CODE:
APP-COO
FairTSA Application Cooperatives
and Associations
Date:
2017-04-18
V.323
FairTSA
1.1.
Contact Information
Name:
Client Number:
Address:
Phone:
Cell phone:
Zip Code and Town:
Fax: None
E-mail:
State/Province/Region
Country:
Contact for organic and Fair Trade program manager with phone numbers, e-mail, etc,
(if different from above):
1.2 Certificate Holder
Name & address of entity in whose name the certificate should be issued:
1.3 Organic certification
Is the cooperative certified organic? Yes □ No □
If yes, please provide the contact information of the organic certifier and the name of
the representative in charge:
2. Members and Organization
How many members does the cooperative have?
What is the average acreage/hectares and range (smallest and largest farm) of the
member farms?
Is the cooperative legally incorporated? Yes □ No □
If yes, please attach a copy of the incorporation certificate.
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CODE:
APP-COO
FairTSA Application Cooperatives
and Associations
Date:
2017-04-18
V.323
FairTSA
Please describe briefly how the cooperative works and include
3. Products and Pricing
Please list the products to be FairTSA certified and expected average harvested
amounts:
Products
Amounts
How do you determine the prices for organic products for your cooperative members?
Are there any additional payments or payment mechanisms that increase the price in
certain circumstances? Yes □ No □
If yes, please explain:
4. Additional Services for Cooperative Members
Do you provide additional services to your cooperative members such as agricultural
extension, pre-financing of crops, or any kind of social services? Yes □ No □
If yes, please explain the type and scope of services:
5. Interested Buyers for FairTSA Fair Trade Certified Products
Please list the contact information for all interested buyers for the FairTSA Fair
Trade program. We are happy to contact them and discuss the program with
them in case of questions. Getting existing buyers to sign up as licensees is the
quickest way to get a Community Development Project going, which in turn
makes buying your products more interesting to new clients interested in Fair
Trade!
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CODE:
APP-COO
FairTSA Application Cooperatives
and Associations
Date:
2017-04-18
V.323
FairTSA
6. Internal Control System
Is there an internal control system (ICS) in place or are all member farms inspected
individually? Internal Control System □ Inspected individually □
If there is an ICS, are you aware that the ICS has to be trained to include major Fair
Trade requirements? Yes □ No □
If yes, will your organization be able to do that or is coaching/support by FairTSA
needed? We are able to do this ourselves □ We need support □
7. Processing Facility
Does the operation have a processing facility? Yes □ No □
If yes: Please be aware that the processing facility needs to be certified too.
Please provide address if different from address in section 1:
8. Standard Awareness
We have a copy of the standard: Yes □ No □
We are aware of the following basic standard requirements:
 Written contracts for product purchases with all your cooperative/association
members are necessary: Yes □ No □
 Written employment contracts for all workers are necessary: Yes □ No □
 An Occupational Health & Safety program is required if dangerous equipment is
being used: Yes □ No □
 No discrimination of workers because of race, gender, creed or sexual orientation is permissible: Yes □ No □
 Workers have the right to organize themselves, either in trade unions or in
worker committees for a specific facility: Yes □ No □
 Minimum wages or industry-average wages have to be paid to all workers, including seasonal, migrant, and contract workers: Yes □ No □
 The Social Premium and the Fair Price Premium must be distributed evenly
among cooperative members and no preferred treatment for individual cooperative members is permissible.: Yes □ No □
9. Signature of Responsible Person
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CODE:
APP-COO
FairTSA Application Cooperatives
and Associations
Date:
2017-04-18
V.323
FairTSA
I declare that the above statements are correct and complete and that I am entitled to
represent the organization. I have either transferred the annual producer licensing fee
of $400 ($250 for small organizations with less than 20 members) to the FairTSA bank
account or I am willing to pay that amount once the invoice is received.
___________________________________
Name
____________________
Title
___________________________
Signature
__________________________ _____________ _
Organization
Date
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