GPSU.SF-19.6

VENDOR INFORMATION SHEET (VIS)

Name of the Company ______

AddressLeasedOwnedArea: ______sqm

House No ______

Street Name ______

Postal Code ______

City ______

Region ______

Country ______

Contact Numbers/Address

Telephone Nos. ______Contact Person: ______

Fax No. ______

E mail Address ______Website:______

Location of Plant/WarehouseLeasedOwnedArea: ______sqm

______

______

______

Business OrganizationCorporation PartnershipSole Proprietorship

Business License No.: ______Place/Date Issued:______Expiry Date ______

No. of Personnel ______Regular ______Contractual/Casual ______

Nature of Business/Trade

ManufacturerAuthorized DealerInformation Services

WholesalerRetailerComputer Hardware

TraderImporterService Bureau

Site Development/ConsultancyOthers ______

Construction______

Number of Years in business: ______

Complete Products & Services

______

______

Payment Details

Payment MethodCashCheckBank TransferOthers

Currency Loc.CurrencyUSDEUR Others

Terms of Payment 30 days15 days7 daysupon receipt of invoice

Advance Payment YesNo% of the Total PO/Contract

Bank Details:

Bank Name______

Bldg and Street______

City______

Country______

Postal Code______

Country______

Bank Account Name______

Bank Account No.______

Swift Code______

Iban Number ______

Key Personnel & Contacts (Authorized to sign and accept PO/Contracts & other commercial documents)

NameTitle/PositionSignature

______

______

______

______

Companies with whom you have been dealing for the past two years with approximate value in US Dollars:

Company NameBusiness ValueContact Person/Tel. No.

______

______

______

______

Have you ever provided products and/or services to any mission/office of IOM?

YesNo

If yes, list the department and name of the personnel to whom you provided such goods and/or services.

Name of PersonMission/OfficeItems Purchased

______

______

______

______

Do you have any relative who worked with us at one time or another, or are presently employed with IOM? If yes, kindly state name and relationship.

______

______

______

______

Trade Reference

CompanyContact PersonContact Number

______

______

______

______

Banking Reference

BankContact PersonContact Number

______

______

______

______

IOM is encouraging companies to use recycled materials or materials coming from sustainable resources or produced using a technology thathas lower ecological footprints.

REQUIREMENTS CHECK LIST

Please submit the following documents together with the Information Sheet:

No. / Document / For IOM use only
Submitted / Not Applicable
1 / Company's Articles of Incorporation, Partnership or Corporation, whichever is applicable, including amendments thereto, if any.
2 / Valid Fire Security Certification
3 / Valid Government Permits/Licenses/Clearances/Certificates: (Tax Clearance Certificate, Social Security Clearance Certificate and Valid EOT License)
4 / Valid Public Liability Insurance
5 / Certification that Non-performance of contract did not occur within the last 3 years prior to application for evaluation based on all information on fully settled disputes or litigation
6 / Solemn Declaration that the Hotel Facility and the offered services fully comply with the applicable Greek Legislation

I hereby certify that the information above are true and correct. I am alsoauthorizing IOM to validate all claims with concerned authorities.

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Received by:

______

SignatureSignature

______

Printed Name Printed Name

______

Position/TitlePosition/Title

______

DateDate

______FOR IOM USE ONLY______

Purchasing Organization______

Account Group______

Industry 001002003

where 001 - Transportation related to movement of migrants

002 - Goods (e.g. supplies, materials, tools)

003 - Services (e.g. professional services, consultancy, maintenance)

Vendor TypeGlobal Local

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