VENDOR PRE-QUALIFICATION FORM

Vendor Pre-Qualification Form

SECTION 1: COMPANY IDENTITY
Company Name
Office Address

Street Address

Street Address Line 2

City

Postal / Zip Code Country
Are you an agent or manufacturer *

Agent Manufacturer
Factory Location

Street Address

Street Address Line 2

City

Country
Warehouse Location

Street Address

Street Address Line 2

City

Country
Name of Contact Person *

Prefix First Name Last Name
Position *
Phone Number *
Mobile Number
Email *
example@example.com
Website *
Year Company Formed *
Trade License Number/ Commercial Registration Number *
Country/ City of Registration

Street Address

Street Address Line 2

City

Country
VAT/ TRN Registration Number *
Which type of products your company is providing *

FF&E OS&E BOTH
Name all products category and services
Please indicate if the company is willing to extend invitations to the client and procurement agent for factory inspections as part of the pre-qualification process at your own expense. *

YES NO

If you are providing installation service, when required, does you company have insurance policies in place? *

YES

NOT APPLICABLE

WORKMEN COMPENSATION INSURANCE

EMPLOYER'S LIABILITY INSURANCE

Does your company / products offered possess any international approved quality certification (ISO, EQM etc) *

YES NO
Please upload all international approved quality certificates *

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SECTION 2: BRAND REPRESENTATIONS
What brands does your company represents? *

SECTION 3: COMPANY PORTFOLIO AND REFERENCES

Showcase projects: describe 3 ongoing and/or completed projects in the last 12 months *

PROJECT 1

PROJECT 2

PROJECT 3

PROJECT NAME

LOCATION

CLIENT NAME

CLIENT CONTACT INFO

CONTRACT VALUE

SCOPE OF WORK

PERCENTAGE (%) OF CONTRACT COMPLETION

COMPLETION DATE

Are there any previous, or pending judgments, claims or arbitration proceedings against the company within the last 5 years? *

YES NO
Please describe which previous (or pending) judgments, claims or arbitration proceedings against the company within the last 5 years
Has the company filed any lawsuits or requested arbitration with regard to contracts within the last 5 years? *

YES NO
Please describe lawsuits or requested arbitration, with regard to contracts, which company filed within the last 5 years

SECTION 4: FINANCIALS
Please upload a copy of the most recently audited accounts for your company covering the last two years. (Otherwise for the period that is available if trading is less than two years) *

Browse Files
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Please upload a statement of the company’s turnover, Profit and Loss and cash flow for the most recent full year of trading. (Otherwise for the period that is available if trading is less than two years) *

Browse Files
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Parent company or other guarantees of performance or financial standing may be required. Please confirm the organizations willingness to arrange a guarantee or performance bond *

Yes No

Bank details *

Provide required information

NAME OF BANK

BANK ADDRESS

NAME OF CONTACT PERSON IN YOUR BANK

TELEPHONE NUMBER OF CONTACT PERSON IN YOUR BANK

EMAIL ID OF CONTACT PERSON IN YOUR BANK

ACCOUNT NAME

ACCOUNT NUMBER

IBAN NUMBER

SWIFT/ BIC

SECTION 5: SUSTAINABILITY
Have you published sustainability and corporate social responsibility (CSR) reports? *

YES NO ONLY CSR ONLY SUSTAINABILITY
What environmental management systems and certification systems are you using? Please indicate whether they are consistent with international standards.
What local environmental regulations are you required to comply with?

How likely are you to implement new initiatives or policies within the next year to reduce your environmental impacts and support a green strategy? *

	1	2	3	4	5	6	7	8	9	10

1 is Not at all likely, 10 is Extremely likely

What are your 'green' and sustainable product trends? (E.g. Bamboo toothbrush, recycled plastic coat hangers) *

Please rate the following statements based on the extent to which they are implemented at your company. *

NEVER

RARELY

SOMETIMES

FREQUENTLY

ALWAYS

Final products are packaged using RECYCLE materials

Final products are packaged using RECYCLABLE
materials

We track, report and manage our use of energy, chemicals and water

We recycle our inputs (energy, chemicals, water)

Our facilities use renewable energy

Are any hazardous chemicals or materials used in production? *

YES NO NOT SURE
Please select all terms that describe the raw materials used in your products *

Organic Materials Recycled Materials Virgin Materials Recyclable Materials Biodegradable Materials Compostable Materials Renewable Materials/Resources Non-Renewable Materials/Resources
How are your products disposed of? *

General Waste Compost Waste Recyclable Waste
Do you offer a take-back program for your products at the end of their useful life? *

YES NO
Do you have in place any guidelines or procedures for managing end of life cycle for your product

Form Completed By: *

Provide Required Information

NAME

POSITION

DATE

TELEPHONE NUMBER

EMAIL ADDRESS

The information contained in this questionnaire will be held in confidence by Orsini SPI and it's clients and used for the purpose of determining your suitability for meeting our general requirements. Further assessment and selection may be required before and indication can be given on the success of your application for inclusion on our preferred tender list.
Tick this box to acknowledge that you read and agree with terms above *

I agree
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Vendor Pre-Qualification Form