REQUEST FOR ACCESS Permohonan Akses
Book and Claim in RSPO PalmTrace Book and Claim di RSPO PalmTrace
For sellers of RSPO Credits untuk penjual RSPO Credits
In order to request access to Book andClaim in RSPO PalmTrace as a credit
seller, companies need to
1. Be a member of the RSPO
2. Be registered in RSPO PalmTrace(‘Palm Oil Registration’)3. Be RSPO certified
4. Be licensed in RSPO PalmTraceby their Certification Body
5. Fill in this form correctly andcompletely; and6. Attach a letter from your bankconfirming your company’s bankaccount number1.
Please send the filled in form backto palmtrace.support@ra.org.
For all questions regarding this form andBook and Claim in RSPO PalmTrace, you
can contact the RSPO PalmTrace support
team via palmtrace.support@ra.org or +31(0)20 820 8968.

Untuk mengajukan permohonan akses diBook and Claim di RSPO PalmTracesebagai penjual kredit, perusahaan/kelompok harus:
1. Menjadi anggota RSPO
2. Terdaftar di RSPO PalmTrace(‘Registrasi Kelapa Sawit’)
3. Bersertifikat RSPO
4. Terlisensi di RSPO PalmTraceoleh Badan Sertifikasi (CB)
5. Isi formulir ini dengan benar dan
lengkap; dan
6. Lampirkan surat keterangan daribank yang mengonfirmasi nomor
rekening perusahaan/ kelompok
Kirimkan formulir ini kembali
melalui palmtrace.support@ra.org.
Untuk pertanyaan mengenai formulir ini
dan Book and Claim di RSPO PalmTrace,
Anda dapat menghubungi tim dukungan
RSPO PalmTrace melalui
palmtrace.support@ra.org atau +31 (0)20820 8968.

REQUEST FOR ACCESS Permohonan Akses
Book and Claim in RSPO PalmTrace Book and Claim di RSPO PalmTrace
For sellers of RSPO Credits untuk penjual RSPO Credits
Company Information Informasi Perusahaan/ Kelompok
RSPO PalmTrace account name2:
Nama akun RSPO PalmTraceRSPO Membership number:
Nomor Keanggotaan RSPORSPO PalmTrace Member ID: RSPO_PO
ID Keanggotaan RSPO PalmTrace

Address:
AlamatPostcode:
Kode Pos

City:
Kota/ Kabupaten

Country:
NegaraVAT Number:
Nomor NPWP

1Letter confirming that the bank account indicated in this form indeed belongs to your company.

Please note that we do not request a bank statement on your account balance or activities.
Surat konfirmasi bahwa nomor rekening dalam formulir ini benar milik perusahaan/ kelompok Anda. Mohon dicatatbahwa kami tidak meminta pernyataan bank mengenai saldo atau aktivitas akun Anda.

2

Company name as registered in RSPO PalmTrace.

Nama perusahaan atau kelompok yang terdaftar di RSPO PalmTraceREQUEST FOR ACCESS Permohonan Akses
Book and Claim in RSPO PalmTrace Book and Claim di RSPO PalmTrace
For sellers of RSPO Credits untuk penjual RSPO Credits
Type of Business:Jenis Bisnis

Independent Smallholder GroupKelompok Pekebun Swadaya

OutgrowerPemasok Buah Luar

Pabrik Kelapa Sawit (PKS)

Kernel Crusher
Penghancur Kernel

Are you part of a Holding3?
Apakah Anda bagian dari perusahaan/ kelompok induk?

YES/ Ya
NO/ Tidak

If yes, Name of the Holding:
Jika ya, nama Perusahaan/ Kelompok IndukContact Person for Book and Claim:
Narahubung untuk Book and Claim

Email Address:
Alamat email

Telephone Number:
Nomor telepon

REQUEST FOR ACCESS Permohonan Akses
Book and Claim in RSPO PalmTrace Book and Claim di RSPO PalmTrace
For sellers of RSPO Credits untuk penjual RSPO Credits

Bank Information

Informasi Bank

Bank Account Holder:
Nama Pemilik Rekening

Bank Account Number / IBAN:
Nomor Rekening Bank

Bank Name:
Nama Bank

Bank Address:
Alamat BankSWIFT / BIC:
Kode SWIFT

Contact Person for Payments:
Narahubung untuk Pembayaran

Email Address:
Alamat email

Telephone Number:
Nomor Telepon

I confirm that I am authorized to request access to Book and Claim for the above
named company.
Saya mengonfirmasi bahwa saya berwenang untuk permohonan akses Book and Claim perusahaan/ kelompok diatas

I confirm that the information stated in this document is true and accurate, and that any
changes will be timely communicated to UTZ to palmtrace.support@ra.org.
Saya mengonfirmasi bahwa informasi yang dinyatakan dalam dokumen ini benar dan akurat, dan perubahan yang ada akan
dikomunikasikan ke UTZ segera melalui palmtrace.support@ra.org.

Date:
Tanggal

Name:
Nama

Function Title:
Jabatan

3

Parent company able to sell RSPO Credits on your behalf.

Perusahaan/kelompok induk dapat menjual RSPO Credits atas nama Anda

REQUEST FOR ACCESS Permohonan Akses
Book and Claim in RSPO PalmTrace Book and Claim di RSPO PalmTrace
For sellers of RSPO Credits untuk penjual RSPO Credits