct Fax:+82‐ 6‑6267‐ 5670

*Rows

as needed

beSig4ature ofthe noHlinated lbcal Point:

Name:Ohno Masatsugu
Date:13/12/2022

SpeCi日 ■en Signature:

DISCLAIMER:Any ne帝 represOntat"e for a focal point entity is recOgnized to hold he sameぉntiけ as 証hdd by he pttvbus sttatory.
田孟。
rけ dettgMttdto Hhれ ξo沖旅Ifa change to A prttect pattiё ipant requetted in this section iS also applicable to a focal point

entitt itiS recognized hⅢ
with the same 10gal

he prttect ptticipant and he focal point are the same legЛやgiSttatiOn h he respettivejuttSd8onent転JCM ID F Ⅳ【oC ver01.0

JCWI Modalities of CorlHlunication Statement Form

ANNEX lThis annexね to be uscd by the nOminated foc』 point(s)tO requestchangestO prtte飢 pa■ たipant
status and contact details offocal point entity(ies)fOl10Wing prtteCt tegistration.

3ccti()nl:1)ro.icct dCtails
Title ofthe prtteCt

Introduction ofHigh Efflciency Looms in Weaving

CountリThc Republic oflndonesia

PrttCCt reference number:

ID020

Date of Submission

4 Apr 2023

Ⅳ【ill島cction 2:Additionた hange or name OF a proticct participant□ Add pr筍 eCt p証 iЫ pant匠]Change namc ofprttect panicipant(if selected,indicate former name below)
The following entity is hereby added as a prttcct participant or is newly named in rcspect ofthe above prttect.By providing a specimen signature below,the prttect participant conirms
its acceptance ofthe curOnt llnodahties ofcommunication.

Name of entity:
Address(ind・ postcode):
Former name ofproteCt ParticiPant(if applicable):

Telephone:
E― mail:
Prilnary authorised signato呼￨ Fax:￨Website::

I First name:Last name:Title:

Date:dd/mm/̲Specilnen signature:

Alternate authorised sign4tOry:

Mr.□

Last name:First name:Ms.□

Title:

Date:dd/mnV̲Specimen signElture:

Contact person:

Mr.□

Last mame:First name:Title:

Departmemt

6Ms.□

JCM ID F MoC ver01,0

ⅣIobile:I I)irect tel.:

E― maili

Direct Fax:

Signature ofthe noHlinated focal point:

Name:

Date:dd/mm/̲Specil■ en signature:

Scction 3:V(〕 Iuntary with(lrawal of protect paHicipants

The following entity is registered as a prttect panicipant in the abovc prtteCt and hcrcby
confirms its voluntary consentto bc removed.

Name of entity:
Name of authorised signatory:Mr,□

Last name:First name:Ms。

□Title:Date:ddrmm/yyyy

Specil■ en signature:*Rows rnay bc added,as nccded

Signature ofthe nominated focilI POint:

Name:

Date:dd/mm/̲SpeciHmen signature:

Scction 4i Change of contact details(pr()iCCt participants or ril)cal pOint entity(ies))
Thc following entity is an existing prttcCt patticipant/ゃprtteCt and hcreby requcsts the following changcさCal pOint entity in respect ofthe abovc

to its conta,t detaitsi□ Prttect participant匪更 Focal pOint

Name of entity:―Nisshinbo Textile lnc.

maChi,Chuo― ku,Osaka 541‑0057,Japan
Address(incI・ POStCOde):2‑4‑2,Xζ takyuhoii― 】

Fax:+81‑6‑6267‑5667

Telephone:+81‑6‑6267‑5513

Webさ ite:

E… mail:ohnomasatsugu@niSShinbo,co」 p

https://― .niSShinbo―textile.co.jp

Mr.図

PriHnary authorised signatory:

Last name:Ohno

Ms.回

I First name:Masatsusu

Title:Senior l■ ElmElger

Date:4/4/2023

SpeciHnen signature:

7

JCM ID F MoC ver01.0

Ms.回′オ＼イ￨(rり 11,上 1lkⅢ ,ょ Iド 士(ぃ (}榛 (<,「 Sに 1吋 iFF口 t、41

Mr.図LASt name:Suzuki

First name:Katsuaki

耐Title:Managerml屯∵Date:4/4/2023

Mr.図MS.□

rirst name:Katsuaki

Last name:Suzuki
Title:ManageF
Department:ProduCdOn contoЮ l department

Mobile:NADirect tel.:+81‐ 6.6267‐ 5552

E‐ maih suzuki.katsuaki@nisshinbotooJpE)irect fttx:+82‐ 6‐ 6267‐ 5670

半Rows lnay be addedtt as needed

Signature oFthe nomin4俺 d focal point:

Name:Ohho Masatswgu
Date:4/4/2023

SpeciH■ en signature:

咽 cttiR鳥ェw岬 甲 飢 ri勘 ハ boal point entけ is re∞ gnizOd to holdhe same

auh6rtt designated to him/her by he entity asthat hOm by the pre胡 ous signatory.
Ifa chmtte tO a O中 jeCt patticipant requested in this section is aiso applicable to a focal point
entitt it― is recognized that he prttect partLipant and he focal point aFe ne Same legal en日

iOn in he respe∝ やejurisdiction.
at regiS仕 誠
with he sameに Ё8私