SAMPLE TEMPLATE - Amazon Web Services



organisation profile Will your organisation comply, if required, with Our Code and our Anti-Corruption policy?Yes FORMCHECKBOX No FORMCHECKBOX Will your organisation conform, if required, to our Quality, Safety and Environmental Management systems and site specific Quality, Safety and Environmental Plans?Yes FORMCHECKBOX No FORMCHECKBOX Registered NamePostal AddressPost Code ABN No.Trading Name Email AddressName of Bank BSBAccount NumberType of Organisation (Pty Ltd, Public Ltd, Partnership/Sole Trader)Number of EmployeesPlease provide contact details within your OrganisationPositionNameTelephoneEmail AddressManagerSales/EstimatingProduction/ConstructionAccounts Who is your contact for the Company?Contact NameDoes your organisation have a minimum of 25% indigenous ownership?Yes FORMCHECKBOX No FORMCHECKBOX 2industry classification Select your Organisations primary businessAccommodation & Diners FORMCHECKBOX Business Services FORMCHECKBOX Construction FORMCHECKBOX Cultural & Recreational Services FORMCHECKBOX Education & Training FORMCHECKBOX Finance & Insurance FORMCHECKBOX Health & Community Services FORMCHECKBOX Information Tech & Comm FORMCHECKBOX Mining FORMCHECKBOX Manufacturing FORMCHECKBOX Plant & Equipment FORMCHECKBOX Retail Trade FORMCHECKBOX Transport & Storage FORMCHECKBOX Wholesale Trade FORMCHECKBOX Other (please specify) FORMCHECKBOX Please detail your Organisation’s Work Type, i.e. if Construction, the Work Type may be concreting, or drilling etc.3legalHas your Organisation been prosecuted by a regulatory body?Yes FORMCHECKBOX No FORMCHECKBOX If Yes, please provide further informationIs your Organisation involved in any bankruptcy or reorganisation proceedings?Yes FORMCHECKBOX No FORMCHECKBOX If Yes, please provide further information4referencesProvide contact information for your current or previous 3 jobsNameReferee 1Referee 2Referee 3Client Name Contact Name Contact Details Fax Number Email AddressValue $5insurancesPlease complete and supply copies of current certificates of insurances in ALL INSTANCESInsurance TypeInsurerPolicy NumberExpiry DateValueWorkers CompProfessional IndemnityPublic LiabilityMotor Vehicle Other - Marine Cargo Ins6registrations and licencesProvide details of, and expiry dates of all statutory Registrations and Licences held by your Organisation for example: Builders, Classified Plant, Painters, Registrations, Plumbing, Electrical, Gas, Dangerous Goods, Radiation, Explosives, Dewatering, Demolition Licences, etc.S. NoRegistration TypeRegistration NumberExpiry Date1234Provide details of licencesS. NoLicence TypeLicence NumberExpiry Date1234DeclarationOn behalf of our Organisation, I hereby certify that the information provided in this questionnaire is an accurate reflection of our Organisation and we will provide appropriate documented evidence if requested. I also confirm access will be permitted to our Organisation premises for audit if requested.Name of OrganisationName of Authorised SignatoryPositionDateSignatureFor office use onlyName of AssessorDateSignature RatingApproved FORMCHECKBOX Review FORMCHECKBOX CommentsCommercial Manager/System Manager approval:NameDateSignature ................
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