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SUPPLIER REGISTRATION FORM

COMPANY DETAILS & GENERAL INFORMATION

Company Name (Full Legal Name) *

Phone

Fax

Email *

Company Website

Contact Name and Job Title

Address

Parent Company (Full legal / officially registered company name) *

Names of owner(s) and principals – Subsidiaries / Affiliates / CEO / Managing Director / Managing Member and those with controlling interests ifapplicable (attach a List if necessary) *

International Offices/Representation (Countries where the Company has local Offices/Representation) *

Nature of Business *

Type of Business (Mark one only)

Corporate/ Limited

Partnership

Other

Year Established

Number of Full-time Employees

Licence No./State where registered and validity date *

VAT No./TaxI.D

SST No

Bank Name (and Bank ID if any)

Branch Name (and Branch Code if any)

Phone

Fax

Bank Account Number

Account Name

Branch Address *

Account currency

Swift/Bank Identifier Code (BIC)

International Bank Account Number (IBAN) *

For Goods only, do those offered for supply conform to National/International Quality Standards?

List below up to a maximum of ten (10) of your core Goods/Services offered *

Description (one Line for each Item)

National/International Quality Standard to which Item conforms

Recent Contracts with the local and/or other International Aid Organizations *

Do you have outstanding bankruptcy, judgment or pending legal action that could impair operating as a going concern?

Please list any Disputes and Bankruptcy your Company has been involved in with any Organizations over the last 3 Years *

Is your company aware of the UN Secretary General’s Global Compact initiative?

If yes, have you signed up to this initiative or are you going to sign up to? Please state *

Does your Company have a written Statement of its Environmental Policy? (If yes, please attach a Copy)

Does your organisation hold any accreditation such as ISO 14001 related to the environment? 0r any other ISO cerificate?

Vendor who wish to do business with UI are required to comply with the UI Supplier Code of Conduct. Please download and read the UN Supplier Code of Conduct

By signing this VRF, potential vendors confirm that they have read, understood and will comply with the UI policy on the “zero tolerance” that strictly prohibits the acceptance of any type of gift and/or hospitality by UI staff members participating in the procurement process. Please confirm.

Is your company already registered with the UNIFIED INDUSTRIES (M) SDN BHD vendor portal (UIVP)? If so, please provide registration number *

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