Propertyserve UK Prequalification Questionnaire

Instituto Nacional de Farmácia e Produtos Medicos Prequalification Questionnaire
This online form allows companies to register for prequalification with the Directorate of Procurements. Prequalified companies will be eligible to receive bid invitations for relevant procurements.

Please note: Completing this form does not guarantee prequalification. The Directorate of Procurements will review all submissions and contact qualified companies.
Company details
Name*

First NameLast Name
Phone*
Email*
Full name of organisation*
Website
Registered office address*

Address

City

City/TownCounty

Postcode
Company operating address (if different from that of registered office above)

Street Address

Street Address Line 2

City/TownCounty

Postcode
Type of organisation? Please also provide Companies House reg number if applicable*
E.g. PLC, Limited Company, LLP, other partnership, sole trader or other
Company reg no.*
Name of ultimate parent company

Regulatory Compliance
Please Provide Certificate of incorporation or business registration documents from purchaser country or country Origin *

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Please Provide Business licenses and permits relevant to pharmaceutical operations from purchaser country or country Origin *

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Please Provide Manufacturer authorization form for supplier bidder /Manufacture Registration for letter for Manufacturer bidder *

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Please Provide List of Products Catalogue from your Company *

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If you products from ROOT A Regulatory Please Attach evidence* of international product approval by the Regulatory Authority: Indonesia BPOM, Singapore HSA, Thailand FDA, Malaysia NPRA, Australia TGA, European Union EMA, Health Canada, Switzerland SwissMedic, Japan PDMA, US FDA or WHO pre qualified listed on your products Catalogue*

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If you products not listed from ROOT A Regulatory Please Attach a) Valid GMP certificate for the finished product manufacturing facility, issued no longer than 2 years ago, b) Valid CoPP for this product for export to Timor-Leste listed, c) List of countries where the product is approved *

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Please Provide Market authorization form for each item listed you Products Catalogue by Regulatory Authority from country origin*

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Please Provide Import or export license issued by Ministry of Health/regulatory authority from the country of origin or manufacturing country for each item listed your product Catalogue*

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General Experience (Contextually appropriate)
Please Provide document's Experience in the role of prime contractor, Joint Venture (JV) member, sub-contractor,*

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Please provide documents JV with experiences manufacturers or supplier for the supply of medicine into multiple low or middle-income countries for at least the last two years preceding the application.*

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Quality Management
Please provide Good Distribution Practice (GDP) SoP/certificate *

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Do you have procedures for periodically reviewing, correcting and improving quality performance? *

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Financial Information
Please note that where the supplier organisation is a subsidiary within a group, the responses below should provide details of the organisation responsible for the group.
(i) The Applicant shall demonstrate that it has access to, or has available, liquid assets, unencumbered real assets, lines of credit, and other financial means (independent of any contractual advance payment) of $100,000.00, calculated as being sufficient to meet the minimum cash flow requirements for a maximum estimated contract value of $100,000.00, net of the Applicants other commitments*

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(ii) The Applicant shall also demonstrate that it has adequate sources of finance to meet the cash flow requirements on works currently in progress and for future contract commitments.*

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Please note if the account for the previous full year have yet to be audited then a statement or balance sheet will also need to provided for this period. Cancelof
(iii) The audited balance sheets for the last one (1) year shall be submitted and must demonstrate the current soundness of the Applicant’s financial position and indicate its prospective long-term profitability.*

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Please include Public and Employee liability, Professional Indemnity, and any other relevant policies. Cancelof

Staffing
Number of employees
Please Attached List of Employees

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Business and professional standing
Please note that information supplied in this section will be taken into account in assessing the outcome of this application where the circumstances of judgement are pertinent to future projects. It will not necessarily constitute a reason for rejection
Has your company or any of its Directors and Executive Officers been the subject of criminal or civil court action (including bankruptcy and insolvency) in respect of the business activities currently engaged in, for which the outcome was a judgement against you or them?*

YesNo
If yes, please provide details:
Is your company or any of its Directors and Executive Officers the subject of ongoing or pending criminal or civil court action (ncluding for bankruptcy or insolvency) in respect of the business of the business activities currently engaged in?*

YesNo
If yes, please provide details

References and additional information
Please provide details of references for whom you have undertaken work of a similar nature to that applied for here.*
Please provide address, contact details and name of 2 references for works undertaken in the past 12 months.
Please provide any other information that may act in favour of your submission.
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Declaration
I confirm that the information provided in this form is a true and accurate record and correct as of date of submission.*

First NameLast Name
Signature*
Should be Empty:

Instituto Nacional de Farmácia e Produtos Medicos Prequalification Questionnaire

Company details

Regulatory Compliance

General Experience (Contextually appropriate)

Quality Management

Financial Information

Staffing

Business and professional standing

References and additional information

Declaration