PAYEE INFORMATION FORM

This form is for the use of new and existing Intel suppliers to include or update their information,thedata provided will be entered into Intel's Supplier Database and the details will be used for general procurement and payment activities.

Intel is committed to respect your privacy and confidential data.For more information on Intel's personal information handling practices, please visit: .

Please complete all fields or add “N/A” for those that do not apply. Fields highlighted in red are mandatory.

Type of business (Mark with “X”the option that best identifies your company)

Company ( ) Sole Proprietor ( ) Individual ( ) Government / Tax authority( )

DUNS #(9 digits): (Fill in if you have, or you may request it from Dun & Bradstreet –

Section 1: Company Name and data and Tax Identification

  • Legal company name: (legal company’, not legal representative name)
  • Business Trade name: (trade name, not business nature)
  • TaxID: *

* Based on country’s legislation: US: FEIN/SSN, Brazil: CNPJ, India: PAN, Malaysia: GST, etc.

  • Supplier’sfull address (Order from)
  • Supplier’s full address (Remit to address)

(If it is different from above)

Section 2: Contact Information

Role / Representative Name / e-mail / Phone
Billing / Payment
Sales
If it’s a public domain (E.g.: Gmail, yahoo …) please provide the Tax Certificate or Business License according your country law

If your email domain is different from the company name, please provide an explanation below:

Section 3: Bank Information

Bank Name: / Bank Account number:
Bank Country: / IBAN (Europe):
Bank Address: / Account Holder Name:(select one using “X”)
Same as Legal Name _____
Same as Business Trade Name
Other: Provide the relation with company ____
Bank Code # or ABA, BSB, IFSC, Other: / SWIFT Code:
Currencies Accepted in the Account: / Account type (E.g.: Savings, cash):
Intermediary Account (If applicable)
Bank Name and country: / Bank Account number:
Bank SWIFT Code: / Bank Code (ABA, BSB, IFSC, Other)

Section 4: Supplier Name Change (If applicable)

Old Name / New Name
Legal:
Trade:
Reason for change: Merge Bought out Tax ID change (provide tax forms) Other (Explain)
If tax information has changed, provide previous tax number(s) in the box below (Mandatory for Tax ID Changes)Previous TAX ID

Statement:

I, as the representative of the company, certify that the information above is correct and authorize the Intel's Account Payable Department to deposit electronically payments into the designated bank account as stated in Section 3 in this form.

Authorized Name: Signature: Date: (mm-dd-yy)

Send this form throughOTP (one time password)system provided by email.

You might be contacted by for verification processes.

For additional help ask to the Data Gatherer who is contacting you to process your case.

Intel makes no representations, warranties, or assurances of any kind about the accuracy or completeness of the information provided above.