/ VENDOR PREQUALIFICATION FORM / Reference: / PROC-F-2
Rev: / 1
Date of Issue / 1/3/2012

VENDOR PREQUALIFICATION FORM

NAME
ADDRESS
TEL#:
FAX#:
WEBSITE/E-MAIL:
NAME OF OWNER/PARTNER
COMMERCIAL REGISTRATION #, DATE
CHAMBER OF COMMERCE REGISTRATION #, DATE
LATEST ZAKAT CERTIFICATE #, DATE.
LICENCE # OF MINISTRY OF IND. & ELECT
DATE OF START OF ORGANIZATION
BANK REFERENCE/ IBAN
MANAGEMENT SYSTEM CERTIFICATION, IF ANY

Note: copies shall be attached

MAJOR FIELD OF ACTIVITIES:

I. MATERIALS.

SN# / DESCRIPTION OF MATERIALS MFG. / SUPPLYING

II. SERVICES.

SN# / DESCRIPTION OF SERVICES OFFERED

DETAILS OF MAJOR SUPPLIES / PROJECTS COMPLETED DURING

THE LAST THREE YEARS

SN# / Description of major Supplies / Projects completed / Client / Total Amount / Remarks

NOTE: If required, attach a separate list

DETAILS OF MAJOR PROJECTS ON HAND

SN# / Description / Details of Project / Client / Estimated Cost / Completion Date.

DETAILS OF MANPOWER CATEGORIES PRESENTLY AVAILABLE:

SN# / Category / No of manpower / Nationality
DETAILS OF MACHINERIES / EQUIPMENTS AVAILABLE:

NOTE: List may be provided.

DETAILS OF MANUFACTURING FACILITY AVAILABLE :

NOTE: Details may be provided.

DETAILS OF KEY PERSONNEL OF ORGANIZATION

SN# / Name of Person / Position / Experience / Tel #, Fax #, Email.

SPECIAL INSTRUCTIONS

In case of manufacturer, Specify name, details of Product.

In case of Authorized Agent submit copy of authorization from Manufacturing Co.

Catalogue, Brochure of Company shall be submitted.

To register more than one Category, Vendor has to submit separate Pre qualification Forms for each Category.

PLEASE SUBMIT A SOFT COPY OF COMPLETED REGISTRATION FORM AND ALL YOUR SUPPORTING DOCUMENTS IN A FLASH MEMORY OR A CD.

DECLARATION

I declare that, the information provided above is true and correct.

NAME:
SIGNATURE:
DATE:

COMPANY’S SEAL

NOTE: Duly filled Prequalification Form [Hard Copy] shall be sent to:

Mr. Sulaiman K. Al-Homaidan

Procurement Manager

Procurement Department

Farabi Petrochemical Co.

PO Box 11763.

Jubail Industrial. City 31961

Rev.: 1 FIMS-F-4