Contractor Assessment Form

CONTRACTOR ASSESSMENT FORM
Welcome to Statewide Restorations

At Statewide Restorations, we place great importance on delivering quality workmanship and maintaining a high level of professionalism. If you share these values and are interested in working with us, we invite you to take the next step. To initiate the process, kindly complete all the required fields below in the provided form. Once you submit the form, our dedicated Procurement Team will promptly review your submission. We highly value open communication and look forward to getting in touch with you shortly to discuss potential opportunities for collaboration.
Company Name
ABN
Bank Name
Bank Details
BSB
Bank Details
Account Number
Bank Details
Please list services provided
Can you provide emergency make safe services?”
Can you provide after hour emergency make safe services
Do you currently undertake any works for other insurance panel builders? If so,please list.
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Directors Name

First NameLast Name
Company Address

Street Address

Street Address Line 2

CityState / Province

Postcode
Company Email
example@example.com
Company Mobile
Please enter a valid phone number.Format: 0000000000.
Upload your IICRC/ITI Certification

You can upload multiple files
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Certification Expiry Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Upload your Insurances P/L, PI & WC

You can upload multiple files
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Insurance Expiry Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Upload your National Police Check

You can upload multiple files
Cancelof
National Police Check Expiry Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Upload your White Card

You can upload multiple files
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White Card Expiry Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Upload your Working With Children Check

You can upload multiple files
Cancelof
Working With Children Check Expiry Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Upload your Company SWMS (Safe Work Method Statements)

You can upload multiple files
Cancelof
SWMS Expiry Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Signature
Should be Empty:

CONTRACTOR ASSESSMENT FORM