Rainforest Alliance Payment Facility Registration Form To view instructions in Chinese | Indonesian | Spanish | Japanese | Turkish | Vietnamese The Rainforest Alliance is partnering with Convera to help tea farm certificate holders (“farm CHs”) around the world to receive Sustainability Differential and Sustainability Investment (SD/SI) payments (“Payment Facility”). Supply chain certificate holders that redeem tea out of the Rainforest Alliance’s online traceability platform, MultiTrace (“Redeemers”) may use this Payment Facility to send SD/SI amounts to Farm CHs within their supply chains. In very specific circumstances, Redeemers may decide to meet Shared Responsibility requirements through another mechanism and not use this Payment Facility. To be eligible to receive SD/SI payments for redeemed tea volumes via this Payment Facility, farm CHs must register with Convera by providing the information requested in the form below, including their Rainforest Alliance Certificate Holder Account ID (RA_############ and/or ME01_######). These IDs can be found on the certificate holder's Rainforest Alliance Certification Platform (“RACP”) dashboard and/or MultiTrace. Important Notes: Tea farm CHs may have more than one license and therefore more than one ID (for example, RA_000######### and/or ME01_######). Payments are tied to the ID used when volumes are sold into the tea supply chain. Therefore, please submit a registration to Convera for each ID with certified tea volumes. The information collected in this form will be used to validate bank account details. Convera may reach out to the contact person listed on the form to clarify information. It is important that the farm CH submits accurate and complete information in this form and responds to any communications from Convera requesting validation or clarification of the information provided in this form. If a farm CH does not respond to Convera’s messages requesting validation and/or correct any errors in bank account details as identified by Convera, Convera will not send the payment. By providing the information requested in the below form and clicking the “Submit” button below, I agree and certify, on behalf of my organization, that: I understand that no tax or other governmental charges (including, without limitation, any state or federal income taxes, stamp or documentary taxes, turnover, sales or use taxes, value added taxes (VAT), excise taxes, customs or any other charges) (“Taxes”) shall be included in payments processed, and that my organization is fully responsible for complying with all applicable laws and regulations, including the payment of any applicable Taxes on payments received through the Payment Facility. The information provided in this form is complete, correct and up to date. I consent to sharing with Convera the information provided below, including contact data and my organization’s bank account details for the purpose of transferring SD/SI payments to my organization’s bank account. I understand that payments will not be sent to my organization if my organization has not completed or has failed any compliance checks from Convera. I acknowledge and agree that Rainforest Alliance shall not be liable to my organization or any other person and/or entity for any claim, demand, cause of action, damages, judgment or settlement, or for any loss or injury to earnings, profits, or goodwill, or for any direct, indirect or consequential damages, including attorney’s fees and court costs, in connection with the Payment Facility, including my participation in the Payment Facility and information processed in the Payment Facility. I am authorized on behalf of my organization to agree and certify the above. If questions arise while completing the form, please review Frequently Asked Questions (FAQ) and work directly with your bank to ensure all required fields are accurate. You may also contact the Convera Global Pay Customer Service center via VendorManagement@convera.com IMPORTANT NOTE: You will receive a confirmation email once a payment has been made to the bank account you have provided. Please note that entering incorrect account information may result in a delay or loss of funds. If account information is entered incorrectly, you must notify Rainforest Alliance at customersuccess@ra.org as soon as possible. The Rainforest Alliance and Convera claim no liability for any funds submitted using erroneous account information entered by the user. RA Certificate Holder Account ID A RA Certificate Holder Account ID will look like RA_########### or ME01_#####. 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Currency Select currency in which you would like to receive your funds. Name of Bank Account Holder Enter name of bank account holder. Name must exactly match the name on the bank account. Please contact your bank if unsure. Bank Name Enter name of your bank. Please contact your bank if unsure. Account Number Enter Account number. Please contact your bank if unsure. IBAN Enter your IBAN. If this number is entered incorrectly, we will be unable to make payment. Please contact your bank if unsure. Account Type Checking Savings Select Checking or Saving. Please contact your bank if unsure. Routing Code Enter Routing Code. Please contact your bank if unsure. ACH/ABA/RTN Enter 9 digit ACH/ABA/RTN Code. Please contact your bank if unsure. IFSC Code Enter IFSC code - visit Bank IFSC Code website, if not available enter Routing Code. Please contact your bank if unsure BSB code Enter 6 digit BSB Code. Please contact your bank if unsure. Bank Code Enter Bank Code. Please contact your bank if unsure. Transit Number Enter 4 digit Institution Identifier followed by 5 digit Branch Identifier. Please contact your bank if unsure. Bank SWIFT Code or BIC Enter your bank swift code. Search for your bank by visiting The Swift Codes BIK SKN code If you are not sure what your SKN is, please see Question #6 in the Frequently Asked Questions (FAQ) Individualniy Nomer Nalogoplatelshchika Enter Individualniy Nomer Nalogoplatelshchika. CNAPS Enter CNAPS. Please contact your bank if unsure. Tax Id Enter Tax Id. National ID Number Enter National ID Number. Registro Unico Tributario Number Enter 9 digit Registro Unico Tributario Number. Cedula De Ciudadania Number Enter Cedula De Ciudadania Number. Cedula Juridicia Enter Cedula Juridicia. Bank Address Enter street address of bank branch. Please contact your bank if unsure. Bank City Enter City of bank branch. Please contact your bank if unsure. State / Province Select State/Province of your bank branch. Please contact your bank if unsure. Bank Postal Code Enter zip/postal code of your bank branch. Please contact your bank if unsure. Payee Contact Details Please provide your contact details below. Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Cook Islands Costa Rica Croatia Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Republic of the Congo Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Yemen Zambia Zimbabwe Select Country of residence. Company Enter Company or Institution Name. Legal First (and Middle) Name(s) As Shown On Your ID Enter your first (and middle) name(s) as it appears on your government issued ID Legal Last Name(s) As Shown On Your ID Enter your last name(s) as it appears on your government issued ID Date of Birth For identification purposes, please provide your date of birth. Email Please enter the same email address as used in the application. Address Enter Street address of residence. City Enter City of residence. State / Province Enter state/province of residence. Postal Code Enter zip/postal code of residence. 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