54

ANNEX 4Model client questionnaireThe following is a model questionnaire that would be sent to potential clients seeking fi nance or existing clients prior to a review. These clients would need to complete and return the questionnaire to your fi nancial institution as one input to the screening process.

The questionnaire comprises four parts:

- General information- Established upstream production units- Proposed new upstream production units- Downstream operations

Note to clients about the purpose of the questionnaire:

This questionnaire is designed to help XYZ assess your company’s compliance with XYZ’s responsible palm oil policy. We would be grateful if you could provide the requested information and supporting documents and answer all questions relevant to your company’s circumstances. If you have any questions, XYZ’s contact person is (insert name, position, telephone number and email address).

If your company is part of a larger corporate group and its sister companies or subsidiaries also participate in the palm oil sector, please fi rst discuss the corporate structure with our credit risk assessors. XYZ may decide to treat your corporate group (or parts of it) as a single unit for the purpose of applying XYZ’s palm oil policy. In that case, you should complete this questionnaire on behalf of the whole corporate group or the part of it so determined.

55

Nam

e of unitLocation (province/state and country)

Capacity of

CPO

mill

Plantation A

reaYear of fi rst harvest

Status of compliance w

ith RSPO

criteria (check relevant category �

)

Supporting documenta-

tionprovided

Other com

ments

� R

SP

O certifi ed

� In-progress

� N

ot certifi ed or in-progress�

Not yet assessed

� R

SP

O certifi ed

� In-progress

� N

ot certifi ed or in-progress�

Not yet assessed

2. Established upstream

production units Please com

plete the following table by listing each production unit (ie. C

PO m

ill and the plantations that supply it) owned or m

anaged by your company and fi lling in the colum

ns for that unit. Please see guidance m

aterials on classifi cation of status of compliance w

ith RSPO

criteria. Please include any production units that your company is in the process of buying or

otherwise acquiring.

1. General inform

ation

Please nominate your contact person on m

atters relating to compliance w

ith our banks sustainable palm oil investm

ent policy:

Nam

e: Em

ail:

Position:

Telephone:

Is your company a m

ember of the R

SPO? Please attach a m

ap showing the location of the production units listed in the follow

ing tables.

Dow

nload this form at w

ww

.panda.org/palmoilfi nancing

Nam

e of

uni

tLo

catio

n (p

rovi

nce/

stat

e an

d co

untr

y)Pr

opos

ed c

apac

-ity

of C

PO m

illPr

opos

ed p

lan-

tatio

n ar

eaEx

pect

ed

Year

of fi

rst

ha

rves

t

Stag

e of

dev

elop

men

t (c

heck

cat

egor

y th

at b

est d

escr

ibes

cu

rren

t sta

ge �

)

Supp

ortin

g do

cum

enta

-tio

npr

ovid

ed

Oth

er c

omm

ents

� S

ever

al s

ites

unde

r co

nsid

erat

ion

� S

ite c

hose

n�

ES

IA u

nder

way

� L

and

acqu

isiti

on u

nder

way

� L

and

prep

arat

ion

and

plan

ting

unde

rway

� S

ever

al s

ites

unde

r con

side

r-at

ion

Site

cho

sen

� E

SIA

und

erw

ay�

Lan

d ac

quis

ition

und

erw

ay�

Lan

d pr

epar

atio

n an

d pl

antin

g un

derw

ay

3. P

ropo

sed

new

ups

tream

pro

duct

ion

units

Plea

se c

ompl

ete

the

follo

win

g ta

ble

by li

stin

g ea

ch p

lann

ed n

ew p

rodu

ctio

n un

it (ie

. a C

PO m

ill a

nd th

e pl

anta

tions

that

supp

ly it

) or p

ropo

sed

expa

nsio

n of

pla

ntat

ion

area

or m

ill c

apac

ity in

an

exis

ting

prod

uctio

n un

it ow

ned

by y

our c

ompa

ny a

nd fi

lling

in th

e co

lum

ns fo

r tha

t uni

t.

56

Que

stio

ns c

once

rnin

g ne

w o

r exp

andi

ng u

pstr

eam

pro

duct

ion

units

1. Is

you

r com

pany

will

ing

to c

omm

it to

impl

emen

ting

an R

SPO

alig

nmen

t pla

n (o

r equ

ival

ent)

for e

ach

plan

ned

new

pro

duct

ion

unit

or si

gnifi

cant

exp

ansi

on o

f pla

ntat

ion

area

or m

ill

capa

city

in a

n ex

istin

g pr

oduc

tion

unit?

� Y

ES

(If y

es, p

leas

e pr

ovid

e a

copy

) � N

O

2. D

oes y

our c

ompa

ny a

lread

y ha

ve a

doc

umen

ted

RSP

O a

lignm

ent p

lan

or si

mila

r for

eac

h of

the

abov

e lis

ted

units

?

� Y

ES

(If y

es, p

leas

e pr

ovid

e a

copy

) � N

O

Dow

nloa

d th

is fo

rm a

t ww

w.p

anda

.org

/pal

moi

lfi na

ncin

g

Nam

e of business operation

HQ

location (province/state and country)

Palm oil sector activities (check one or m

ore �)

Other com

ments

□ trading in palm oil products (including oleochem

icals);□ crushing palm

kernels;□ refi ning palm

oil and/or palm kernel oil;

□ production of oleochemicals;

□ food production;□ production of soaps and detergents □ production of cosm

etics;□ production of biofuel;□ electricity generation; □ retailing□ other, please specify …

……

.

□ trading in palm oil products (including oleochem

icals);□ crushing palm

kernels;□ refi ning palm

oil and/or palm kernel oil;

□ production of oleochemicals;

□ food production;□ production of soaps and detergents □ production of cosm

etics;□ production of biofuel;□ electricity generation; □ retailing□ other, please specify …

……

.

57

4. Dow

nstream operations

Please complete the follow

ing table by listing each of your company’s dow

nstream operations in the palm

oil sector (i.e. businesses that refi ne palm oil or

trade, manufacture or m

ake industrial use of products containing palm oil).

Questions concerning your com

pany’s downstream

operations

1. Do you have a policy for the responsible purchasing of palm

oil ?

� Y

ES

(If yes, please provide a copy of your policy or specify your weblink.) �

NO

2. Does it cover all of the above listed business operations?

� Y

ES

� N

O (If no, please specify the scope of the policy.)

3. What is your estim

ate of the total volume of palm

oil entering your company’s supply chains?

____tonnes per year

4. What proportion of this is sourced from

RSPO

certifi ed production units?____%

5. Have you set targets for progressively increasing the proportional am

ount of palm oil w

ithin your com

pany’s supply chains that is sourced from R

SPO-certifi ed production units?

� Y

ES

(If yes, please describe your target.) � N

O

Dow

nload this form at w

ww

.panda.org/palmoilfi nancing