Business Partners Application form (Offset)
COMPLETION INSTRUCTIONS:
Please complete this form and return to
This form is provided because your company is under consideration for a business relationship with BAE SYSTEMS that may involve the generation of Offset Credits. Please respond to all of the questions in a clear and candid manner. If your response to any of the questions requires more space than that which is provided, please reference the section, the specific question and the response on a separate piece of paper and attach it to this form.
Please note that submission of this form to BAE SYSTEMS is only one step in our corporate review process, and such submission does not affirm the existence of a business relationship between BAE SYSTEMS and your company. Completion of this form will not necessarily mean that a business relationship with BAE Systems Inc. will ensue.
Please complete this form and return to
NN MM
Industrial Cooperation Manager
BAE Systems Hägglunds AB
SE-89182 Örnsköldsvik
nn.
+46-(0) 660 8xx xx
Background Information:
Name of Applicant ______
Name of Point of Contact at Applicant:
Applicant’s Postal Address:
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Registered Address (if different from mailing address)
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Telephone: Fax:
Email Address:
Website:
Type of Organization - Please (mark with an “x”) the applicable description:
PartnershipPrivate Corporation
Public Corporation
Sole Proprietorship
Other (describe)
Size of Organization – number of employees
0-100100-500
500-1000
1000+
Date and Place of Incorporation/registration (if applicable):
If Applicant is a company, list Applicant’s branch offices, parent/subsidiary organizations, joint ventures and related companies:
………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
If Applicant is a company, please provide copies of all corporate foundation and registration documents translated into English if necessary.
If Applicant is a publicly traded company, please provide a copy of the company’s most recent corporate reports, or web address from which corporate reports may be downloaded.
All directors and officers of the Applicant’s organization:
Name / Position/Title / NationalityShareholder(s) of Applicant (if entity is not a public company) (continue on extra sheets if necessary):
Name / Nationality / % Owned / Date Equity AcquiredBeneficial or other owner(s) of Applicant (continue on extra sheets if necessary):
Name / Nationality / Relationship to ApplicantReferences: Please provide three recent business references
Name of Company / Point of Contact Name and email address / Mailing Address / Telephone and fax / Nature of relationshipCompliance Questions
1. Is any owner, officer, or employee of Applicant employed by, or the agent of, any customer of the BAE SYSTEMS group?
Yes / No
If YES, please give full details.
2. Does any government or any department, agency or other organization of that government, or any official[1] or employee of that government own or have any other direct or indirect interest in Applicant, including beneficial interests?
Yes / No
If YES, please give full details.
3. If Applicant is an individual, is Applicant an elected or appointed official of any government, or an employee of any government department, agency or other organization of that government, including military or paramilitary forces?
Yes / No
If YES, please give full details.
4. Is any owner, shareholder, officer or employee of Applicant, an elected or appointed official of any government, member of any relevant royal family, or an employee of any government department, agency or other organization of that government, including military or paramilitary forces?
Yes / No
If YES, please give full details.
5. Does any owner, officer or employee of Applicant, have a family relationship with any current official or employee of any government or of any department, agency or of the organization of that government?
Yes / No
If YES, please give full details.
6. Does Applicant, or any of its shareholders or beneficial owners make any political donations?
Yes / No
If YES, please give full details.
7. Does any current or former government official, political party official or candidate for office have any direct or indirect ownership interest in Applicant?
Yes / NoIf YES, please provide full details, including their name, office, interest and role with respect to the Applicant.
8. Is any officer or employee of Applicant, a political party official, candidate for political office or current or former government official?
Yes / NoIf YES, please provide full details, including their name, office, interest and role with respect to the Applicant.
9. Has the Applicant, or any owner, officer or any employee of the Applicant, ever been debarred, ‘blacklisted’, or suspended from being allowed to work with any office of the local government on procurement issues?
Yes / NoIf YES, please give full details, include a description of the incident and how it was concluded, and whether the suspension or debarment is still active.
