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					                                                     AIG
     Vendor/Consultant Certification Program
                  Application
Please understand that all information requested in this application will be kept CONFIDENTIAL. AIG respects your
privacy, and does not intend to compromise your trust and goodwill.

                                       DEFINITIONS USED IN THIS APPLICATION

Vendor/Business Entity:      This is your Company. It may be an incorporated company, or an individual doing
                             business as (d.b.a.) a company (i.e., John Smith, d.b.a. Smith Plumbing of Peoria).
Applicant:                   The person signing this application (an owner, officer, principal partner, etc) who is
                             authorized to engage in this application process.

Principal:                   Any individual holding 5% or greater interest in the Vendor/Business Entity, and who
                             would typically hold a title of owner, general partner, limited partner, officer, or director.
Employee/Consultant
 Subcontractor:              Employees, Consultants and Subcontractors are those individuals who do not own
                             significant (5% or more) interest in the Business Entity, and represent the
                             Vendor/Business Entity at AIG.

                                                    Important Notice
       If your company is publicly traded on a U.S. or foreign exchange, you are required to have those employees, consultants
        and/or sub-contractors who work with AIG (remotely or at an AIG facility) complete sections C-2 (Principal-Employee-
        Consultant-subcontractor application AND C-3 (The Fair Credit Reporting Act Consumer Disclosure and General
        Authorization)
       If your company is privately held, you and your employees, consultants and/or subcontractors, who work with AIG
        (remotely or at an AIG facility) are required to complete ALL forms contained in this package.

                                         INSTRUCTIONS FOR THE APPLICANT

It is the responsibility of the Applicant to complete the Vendor/Business Entity packet, and further to ensure that each
Principal and any or all employees/consultants/subcontractors complete his/her packet. In accordance with the note
above, All sections in this application need to be completed accurately and legibly, and the FCRA forms must
be dated and signed. Additional Principal/Employee/Consultant/Subcontractor packets can be downloaded from
www.aigscreen.com. Be sure to distribute complete packets, including the cover sheet that contains specific
instructions for filling out the packet.

After all of the packets are returned to you, and you have verified their completeness, mail the packets to:

                                    American International Group Inc.
                       ATTN: Security Services Representative – CARCO Group, Inc.
                                              70 Pine Street
                                      Corporate Security, First Floor
                                           New York, NY 10270
                                            FAX: 212-742-8543

If you experience problems filling out this application, please do not hesitate to call CARCO at (800) 773-6506. The
Customer Service Department can also be reached by e-mail at: aigscreen@carcogroup.com.

NOTE: After the certification process is completed, you will be contacted regarding your status as an AIG
Vendor/Consultant. If approved for certification by AIG, the Vendor/Business Entity’s status as an AIG
Vendor/Consultant is subject to the terms and conditions of the applicable agreement between AIG and the
Vendor/Business Entity.
                                                             A-1
                             APPLICANT WORKSHEET
This worksheet has been prepared to assist the Applicant in identifying those Principals, Employees,
Consultants and Subcontractors whose information needs to be collected to begin the process of
qualifying the Vendor/Business Entity as a Certified AIG Vendor/Consultant. This worksheet will also
assist us in maintaining your file’s integrity, so be sure to return it with the Certification Program
Application.

Business Entity Name

Please note: All principals who owns 5% or greater interest in the vendor/business entity must
complete forms C-2 and C-3 in order for Vendor/Business Entity to be certified.


                    NAME                                           SELECT ONE
                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor

                                                   Principal  Employee  Consultant  Subcontractor




                                                 A-2
                                          AIG
           Certification Program Application
                      VENDOR/BUSINESS ENTITY
INSTRUCTIONS
All sections in this application need to be completed accurately and legibly. It is understood that
you may not be able to answer everything asked of you, but please make a sincere effort to furnish the
information requested. Incomplete information will result in our contacting you to request this information
again.

This packet has space for two business addresses (current and two prior). Should this packet prove to
have less space than needed for the requested information, please make extra photocopies of the
necessary form(s).




NOTE: You are strongly encouraged to make a copy of all application materials for your records.




                                                   B-1
      INFORMATION ON VENDOR/BUSINESS ENTITY
Vendor/Business
Entity Name
Fictitious Business Name (d.b.a.)
Date Company Formed
Current Address

City                                         County
State                                       Country
Zip                                         Phone #
Fax #                                        E-Mail
Dates at this address       from                                to    present
Parent Business Entity Name
Federal Tax ID # of the
Vendor/Business Entity
SIC Code/Type of Business
*AIG Manager Name                                           Phone #
*AIG Manager E-Mail                                @ AIG.com
*AIG Company/Branch/Department Code: _______________/_______________/_______________
# of employees/consultants/subcontractors
who represent vendor/business entity at AIG
* Required PRIOR to start of background check.



Prior Address Information – Please record all other addresses for the past seven
(7) years, listed from most to least current.

The following is a  Mailing Address          Physical Address
Company Address
City                                                   County
State                                                  Country
Zip
Dates at this address           from                              to
                                                 month/year            month/year



The following is a  Mailing Address          Physical Address
Company Address
City                                                   County
State                                                  Country
Zip
Dates at this address           from                              to
                                                 month/year            month/year
                                                   B-2
                                            AIG
            Certification Program Application

      PRINCIPAL – EMPLOYEE – CONSULTANT -
                SUBCONTRACTOR
YOU ARE A PRINCIPAL if you hold 5% or greater interest in the Vendor/Business Entity.
Typically, you would have a title of Owner, General Partner, Limited Partner, Officer, or Director.

