Type of Business (mark one only)
Corporate LimitedPartnershipOther (specify)
Nature of business
ManufacturerAuthorised AgentTraderService ProviderOther (specify)
If you mark "Authorised Agent" or "Trader", please provide proof or certificate(s) from your manufacturer that you are authorized to offer their products
Please attach a listing of reference sources for services rendered by your firm within the last 12 months. Please also indicate fax numbers and contact person for your reference sources.
Annual Value of Total Sales for the last 3 years
List below up to ten (10) of your Core Goods/Services offered Authorised agents and Traders must submit proof of certificate from manufacturers that they are authorized to offer the products listed.
I, the undersigned, warrant that the information provided in this form is correct, and in the event of changes details will be provided as soon as possible.
Please note that your company will be automatically de-registered if you do not provide any response to tender invitations by returning the Acknowledgement Letter, which is attached to the Invitation to Bid/Request for Proposal, on three consecutive occasions.