JCM_MV_F_MoC_ver01.0

JCM Modalities of Communication Statement Form
Section 1: Project description
Title of the projectCountry
Date of Submission

dd/mm/yyyy
Section 2: Nomination of focal point entity

Name of entity:
Address (incl. postcode):
Telephone:

Fax:

E-mail:Website:Primary authorised signatory:Mr.

Last name:First name:Ms.

Title:
Specimen signature:Date: dd/mm/yyyy

Alternate authorised signatory:Mr.

Last name:First name:Ms.

Title:
Specimen signature:Date: dd/mm/yyyy

Contact person:

Mr.

Last name:First name:Ms.

Title:
Department:
Direct tel.:E-mail:Is this entity changing its name?

Direct fax:
Yes
(Former entity name:No

Is the entity also a project
participant?

Yes
NoIf the entity is also a project
participant, do the same
signatories represent it in its
project participant role?

Yes
No

USE THIS SECTION FOR
POST-REGISTRATIONSUBMISSIONS ONLY

Mobile:1)

JCM_MV_F_MoC_ver01.0

Section 3: Third-party entity (TPE)
Name of the TPE that conducts validation(and verification) for the project:
Address (incl. postcode):
Contact person:

Mr.

Last name:First name:Ms.

Title:
Department:
E-mail:Telephone:

Section 4: List of project participants other than nominated focal point entity
Name of project participant
(1)
(2)
(3)
(4)
(5)
(6)
*Rows may be added, as needed*Contact information of each participant is indicated in Section 5.

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Section 5: Contact information(Project participant(s) other than focal point entity )Project Participant (1)Name of entity:
Address (incl. postcode):
Telephone:

Fax:

E-mail:Website:Primary authorised signatory:Mr.

Last name:First name:Ms.

Title:
Specimen signature:Date: dd/mm/yyyy

Alternate authorised signatory:Mr.

Last name:First name:Ms.

Title:
Specimen signature:Date: dd/mm/yyyy

Contact person:

Mr.

Last name:First name:Ms.

Title:
Department:
Mobile:Direct tel.:

USE THIS SECTION FOR
POST-REGISTRATIONSUBMISSIONS ONLY

E-mail:Direct fax:
Yes
(Former entity name:No

Is this entity changing its name?

*Tables may be added, as needed3)

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Section 6: Statement of decisionThis statement is effective with all project participants and will be valid until a supersedingstatement is submitted to the Joint Committee by the focal point entity. The project
participants do not include or refer to private contractual arrangements in this statement suchas the establishment of conditions for the designation or change of focal point. The project
participants and focal point are solely responsible for honouring such arrangements. By
signing below, all project participants confirm that they decide the terms of this decision on a
voluntary basis.
Focal point entity(1)

For (name of focal point entity):

For (name of entity):

Name of authorised signatory:

Name of authorised signatory:

Signature:

Signature:Date: dd/mm/yyyy

Date: dd/mm/yyyy

(2)

(3)

For (name of entity):

For (name of entity):

Name of authorised signatory:

Name of authorised signatory:

Signature:

Signature:Date: dd/mm/yyyy

Date: dd/mm/yyyy

(4)

(5)

For (name of entity):

For (name of entity):

Name of authorised signatory:

Name of authorised signatory:

Signature:

Signature:Date: dd/mm/yyyy*Rows may be added, as needed*Contact information of each entity is indicated in Section 5.

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Date: dd/mm/yyyy

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Section 7: Declaration of avoidance of double registration
By signing this declaration below, the focal point entity ensures the proposed JCM projectwill not result in double registration in other climate mitigation mechanisms, which thenavoids double counting of GHG emission reductions by the project.
I hereby declare that the proposed JCM project is not registered under any otherinternational climate mitigation mechanisms other than the JCM, therefore, the proposed
JCM project will not result in double counting of GHG emission reductions. I also herebydeclare that if the proposed JCM project is registered under the JCM, the same project will
not be registered under other international climate mitigation mechanisms, and vice versa.
Focal point entity:

Mr.

Last name:First name:Ms.

Title:
Specimen signature:Date: dd/mm/yyyy5JCM_MV_F_MoC_ver01.0

JCM Modalities of Communication Statement Form
ANNEX 1This annex is to be used by the nominated focal point to request changes to project participant
status and contact details of focal point entity following project registration.
Section 1: Project details
Title of the projectCountryProject reference number:
Date of Submission

dd/mm/yyyy

Section 2: Addition/change of name of a project participant
Add project participant
Change name of project participant (if selected, indicate former name below)
The following entity is hereby added as a project participant or is newly named in respect of
the above project. By providing a specimen signature below, the project participant confirms
its acceptance of the current modalities of communication.
Name of entity:
Address (incl. postcode):
Former name of project participant (if applicable):
Telephone:

Fax:

E-mail:Website:Primary authorised signatory:Mr.

Last name:First name:Ms.

Title:
Specimen signature:Date: dd/mm/yyyy

Alternate authorised signatory:Mr.

Last name:First name:Ms.

Title:
Specimen signature:Date: dd/mm/yyyy

Contact person:

Mr.

Last name:First name:Title:
Department:

6

Ms.

JCM_MV_F_MoC_ver01.0

Mobile:Direct tel.:E-mail:Direct fax:

Signature of the nominated focal point:
Name:
Specimen signature:Date: dd/mm/yyyy

Section 3: Voluntary withdrawal of project participants
The following entity is registered as a project participant in the above project and hereby
confirms its voluntary consent to be removed.
Name of entity:
Name of authorised signatory:Mr.

Last name:First name:Ms.

Title:
Specimen signature:Date: dd/mm/yyyy*Rows may be added, as needed
Signature of the nominated focal point:
Name:
Specimen signature:Date: dd/mm/yyyy

Section 4: Change of contact details (project participants or focal point entity)
The following entity is an existing project participant/focal point entity in respect of theabove project and hereby requests the following changes to its contact details:
Project participant
Focal point
Name of entity:
Address (incl. postcode):
Telephone:

Fax:

E-mail:Website:Primary authorised signatory:Mr.

Last name:First name:Ms.

Title:
Specimen signature:Date: dd/mm/yyyy

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Alternate authorised signatory:Mr.

Last name:First name:Ms.

Title:
Specimen signature:Date: dd/mm/yyyy

Contact person:

Mr.

Last name:First name:Ms.

Title:
Department:
Mobile:Direct tel.:E-mail:*Rows may be added, as needed
Signature of the nominated focal point:
Name:

Direct fax:

Specimen signature:Date: dd/mm/yyyy

DISCLAIMER: Any new representative for a focal point entity is recognized to hold the sameauthority designated to him/her by the entity as that held by the previous signatory.
If a change to a project participant requested in this section is also applicable to a focal point
entity, it is recognized that the project participant and the focal point are the same legal entity,
with the same legal registration in the respective jurisdiction.

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