YOU ARE AN EMPLOYEE, CONSULTANT OR A SUBCONTRACTOR if

        (a) You own less than 5% in the Vendor/Business Entity, and
        (b) You represent the Vendor/Business Entity at AIG.

If you do not fall within one of the above categories, it is not necessary for you to fill out this application
packet.



INSTRUCTIONS
All sections in this application need to be completed accurately and legibly. It is
understood that you may not be able to answer everything asked of you, but please make a
sincere effort to furnish the information requested.

This packet has space for four home addresses (current and three prior). Should this packet
prove to have less space than needed for the requested information, please make extra copies
of the necessary form(s).

It is critically important that you also sign and date the FCRA form (page C-3). Work cannot
begin on your application without our receipt of this signed and dated form.

When you have finished completing this packet, return it to your manager, the owner/s, or the
person who gave this application to you.



NOTE: You are strongly encouraged to make a copy of this application packet for your records.




                                                       C-1
                         INFORMATION ON
          PRINCIPAL/EMPLOYEE/CONSULTANT/SUBCONTRACTOR
I am a     Principal/Owner      Employee            Consultant Subcontractor
Legal Name
                              Last                               First                        Middle
Alias or Maiden Names
Date of Birth                                       Social Sec. #
                  Month/day/year
Gender Male  Female 
Drivers License #                                                         State of Drivers License
Current Address
City                                                       County
State                                                      Country
Zip
Dates at this address                from                                         to         present
*Your Business Entity’s Name
*Contact Name/Email Address
*Contact Phone #
Ownership Interest*           %                                      *Principal ONLY
*AIG Company/Branch/Department Code:                          /     /
*AIG Manager Name                                        *AIG Manager Phone #
*AIG Manager E-Mail
*AIG Business Group           
* Required before background check will be started.
Prior Address Information – Please record all other addresses for the past seven (7) years, listed
from most to least current.
The following is a  Mailing Address         Physical Address
Address
City                                                       County
State                                                      Country
Zip
Dates at this address                from                                         to
                                                  month/year                                month/year

                                             Physical Address
Address
City                                                       County
State                                                      Country
Zip
Dates at this address                from                                         to
                                                  month/year                                month/year

                                             Physical Address
Address
City                                                       County
State                                                      Country
Zip
Dates at this address                from                                         to

                                                     C-2
              Principal/Employee/Consultant/Subcontractor Information

                    THE FAIR CREDIT REPORTING ACT (FCRA)
            CONSUMER DISCLOSURE AND GENERAL AUTHORIZATION
          (To be signed by Principal and all Employees working with AIG)

In connection with the Business Entity’s application for vendor certification by American
International Group Companies (AIG) to provide service to AIG, a Consumer Report, as this
term is defined in the federal Fair Credit Reporting Act as amended (FCRA), 15 U.S.C. 1681 et
seq., will be obtained by AIG from CARCO Group Inc., a consumer reporting agency. CARCO
may not give out information about you to AIG without your written consent below.

The Consumer Report may include a verification of your identity, a criminal history record check,
financial, license, and a driving history check.
By signing this form, you are authorizing AIG to procure a Consumer Report for the intended
purpose only and no other.




I hereby authorize AIG to obtain a Consumer Report on me contingent upon the limitations
stated above. This authorization does not include the release of any medical information. This
authorization is valid only for the purpose set forth herein.

Printed Name _________________________________________________________________

Signature ___________________________________________________________________

Today’s Date _________________         [NOTE: This form is valid for three (3) months only]


Date of Birth ____________________       Social Security # ______________________________

Driver’s License # __________________________________________ State _____________

AIG Contact Name & Email Address _______________________________________________




  A photocopy or electronically generated copy of this form may be treated as original.




                                                 C-3
           AIG VENDOR CERTIFICATION PROGRAM

      INDIA CRIMINAL RECORD VERIFICATION
                 RELEASE FORM


INSTRUCTIONS
All sections in this application need to be completed accurately and legibly.

Subject must complete this form for each address in India in which the subject resided during
the past 7 years. Please do not complete this form for US addresses.

A separate form must be completed for each individual address. Make extra copies of the form
as necessary.

Period of Residence must include actual dates subject resided at address indicated.

It is critically important that you also sign and date the form. Work cannot begin on your
application without our receipt of this signed and dated form.

When you have finished completing this packet, return it to your manager, the owner/s, or the
person who gave this application to you.




                                              C-4
     MAILING ADDRESS
   POST OFFICE BOX 1600
SMITHTOWN, NEW YORK 11787
      Tel: 631.862.9300
      Fax: 631.862.7471




   Subject:        INDIA CRIMINAL RECORD VERIFICATION


   We would be grateful if you could confirm from your records, whether out employee, whose
   details are given below, has had any criminal case booked against him during the period as
   indicated:


   Name:                           _________________________________

   Father’s/Husband’s Name:        _________________________________

   Residential Address:            _________________________________

                                   _________________________________

   Period of Residence:            _________________________________


   Thank you for your cooperation.




   CARCO Group, Inc.



   I hereby authorize all persons, courts, and law enforcement agencies to release such information without
   restriction or qualification. I authorize CARCO and any of their designees or agents to obtain a Consumer
   Report on me contingent upon the limitations stated above. I am willing that a Photostat or electronic
   duplication of this authorization be considered as effective and valid as the original. This authorization
   does not include the release of any medical information. This authorization is valid only for the purpose
   set forth herein.


   Printed Name:

   Signature:                                                Date of Birth:

   Today’s Date:                                     (NOTE: This form is valid for three (3) months only).



                                                      C-5

				
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posted:11/20/2011
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