PFMI NEW VENDOR REGISTRATION FORM

PFMI NEW VENDOR REGISTRATION

Contractors, Consultants, Suppliers, Service Providers
Integrity Commitment for Vendor Registration
INSTRUCTIONS:
1. Please read the instructions carefully before filling up this form. Fields marked with an asterisk (*) are mandatory.

2. Please enclose the necessary documents as stipulated in the online registration form. Incomplete application will not be considered.

3. Please enclose your company's catalogues/brochures to support the supply of goods and/or services.

4. A minimal registration fee will be imposed as stated in the online registration form. Your registration will be evaluated based on predetermined and you will be notified on the status of your registration.

5. This registration however does not guarantee vendor that they will be invited/awarded for any upcoming purchases undertaken. Vendors are still required to promote their products/services separately.

6. If you have questions or clarifications, please send your feedback and/or queries directly to Procurement & Contract Department at contract@pknsfmi.com or contact us at 03-5524 5644.

1. Company Contact Information
Organization/Business Name*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Year Established*
Name*

First NameLast Name
Phone Number (Office)

Area CodePhone Number
Phone Number (H/P)*

Area CodePhone Number
E-mail*

2. Company Overview
Type of Business Registered
Date of Incorporated

MonthDayYear
Date
Bumiputera Status

BumiNon-Bumi
General Details of Services/Goods
Specialization
if others, please state
Website (if any)
www.example.com.my
CIDB Grade
Registration with CIDB (ex. Code=CE01, Detail Code=Pembinaan Jalan dan Pavemen)
Registration with MOF (ex. Code=221001, Detail Code= Pembersihan Bangunan dan Pejabat
Registration with Professional Bodies (If any, please specify)

3. Financial Information
A. Capital Structure
B. Banking Information

4. CHECKLIST DOCUMENT REQUIRE FOR SUBMISSION (Whichever related based on your entity registration type). All documents are MANDATORY to be submitted to complete the vendor registration process.
File Upload*

if unable to upload the file, please email to contract@pknsfmi.com with email subject "PFMI NEW VENDOR REGISTRATION (COMPANY NAME)"
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5. Payment

Vendors must provide a registration fee of RM50.00 (Ringgit Malaysia Fifty Ringgit Only) *Non-Refundable*. Payment must be made via online transfer to the account as below.

Account Holder	:	PKNS FM Integrated Sdn Bhd
Account Number	:	12261010018855
Bank Name	:	Bank Islam Malaysia Berhad
Recipient Reference	:	daftarvendor

Registration valid for ONE (1) YEAR from the date of application. Please attach payment receipt below.

Receipt of Payment*

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5. Declaration & Certification of Information
1. I/We hereby certify that the information provided in this Form is complete and accurate to the best of my/our knowledge and belief.

2. I/We certify that in the event of any new and/or additional and/or change of information that is related to this Form, I/We undertake to promptly report that information to Procurement via e-mail at contract@pknsfmi.com.

3. I/We shall comply with all data protection and privacy laws and regulations, including the Personal Data Protection Act 2010 (“PDPA 2010”) in relation to the collection and processing of any personal data during the performance of my/our services and/or supply of products and/or services by providing the supporting documents required.

4. I/We hereby agree that any personal data and/or information contained in the documents may be held, used, processed and disclosed by PKNS FM Integrated Sdn Bhd.

5. I/We hereby declare our understanding that the processing of any personal data and/or information held by PKNS FM Integrated Sdn Bhd as mentioned would mainly be for the purposes of evaluation and screening PKNS FM Integrated Sdn Bhd ’s service provider(s), Vendor(s) and/or Supplier(s)and towards other purposes required to smooth operation and maintenance of our business.

6. I/We understand that the data owner shall retain the rights to have access to and to request correction of any personal data and/or information held by PKNS FM Integrated Sdn Bhd, by contacting Procurement & Contract via e-mail at contract@pknsfmi.com.
Date*

DayMonthYear
Date
Should be Empty:

PFMI NEW VENDOR REGISTRATION

Integrity Commitment for Vendor Registration

1. Company Contact Information

2. Company Overview

3. Financial Information

5. Payment

5. Declaration & Certification of Information