GHG Verification Application Form

Formulir Permohonan Verifikasi GRK

To,

VVB GHG PT. SBC Asia Sertifikasi

At – Kebumen

Dear Sir/Madam,

We hereby submit the Greenhouse Gas (GHG) Verification Application Form along with the company data as provided below:

General Information (Informasi Umum)
Verification Information (Informasi Verifikasi)
Note: If group/multi company, please complete the table below
Name of Company Address Kind and Number of Facilities
Previous VVB Name Verification Period
Verification Objective
Verification Scope
No. Category Sub Category Identified
Yes
Identified
No
1 Category 1: Direct GHG emissions and removals Direct emissions from stationary combustion
Direct emissions from mobile combustion
Direct process emissions and removals from industrial processes
Direct fugitive emissions from the release of GHG in anthropogenic systems
Direct emissions and removals from land use, land use change and forestry (LULUCF)
2 Category 2: Indirect GHG emissions from imported energy Indirect emissions from imported electricity
Indirect emissions from imported energy other than electricity
3 Category 3: Indirect emission from transportation Indirect emissions from upstream transport and distribution for goods
Indirect emissions from downstream transport and distribution for goods
Indirect emissions from employee commuting
Indirect emissions from client and visitor transport
Indirect emissions from business travel
4 Category 4: Indirect GHG emissions from products used by organization Indirect emissions from purchased goods
Indirect emissions from capital goods
Indirect emissions from the disposal of solid and liquid wastes
Indirect emissions from the use of assets
Indirect emissions from the use of other services
5 Category 5: Indirect GHG emissions associated with the use of products from the organization Indirect emissions or removals from the use stage of the product
Indirect emissions from downstream leased assets
Indirect emissions from end of life stage of the product
Indirect emissions from investments
6 Category 6: Indirect GHG emissions from other sources
Organizational Activities
GHG Calculation Methodology (Metode Perhitungan GRK)
GHG Emission (Emisi GRK)
No. Category Sub Category Emission (tCO₂eq)
1 Category 1: Direct GHG emissions and removals Direct emissions from stationary combustion
Direct emissions from mobile combustion
Direct process emissions and removals from industrial processes
Direct fugitive emissions from the release of GHG in anthropogenic systems
Direct emissions and removals from land use, land use change and forestry (LULUCF)
Total Category 1
2 Category 2: Indirect GHG emissions from imported energy Indirect emissions from imported electricity
Indirect emissions from imported energy other than electricity
Total Category 2
3 Category 3: Indirect emission from transportation Indirect emissions from upstream transport and distribution for goods
Indirect emissions from downstream transport and distribution for goods
Indirect emissions from employee commuting
Indirect emissions from client and visitor transport
Indirect emissions from business travel
Total Category 3
4 Category 4: Indirect GHG emissions from products used by organization Indirect emissions from purchased goods
Indirect emissions from capital goods
Indirect emissions from the disposal of solid and liquid wastes
Indirect emissions from the use of assets
Indirect emissions from the use of other services
Total Category 4
5 Category 5: Indirect GHG emissions associated with the use of products from the organization Indirect emissions or removals from the use stage of the product
Indirect emissions from downstream leased assets
Indirect emissions from end of life stage of the product
Indirect emissions from investments
Total Category 5
6 Category 6: Indirect GHG emissions from other sources
Monitoring Data Information (Pemantauan Level Data dan Informasi)
Emission Sources/Sink Level Data Transfer Number of Data (in Year Reporting Period)
Availability of GHG Documents

We have filled out this application completely and accurately.

We submit this application form, and thank you for your attention.

Sincerely,