Vendor Pre-Qualification Statement Form
Name of Vendor:*
Registered Address:*
Legal Status: CorporationPartnershipIndividualOther
Telephone:
Mobile:*
Website:
Contact Person Name:*
Designation:
Email:*
Vendor Type (Local/Overseas):*
Questionnaire:
1. How many years your company is in business as supplier?
2. Have you ever provided services or supplies to our company? YesNo
3. Please mention the categories in which you have specialization:
A)
B)
C)
D)
E)
F)
4. Please list your top 3 customers/projects:
5. Please provide Bank Reference:
Beneficiary Name:
Bank Name:
Account No.:
IBAN:
6. Do you have any Health, Safety, Security, Environment policy (HSSE)? if yes, provide a copy. YesNo
7. Does your Company comply with all legal and statutory requirements applicable to the Company? YesNo
8. Does your operators are authorized or certified to operate equipment? if yes, provide certificate. YesNo
9. Do you provide necessary Personal protective equipment (PPE) to your staff and labor? Confirm. YesNo
10. Do you have procedures to notify customer in advance of late deliveries? YesNo
11. Do you have procedures for handling customer complaints? If yes, provide a copy. YesNo
12. What are your average payment terms:
13. What is your ideal delivery time:
Attachment checklist (Please attach following documents with this Form):
Company Registration Certificate:
VAT Registration Certificate:
Company Profile:
Bank Account Details:
Equipment Operating Certificates (optional):
Declaration by Vendor:
I / We acknowledge that inclusion of a firm on any list of pre-qualified Suppliers is in the sole discretion of Alkawther. I / We understand that Alkawther may use some or all of the information provided to make inquiries of third parties regarding our firm, its experience, finances and qualifications and do hereby consent to the use of such information for these purposes and to Alkawther making such inquiries as it deems necessary in the circumstances. I/We waive any claim that I/We may have against Alkawther resulting from the use of the foregoing information and / or Alkawther making inquiries concerning our firm. I/ We further certify that there is no conflict of interest between our firm or any of its employees with Alkawther employee that can influence any official decision or judgement of Alkawther as on the date of declaration, which needs to be disclosed to Alkawther.
Qualification and Approval:
Procurement Manager Name:
Signature & Date:
Approved:YesNo
Comments (if any):
Vendor Category:
SoleGeneral
Please draw the signature here:-
Vendor company stamp:
