Empower form

Collection & Supply Partner Verification - Due Diligence

In order for your organization to qualify for selected services in Empower Platform, Empower conducts a partner check (due diligence). This includes for your organization to complete an assessment that addresses key info on such as the organization's location, size, policies and cooperations.

The form should be filled out by a person in the organization with the necessary authorisation.

If you have any further questions, please reach out at compliance@empower.eco

Name of organisation * Provide the full legal name of the organisation

Organisation type *

NGO (Non-Governmental Organization)

Non-Profit Organization

For-Profit Organization

Year of establishment * Enter the year the organisation was officially established

Organisation description * Please give a short description of the organisation; what are your current activities and focus?

Country and region * Please list the country and region in which the organisation is operating

Address * Please provide the address of the organisation's main office/site

Webpage of organisation If your organisation has a webpage, please provide the link

LinkedIn profile of organization If your organisation has a LinkedIn page (www.linkedin.com), please provide the link

Relevant manager LinkedIn profile If the manager of the entity related to a collaboration with Empower has a LinkedIn profile (www.linkedin.com), please provide the link to the profile

Public record * Please upload a copy, image or pdf of constitutional documents of the organization (such as by-laws/memorandum of incorporation/articles of association etc.)

Key owner information * Please provide basic ownership information of the organisation, meaning name of the founder(s), name of the CEO and name of board chairman

Number of employees * How many employees and people are involved in the organisation? Please include both, but differentate between, employeed and unemployeed involved personnel

Does you organization have any of the following policies in place? * Please tick off all that apply

Health, Safety & Environment policies

Policy against Child Labour

Policy for combatting Corruption

Policies Please upload any documentation to the policies you may have listed above, if available

Please list any local organisation or community your organisation is cooperating with * Write the name of the organisation(s) and include a short description of the cooperation, or write "not applicable"

Please list any international organisations your organisation is cooperating with * Write the name of the organisation(s) and include a short description of the cooperation, or write "not applicable"

Please list any public bodies your organisation is cooperating with * Write the name of the organisation(s) and include a short description of the cooperation, or write "not applicable"

I have read and understood Empower's Code of Conduct * Read from <a href="https://ewts.empower.eco/code-of-conduct">link</a>

Please confirm your full name, as the representative filling out and confirming the truthfulness of the content of this form *