10. Has the Applicant, any former or associated organization of the Applicant, any present or former owner, officer or employee of the Applicant been charged with any criminal act, or been the subject of any allegation or investigation of fraud, bribery or other corrupt activity?
Yes / No
If YES, please give full details.
11. Has the Applicant ever been the defendant in a civil suit where the plaintiff alleged that the defendant had committed fraud (of any type or form) or breach of contract? If so, when did this occur, what were the circumstances and how/when was it resolved?
Yes / No
If YES, please give full details.
12. Does the Applicant have any business or financial arrangements where equity is pledged as collateral or whereby there may result in a change in any portion of ownership from the configuration described above in this Application?
Yes / No
If YES, please give full details.
13. Does your company currently employ individuals who hold passports from Afghanistan, Burma, Belarus, China, Cote d’Ivoire, Cyprus, Democratic Republic of Congo, Sierra Leone, Cuba, Eritrea, Haiti, Iran, Iraq, Lebanon, Liberia, Libya, North Korea, Somalia, Sri Lanka, Sudan, Syria, Vietnam, Venezuela, Yemen or Zimbabwe?
Yes / No
If YES, please give full details.
14. Does the Applicant have a written policy concerning the following:
(a) Code of Conduct
Yes / NoIf YES, please provide
(b) Bribery and anti-corruption
Yes / NoIf YES, please provide
(c) the giving of gifts or gratuities to government officials or government employees:
Yes / NoIf YES, please provide
(d) the provision of hospitalities, such as travel expenses or entertainment, to government officials or employees:
Yes / NoIf YES, please provide
(e) the hiring of current or former government officials or government employees:
Yes / NoIf YES, please provide
15. Please list any individuals or organizations that may be sub-contracted by your entity in the course of discharging the proposed project:
Name / Position/Title / Nationality / ExperienceCertification of Compliance with Anticorruption Laws
I hereby make the following declarations, statements, representations and promises:
a) I make this declaration as either the owner, or duly authorized director, officer or employee of the Applicant named below. I certify that I am authorized to so act on behalf of the Applicant.
b) The information I have provided is true to the best of my knowledge. I understand that you will rely on this information in deciding whether to enter into any contractual agreement with the Applicant named below. I hereby consent to your making such enquiries as you may consider necessary to verify this information and to process, store, and transfer such information in the manner you consider appropriate, including by electronic means including within BAE Systems Inc., the BAE Systems Group, and/or to BAE Systems plc. in the UK .
c) I have received, read and understand BAE Systems’ Code of Conduct and the attached briefing note on BAE’s anticorruption policies and will fully comply with these policies (the “Policies”) and with all applicable laws.
d) Neither I nor any officer, director, shareholder or employee of the Applicant named below will give, promise, or offer or attempt to give, promise or offer anything of value for the purpose of obtaining or retaining business or to obtain any improper advantage from a government official, political party official, or candidate for public office. Applicant will not ask anyone to give or attempt to give anything of value on Applicant’s behalf for the purpose of obtaining or retaining business or to obtain any improper advantage from a government official, political party official, or candidate for public office in relation to BAE SYSTEMS, US business.
e) No-one at the Applicant will give, offer or promise anything of value to a commercial business partner or to any BAE Systems employee for any improper purpose or to secure an improper advantage.
f) In the event that BAE Systems enters into a business relationship with the Applicant, I will report promptly any breach, or possible breach, of which I may become aware of the provisions of the Policies or of any law, whether enacted pursuant to the OECD Convention or the US Foreign Corrupt Practices Act, to my primary point of contact at BAE Systems who shall be named in any forthcoming agreement should Applicant’s appointment be approved.
Signed ……………………………………………………………………
Name (please print in capitals)…………………………………………………………………
TITLE (in capitals): …………………………………………………………………
Name of Applicant: …………………………………………………………………
Date: ……………………………………
Doc no 725844-v2
2015-01-21
[1] Including members of any relevant royal family