An entity wishing to voluntarily participate in the Cap-and-Trade Program (Program) as an opt-in covered entity must request approval from the California Air Resources Board’s (ARB) Executive Officer. ARB requests that any entity that wishes to opt in voluntarily submit the information contained in this form to the Industrial Strategies Division. Requests to opt into the Program must be submitted by March 1 of the calendar year immediately preceding the first year in which the entity voluntarily elects to be subject to a compliance obligation. Please submit to the address shown above. For further instructions, see page 2 of this form. Opt-In Year: ARB GHG Reporting ID: Contact Name Legal Name of Entity: First Name: Operating/Trade Name of Entity: Middle Name: Last Name: Entity (Company Name) Contact Information E-mail Address: Telephone: Fax Number: Mobile Phone: Website Address: Physical Address Address Line 1: Mailing Address (if different from physical address) Address Line 2: Address Line 1: City: Address Line 2: State or Province: City: Zip Code: State or Province: Country: Zip Code: Country: Entity Activity NAICS Code: Activity 1: Code: Activity 2: Activity 1: Activity 2: NAICS Code: Activity 1: Code: Activity 2: Activity 1: Activity 2: Submission of this information to the California Air Resources Board’s Executive Officer constitutes a request to become an opt-in covered entity within the Program. If an entity opts into the Program, it is subject to all reporting and verification requirements, compliance obligations, and other requirements of covered entities from the date of opt-in through the end of the compliance period. If approved, the entity must complete registration and maintain an account in the Compliance Instrument Tracking System Service. By signing this form, I attest that I am a legal representative of the entity named above, and that all information contained in this form is true, accurate, and complete. Print Name
An entity wishing to voluntarily participate in the Cap-and-Trade Program (Program) as an opt-in covered entity must request approval from the California Air Resources Board’s (ARB) Executive Officer. ARB requests that any entity that wishes to opt in voluntarily submit the information contained in this form to the Industrial Strategies Division. Requests to opt into the Program must be submitted by March 1 of the calendar year immediately preceding the first year in which the entity voluntarily elects to be subject to a compliance obligation. Please submit to the address shown above. For further instructions, see page 2 of this form. Opt-In Year: ARB GHG Reporting ID: Contact Name First Name: Middle Name: Last Name: Entity (Company Name) Legal Name of Entity: Operating/Trade Name of Entity: Contact Information Telephone: Mobile Phone: E-mail Address: Fax Number: Website Address: Physical Address Address Line 1: Address Line 2: City: State or Province: Zip Code: Country: Mailing Address (if different from physical address) Address Line 1: Address Line 2: City: State or Province: Zip Code: Country: Entity Activity NAICS Code: Activity 1: Activity 2: Code: Activity 1: Activity 2: NAICS Code: Activity 1: Activity 2: Code: Activity 1: Activity 2: Submission of this information to the California Air Resources Board’s Executive Officer constitutes a request to become an opt-in covered entity within the Program. If an entity opts into the Program, it is subject to all reporting and verification requirements, compliance obligations, and other requirements of covered entities from the date of opt-in through the end of the compliance period. If approved, the entity must complete registration and maintain an account in the Compliance Instrument Tracking System Service. By signing this form, I attest that I am a legal representative of the entity named above, and that all information contained in this form is true, accurate, and complete. Print Name
optin_request_form.docx