Annex 7: supplier registration form - DOC

							                                                                                  September 2008

Annex GEN 1-3: Supplier registration form
To be considered for inclusion in DCA supplier database your company is required to complete all
parts of this form and submit it together with annual reports, brochures, certificates, etc to
DanChurchAid, Procurement & Logistic Division, Noerregade 13, DK-1165 Copenhagen K, Denmark.

                                     GENERAL COMPANY INFORMATION

Parent company (legal name)
Street name and no.
City
Postal code
Country

Phone no.:
Fax. no.:
E-mail:
web-site:

Sales Manager (name)
E-mail:
Direct phone no.

Director (Name)
E-mail:
Direct phone no.

Other contact (Title & Name)
E-mail:
Direct phone no.

Year of Establish

Number of full-time employees

Licensing Authority

Licence number (VAT no./TAX I.D.)

Does your company have a written
statement of its environmental policy?

Does your company have an employee
HIV/AIDS policy?

Please state in which languages
technical documents are available:

Working language:

List of International quality assurance
certification held by your company:
(A copy of each certificate shall be
enclosed)

List of local and national quality




                                            GEN 1-3 page 1
                                                                                        September 2008
assurance certification held by your
company. (A copy of each certificate
shall be enclosed)

International trade / professional
organisations of which your company
is a member:

Local trade / professional
organisations of which your company
is a member:


                                              Sector of Activities

Please list your core goods / services
/civil works offered




Nature of business – tick in one box below:
Importer:           Wholesaler:          Retailer:                   Manufacturer:   Authorised agent:

Consultant:           Contractor:



                        Subsidiaries, Associates an/or Overseas Representative

Countries with registered office:

Countries with representation (agent):



                                             Export and references

Please list countries your company
export to:
Have you supplied to other NGO’s, EU,
UN and other International
Organisations?

If yes, please enclose a list with details
of contracts and customer contact
information for references.


                                             Financial Information




                                                GEN 1-3 page 2
                                                                                               September 2008
Please provide a copy of the company’s most recent annual or audited financial report.

Annual Income and Export sales for the last 3 years (in EUR million)

                        Fiscal year           Income Sales (EUR Million)        Export Sales (EUR million)
Year 1                  2005
Year 2                  2006
Year 3                  2007

Bank name
Bank account no.
Account name
Bank swift/BIC address
Street name and no.
City and Postal code
Country

Please provide credit rating by Dun and Bradstreet or equivalent

Credit rating:
Direct phone no.


                            CONFIRMATION OF ACCEPTANCE OF
              GENERAL TERMS & CONDITIONS FOR SUPPLY CONTRACTS – VER3 2008
              GENERAL TERMS & CONDITIONS FOR SERVICE CONTRACTS – VER1 2006
                 GENERAL TERMS & CONDITIONS FOR CIVIL WORKS – VER1 2006

YES………
NO………. (Please provide details of problematical paragraphs and attach a list if necessary (Non
acceptance of DCA’s General Terms & Conditions may jeopardise award of any eventual Purchase
order to your company)


                                              PAYMENT TERMS
Please state your payment terms:

DCA standard payment for supply contracts is 100% payment within 30 days after delivery of goods and
upon receipt of suppliers invoice, and shipping documents.
Advance payment is only acceptable against a financial bank guarantee covering the full amount of
the advance payment.


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

Name…………………………………………………….Title / Function…………………………………..

Signature………………………………………………...Date:……………………………………………..



                                               NOTE
  Completion of the Supplier Registration Form may facilitate contracting business with DCA but is
                does not necessarily lead to the issue of an order to your company.

      DCA reserves the right to accept or reject registration of a potential Supplier into its list of
                                   Registered Potential suppliers




                                               GEN 1-3 page 3