DETAILS OF COLLABORATORS FOR MAK CIK PC
|Type of Registration [Please tick (√) the appropriate box] |
|New |
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|Existing |
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VENDOR REGISTRATION FORM
(This form must be fully completed by VENDOR. Write ‘Nil’ or ‘N/A’ (not applicable) where appropriate)
|1. Company Name |: | |
|2. Company Reg. No. |: | |3. Business Operating Address |
| | | | |
| | | | |
| | | | |
| | | |Country : _________________ Post Code : _______________ |
|4. Contact Person |: | | |
|5. Designation |: | | |
|6. Phone No. |: | | |
|7. Fax No. |: | |10. Date of Incorporation |: | |
|8. H/P No. |: | |11. Authorized Capital |: | |
|9. Official E-Mail |: | |12. Paid Up Capital |: | |
| | | |13. Working Capital |: | |
|14. Shareholding Structure |: |(Please state in terms of %) |
| | |a. Bumiputra Contents | |
| | |b. Non-Bumiputra Contents | |
| | |c. Foreign Contents | |
| | |Total |100% |
|15. Company Directors : |
|(A certified true copy of Form 49 must be attached with this completed form) |
| |
|Note : Please use additional papers if the above space is inadequate |
|_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I/C / Passport Number:- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
|_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I/C / Passport Number:- _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ |
|_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I/C / Passport Number:- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |
|16. Organization Type : [Please tick (√) the appropriate box] |
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|1. Sdn. Bhd. |
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|2. Berhad |
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|3. Corporative |
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|4. Enterprise |
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|5. Partnership |
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|6. Sole Proprietorship |
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|17. Work Category : Limited to ten (10) main category only |
|Note : Refer to Work Categories Listing attached. Please tick (√) the appropriate box. |
|18. Company’s Registration : |
|Registered with : [Please tick (√) the appropriate box] |
| |
|a |
|Kementerian Kewangan Malaysia (MOF) |
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|f |
|Jabatan Bekalan Elektrik (JBE) |
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|b |
|Board Of Engineers Malaysia (BEM) |
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|g |
|Board Of Architect (BOA) |
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|c |
|Pusat Khidmat Kontraktor (PKK) |
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|h |
|Suruhanjaya Tenaga (ST) |
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| |
|d |
|Kementerian Dalam Negeri (KDN) |
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|i |
|Others (please specify) |
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|e |
|Construction Industry Development Board (CIDB) |
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|j |
|Not applicable (N/A) |
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| |
|19. No. of Employee : _____________ |20. Preferred Banker |
|21. Type Of Office | _______________________________ |
|Own |Account Number:- |
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|Rental | |
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| | |
| |________________________________ |
|22.0 |COMPANY’s DECLARATION | | |
| | |
| |22.1 |The undersigned hereby declare that all particulars contained in this completed form and all duplicate copies of certificates, |
| | |letters and document attached herewith are true and accurate, and there has been no deliberate suppression of facts which are |
| | |required for the completion of this form. |
| | | |
| |22.2 |The undersigned agreed that MIMOS Berhad be granted the right to contact our clients on our company’s performance and also to |
| | |verify independently, our company’s financial standings with our banks. |
| | | |
| |22.3 |The undersigned also agreed to allow employees or representative of MIMOS Berhad to visit our company and inspect all the |
| | |particulars furnished in the form. |
| | | |
| |22.4 |The undersigned fully understand that no consideration will be granted to our company if any of the particulars are found false|
| | |and incorrect. |
| | | |
| |22.5 |The undersigned accept that our company will be liable to instant de-registration without notice if :- |
| | |(i) |Any particulars subsequent to our registration are found to be false and incorrect; |
| | | | |
| | |(ii) |Our company fails to notify immediately MIMOS Berhad on any change in the shareholding and/or any major changes in our|
| | | |company’s organization structure; and |
| | | | |
| | |(iii) |Our company generally appears in the market as practicing unprofessional business ethics. |
| |AUTHORISED SIGNATORY |: | | |
| | | | | |
| |NAME |: | | |
| | | | | |
| |DESIGNATION |: | | |
| | | | | |
| |DATE |: | | |
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| |COMPANY STAMP |: | | |
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(*) MIMOS BERHAD INTERNAL USE:-
For one time / direct payment purpose only:-
I hereby signed on behalf on the company and shall liable of any false and incorrect information stated in the form.
| |SIGNATORY |: | | |
| | | | | |
| |NAME |: | | |
| | | | | |
| |DESIGNATION |: | | |
| | | | | |
| |DATE |: | | |
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VENDOR REGISTRATION CHECKLIST
[Please tick (√) the appropriate box]
|Mandatory Supporting Documents for Local Company | |
| | |
|1 |Company Profile (Organisation Chart, Services Offered, Product Information & catalogue) | |
| | | |
|2 |Certificate of Registration with Government Bodies, Private Sectors and Public Sectors. | |
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|Additional Documents for Private Limited and Public Limited Company |
|1 |Form 9 / Form 13 | |
| | | |
|2 |Form 24 – Return of Allotment of Shares. | |
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|3 |Form 32A – Transfer of Shares | |
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|4 |Form 49 – Latest Particulars of Directors, Managers and Secretaries. | |
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|5 |Audited Account for the last Financial Year | |
| | | |
|Additional Documents for Sole Proprietor |
|1 |Form B - Business Information & Current Owner | |
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|2 |Form D – Registration Confirmation | |
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|3 |Income Statement & Balance Sheet for the last Financial Year | |
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|Additional Documents for Partnership |
|1 |Form A or Certificate of Registration | |
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|2 |Income Statement & Balance Sheet for the last Financial Year | |
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|Preferable Supporting Documents for Non Local Company | |
|1 |Oversea Certificate of Registration. | |
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|2 |Memorandum of Article (M & A) | |
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|3 |List of directors | |
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|4 |Audited Account for the last Financial Year | |
|Safety Management System | |
|1 |Organization chart reflective to the safety commitment | |
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|2 |Safety policy manual | |
| | | |
|3 |Safety training provided to the staff | |
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