Carbon certification application form (organisation)

carboNZero certTM or CEMARS®

Programmes Leave blank if unsure

Organisation details

Registered Company Name *

Trading names (If different from registered)

NZ Registered Company Number (if applicable)

Primary contact details

Name *

Position title *

Phone Number *

Email *

Physical address

Website

Business details

Core Business Activities * (a general description of your organisation)

Legal ownership (organsation structure diagram including subsidiaries)

Business Structure Diagram (if different from organisation structure; please attach separate document if necessary)

Number of employees * (enter numeric value only)

Number of sites/facilities * (enter numeric value only)

Annual revenue in NZ$M * (if greater than 100$M, say 'greater than 100$M')

Please supply an estimate of your energy use for a 12 month period for the following:

Electricity * Total consumed in kWh or $NZ

Gas * Please state data units (e.g., kWh, GJ, m3)

Fuel

Total petrol consumed in $NZ, litres or distance travelled in km: *

Total diesel consumed in $NZ, litres or distance travelled in km:

Total coal consumed in $NZ: *

Air Travel

Total domestic in $NZ or distance travelled in km: *

Total international in $NZ or distance travelled in km: *

Air Freight

Total Air freight in kg (that you have paid for):

Destinations: (inward and outward - top three destinations)

Road Freight

Total Road freight in kg (that you have paid for):

Destinations: (inward and outward - top three destinations)

Sea Freight

Total Sea freight in kg (that you have paid for):

Destinations: (inward and outward - top three destinations)

Refrigerant

Do you have any refrigerant holdings? Volume of refrigerant stock if applicable

Waste

Total waste produced in a 12 month period

Further information

What certification(s) do you currently have in place, if any?

How did you hear about the programme?

Additional comments