GPPA – GAMBIAN SUPPLIER / CONTRACTOR REGISTRATION FORM - 2004

Registration fee:

·  D500 – for suppliers of goods and services

·  D1,000 – for Contractors

Fill in all sections of the application and return with a fee and required documents to:

The Director General, Gambia Public Procurement Authority (GPPA), 55, Kairaba Avenue, Fajara,

The Gambia. Tel:.(220) 378 502 / 378 504, Fax: (220) 378501, Email:

1. Name of Business or Individual:

2. Address: 3. Managing Director/Owner (Name and Title and contact information). ______1. ______

City: ______Post Box: ______

2. ______

Country: ______

4. Tel.: ______5. Fax: ______

Country code City code Number Country code City code Number

6. Email: 7. WWW Address:

Name of contact for communication regarding bids: ______

8. Parent Company (Full legal Name), or other business names under which you do business, if any:

9. Subsidiaries and Overseas Representative(s): State if partially, fully owned or agent and attach a list if necessary.

10. Type of Business (mark one only):

Corporate / Company: Partnership: Sole Proprietorship Other (specify):

11. Nature of Business:

Manufacturer: Authorized Agent: Trader: Consulting Firm: Construction Contractor Other (specify): ______

*If Trader, Agent or Representative Company, not directly involved in the manufacture of the product, please provide:

1)  Certification from your principals that you are authorized to deal with their products or to act on their behalf.

2) A list of business transacted in the last year for the products you wish to register, giving names and address of customers and value of three most recent contracts.

13. Year Business Established: 14. Number of Full-time Employees:

15. Business Registration Number / Place where registered (Privately held companies must attach copy of certificate of incorporation):

16. Tax Identification Number:______Attach copy of Tax Clearance Certificate

17. Pursuant to Section 23 of the Gambia Public Procurement Act 2001, I hereby certify that the business listed in block 1 above:

a. Has the legal capacity to enter into a contract;

b. Is not insolvent, in receivership, bankrupt or being wound up, or is in the process of being so;

c. Has fulfilled its obligations to pay applicable taxes and social security contributions in The Gambia; and

d. Neither I nor my business listed in block 1 above or any of its officers, have been convicted of any criminal offence in any country.

Signature: ______Title: ______Date: ______

GPPA BIDDER REGISTRATION NUMBER (for use by GPPA) ______

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