/ ISRAEL ELECTRIC CORP. LTD.
Operations and Logistics
Procurement Division
SUPPLIERS'CERTIFICATION UNIT /

MANUFACTURER QUALIFICATION QUESTIONNAIRE

Page 1 of 4

1. Company Details

. / Name
. / Previous Names
Private Company Public Company Other
Address
E-mail / Fax No. / Telephone No.
Address for Correspondence
Country and Registration Date
(Attach a Copy of the Registration Certificate) / Registration No.

Factory Details

Address for Correspondence
Office Name / Name
Address / Address
Telephone No. / Telephone No.
Fax No. / Fax No.
E-mail / E-mail

External Auditor

Office Name
Address
E-mail / Fax No. / Telephone No.

Page 2 of 4

Local Agent*

Name
Address
E-mail / Fax No. / Telephone No.

* Attach letter of authorization including the full details of the local agent

2. Company Profile

General Description of the Company
Company Owners
Names of Senior Company Officers
Chief Executive Officer (CEO)
Chief Financial Officer (CFO)
President
Chairman of the Board
Directors
Vice-President of Finance
Vice-President of Marketing
Other Senior Management Officers
Names of Major Shareholders
Name and Address of Parent Company and Subsidiaries (including percentage of holdings)
Has the company been declared a company in liquidation temporarily/permanently* in the last three years? Yes No 
Has any law court appointed a receiver or trustee or administrator during the last threeyears?
NoYes 
Major Creditors

Page 3 of 4

*Delete the Unnecessary

No Yes  / Has any substantial claim* been filed against the company or is any claim pending?
If yes, specify
1.1Has the company acquired all the necessary licenses required by law in to manage its business and to supply products/services**? yes no 
If no, specify

3. Manufacturing Ability

Description ofmain products***
Description of main manufacturing facilities
Description of annual production capacity

4. Quality

Yes No  / Do you have a certified Quality Management System?****
Yes No  / Are you certified/accredited to other standards**?
If yes, please specify
  • "Substantial claim" is a claim which could have material effect on the Company's capital, profit oroperation.
  • ** Please delete the unnecessary.
  • ** Attach a list of clients and equipment installations during the last three years.
  • **** Attach Quality Management System certifications and a quality manual.

Do you work according to other standards? Yes  No 
If yes, specify

Page 4 of 4

5. Financial Information

Branch / Bank
Country / International Bank Account No.
Specify total turnover for each of the last five years
  • The company must attach to this questionnaire hard copies of annual reports in English (including notes) duly signed and certified by it's independent Auditors and it's authorized officers for the last three years including: balance sheet, income statement and cash flow statement, (attached annexure).
  • The qualified supplier must provide IEC with annual audited Financial Statements in English as mentioned above once every three years, during the period of qualification.
  • IEC reserves the right not to qualify the supplier nor renew his qualification in the event of supplier's failure to submit the requested reports, as requested above.

Please Note:It is the duty of the supplier to inform IEC immediately of any change in the information provided in this questionnaire.

Please send all information to:
ISRAEL ELECTRIC CORPORATION LTD. Operations and Logistics

Procurement Division –Suppliers'Certification Unit

POBox 10

Haifa 31000,

Israel

Tel: 972-4-8182506/7

Fax: 972-72-3428268

______

Signature Position Name Date

שם החברה / Company
ארץ החברה /Country
פרטית או ציבורית /CompanyPrivate or Public:
מטבע / Currency
נתוניהמאזן / Balance Sheet / Year 3 / Year 2 / Year 1
נכסים / Assets / __20 / __20 / __20
סה"כ נכסים שוטפים / Total Current Assets
מזומנים ושווי מזומנים / Cash & Equivalents
ניירות ערך סחירים / Marketable Securities
חייבים (לקוחות) / Trade Receivables
חייבים (אחרים) / Other Receivables
ערך המלאי / Inventory
השקעות לא שוטפות / Non-Current Investments
רכוש קבוע נטו / Net Fixed Assets
רכוש אחר / Other Assets
סה"כ נכסים / Total Assets
סה"כ התחייבויות שוטפות / Total Current Liabilities
התחייבויות לזמן ארוך / Long Term Liabilities
התחייבויות אחרות / Other Liabilities
עתודות / Provisions
זכויות מיעוט / Minority Interest
הון מניות וקרנות / Share Capital & Reserves
יתרת הרווח (עודפים במאזן) / Retained Earnings
שונות / Miscellaneous
סה"כ מאזן / Total Liabilities
נתוני דו"ח רווח והפסד / Profit Loss Account / Year3 / Year 2 / Year 1
__20 / __20 / __20
סה"כ מכירות / Sales
עלות המכירות / Cost of Sales
הוצאות מכירה והנהלה / Selling & Administrative Expenses.
הוצאות מחקר ופיתוח / Research & Development Expenses.
הוצאות(הכנסות)אחרות / Other Expenses (Income)
חלקהחברהברווחיחברותמוחזקות / Share of Subsidiaries Results
הוצאות (הכנסות) מימון / Financing Expenses (Income)
מס הכנסה / Income Tax
הוצאות (הכנסות) לאחר מס / Expenses (Income) after Tax
נתוני דו"ח רווח והפסד / Profit Loss Account / Year 3 / Year 2 / Year 1
__20 / __20 / __20
זכויות מיעוט / Minority Interest
רווח למניה / Earnings per Share
רווח נקי / Net Profit
נתוני תזרים מזומנים / Cash Flow / Year 3 / Year 2 / Year 1
__20 / __20 / __20
מזומנים מפעילות שוטפת (תמ"מ) / Cash from Operating
תזרים מפעילות השקעה / Cash from Investments
השקעה ברכוש קבוע / Purchases of Plant, Equipment Machinery
תזרים מפעילות מימון / Cash from Financing
הפרשי תרגום מטבע / Exchange Differentials
עליה (ירידה) במזומנים ושווי מזומנים / Increase (Decrease) in Cash and Equivalent
מספר עובדים / Number of Employees
ExternalAuditor'sSignature / Company's Authorized Representative Signature