Supplier Registration

01. Company Details and General Information

Name of Company*

Street Address*

Postal Code*
City*

Country*

Tel*
Fax

Email*
Website

Contact Name*
Title*

Email*

Parent Company (Full legal / officially registered company name)*

Subsidiaries, Associates - name, city, country (attach a list if necessary)

International Offices/Representation (Countries where the company has local Offices/Representation)

Type of Business*
Limited / PartnershipOther(specify)


Nature of Business*
ManufacturerAuthorised AgentTraderConsulting CompanyOther(specify)


Year Established*
Number of Full-time Employees*

Company Registration No. (attach copy)*

MIRA TIN No. / TAX I.D. (attach copy)*

Available Storage Facilities, Facility size and Facility Address (e.g. Cold Storage) (attach a list if necessary)*

02. Banking Information

Bank Name*
Branch Name*

Branch Address*
Bank Account Number*

Account Name*
Account Currency*

Swift/Bank Identifier Code (BIC)*
International Bank Account Number (IBAN)

03. Technical Capability and Goods/Services Offered

Quality Assurance Certification (e.g. ISO 22000 or Equivalent) (Please provide a copy of your latest certificate)*

04. Experience

Annual Value of Total Sales for the last 3 years*

Year
USD

Year
USD

Year
USD

Annual Value of Export Sales for the last 3 years*

Year
USD

Year
USD

Year
USD

Please provide a copy of the company's latest annual or audited Financial Report*

Do you have outstanding bankruptcy, judgment or pending legal action that could impair operating as a going concern?*

To which countries has your Company exported and/or managed Projects over the last 3 years?*

05. Official not to benefit

By signing this SRF, potential vendors confirm that they have read, understood and will comply with the MIC policy on the “zero tolerance” that strictly prohibits the acceptance of any type of gift and/or hospitality by MIC staff members participating in the procurement process. Please confirm.*

YesNo

* Any breach of this clause may lead to the termination of all contracts your Company may have with MIC and removal from
the approved vendor database.



I, the undersigned, warrant that the information provided in this form is correct and, in the event of changes, details will be provided as soon as possible.

Self Declaration: I, the undersigned, declare that:

Our company is not involved in any fraudulent or corrupt activities and has not been in the past, and is not currently under any investigation for any such activities which would render our company unsuitable for business dealing with MIC.

Name*

Functional Title*