Application form for incentive providers

1 The Company

2 The Incentive

3 PR & Communication

4 Agreement

The Company
The applicant mentioned below (Ports and other maritime related service providers) hereby applies to become an Incentive Provider (IP) to the Green Award (GA) scheme, with the following contribution:
Company name
Address
Department(s)
Name(s)/Titles(s)
Phone
Email

Multiple e-mail addresses possible. On top of the general communication, monthly ship certification updates, notification to IP’s, newsletters etc will be sent to this (these) e-mail address.
Website
Characteristics of port/company + product/service
For ports, e.g. cargoes handled, throughput (e.g. total, dry, solid, general cargo) + any other PR description. For other maritime service providers/suppliers, indicate company profile, product/service profile. This can also be substituted by a descriptive/comprehensive company + product profile documents.
Reference list (clientele)
For maritime service providers and suppliers applying, please include a reference list (clientele). Please note that the Bureau Green Award may contact one or more of the organisations listed.

The Incentive
In order to participate in the Green Award incentive programme (joining the network), the Incentive Provider must share the same safety and environmental synergies as Green Award (as governed by the industry). As such, the incentive must be contributing to the certified shipping industry by granting a clear incentive offer.
Level of incentive
Applicable to
- Green Award certified shipping company (only if the product/service aims at company level)
- Green Award certified sea-going ships
- Green Award certified inland navigating ships
- other participating Incentive Providers
Preferred starting date
DD
MM
YYYY
(Due to the high interest into the Green Award programme, please kindly understand that the processing time may be longer and that the preferred starting date may not be reached.)
Specific pay-out procedure (if any)
(Example 1: ship manager is responsible for contacting IP and to make arrangements to claim incentives on behalf of ship owner) (Example 2: shipping agent is responsible for contacting IP and to make arrangements to claim incentives on behalf of ship owner)

PR and Communication
Please indicate what kind of (if any) communication/PR plan you would like to follow. The below indicated options are only for references. Our PR & Marketing Team will be in touch with you depending on your indicated wishes.
Promotional
In the event that we mutually agree to arrange an event (e.g. plaque/flag handover ceremony), please note that we require a minimum of one month preparation to make arrangements. Please make sure the incentive agreement is mutually agreed by the applicant and GA well before this period.
- Handover ceremony
  (To commemorate the participation of an Incentive Provider, by standard you will receive a Green Award flag and a plaque (a board with GA logo). There is an option for a Green Award management representative to visit your office premises to do a small handover ceremony for a photograph moment.
- Other (please indicate your wishes in the field below)
Desired PR actions

Agreement
- By ticking this box you agree to applying to become an Incentive Provider, agree to our application procedure and conditions and the Privacy Policy and confirm that the information provided by you is correct and you allow Green Award to contact you and process the data provided by you.
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.

The Company