Self Declaration Form – Antilla Energy

Self-declaration on used cooking oils and fats (UCO) for biofuel production according to the Directive 2009/28/EC1 under ISCC EU

(this document does not apply for deliveries under ISCC DE / 36th BImSchV)

Point of Origin (E.G. Restaurant):

Street address:

Postcode, location:

Country:

Recipient (Collecting Point):

By signing this self-declaration, the signatory declares that the following requirements are met:

1. The delivery consists entirely of used cooking oil2 (UCO) and is not mixed with fresh oil. Please mark either a) or b):

The cooking oil is entirely of vegetable origin

The cooking oil is entirely or partly of animal origin (e.g. lard, butter, tallow)

2. Documentation of quantities delivered is available.

3. Applicable national legislation regarding waste prevention and management (e.g. transport, supervision etc.) are complied with.

Note: By signing this self-declaration, the signatory acknowledges that auditors from certification bodies (may be accompanied by inspectors from authorities with the purpose to evaluate the performance of the certification body) and staff of certification schemes can examine whether the requirements are met as stated in this self-declaration.

Place

Date

Signature

Our Team

Self-declaration on used cooking oils and fats (UCO) for biofuel production according to the Directive 2009/28/EC1 under ISCC EU

(this document does not apply for deliveries under ISCC DE / 36th BImSchV)

2. Documentation of quantities delivered is available.

3. Applicable national legislation regarding waste prevention and management (e.g. transport, supervision etc.) are complied with.