UNITED NATIONS CHILDREN’S FUND (UNICEF) Pakistan Country Office 90 Margalla Road, Sector F-8/2 P.O.Box 1083 Islamabad , Pakistan Phone: 92 51 208 7700, Fax: 92 51 209 7897 SUPPLIERS’ REGISRATION FORM All pages to be completed by suppliers and submitted to UNICEF UNICEF fully subscribes to the Convention on the Rights of the Child and draws the attention of Potential suppliers to Article 32 of the Convention which inter alia requires that a child shall be protected from performing any work that is likely to be hazardous or to interfere with the child's education, or to be harmful to the child's health or physical, mental, spiritual, moral or social development. UNICEF reserves the right to terminate any contract unconditionally and without liability in the ‘event that the supplier is discovered to be in non-compliance with the national labour laws and regulations with respect to child employment. The supplier guarantees that neither the supplier's company, nor any of its affiliates, nor any subsidiaries controlled by the supplier's company, is engaged in the sale or manufacture of anti-personnel mines or of components utilized in the manufacture of anti-personnel mines. The supplier recognizes that a breach of this provision will entitle UNICEF to terminate its contract with the supplier. |, representing the Company, acknowledge and ensure the Company's compliance with the above statements: Name and Title Signature : Date (Please TYPE or PRINT) (Attach additional pages if space provided is not enough for information). Page 10f4NoTi The information mentioned below is strictly confidential and shall only be used for registration of supplier with UNICEF. This information shall be not disclosed to any party outside UNICEF or any other department agency. Please also note that this registration is purely on merit and free of charge. Section 1: General Information 1 1 "1 Name of Company: Parent Company (if applicable)... Full address of the company : Address Post Box No. City Province: Country: Telephone No. (incl. City/Country code) : Fax /Telex No. (incl. City/Country code) :... Email address: Name and contact details of contact person: ‘Type of organization : (one X only) Manufacturer: Wholesaler/dealer: Sole proprietor: Retailer: Marketing company: General trader/General Order Supplier: Year of establishment: NIC number of Chief Executive officer /Owner:. NTN number/Sales tax registration number (if any) Name of senior management with age and contact detail: (Please attach list) Do you hold sole/exclusive rightsilicense? Yes O No O (ifyes, please mention name & address of Principals and geographical area of operations for those exclusive right Page 2 of 4Section 2: Business information 13. Do you maintain bank account’ Yes O No O 14. What is the sales transaction mode: Invoicing Q Cashmemo 0 15. Sales proceeds collected in cash or through bank: .. 16. What record is maintained for sales and purchases: 17. Do you sale in cash or on credit, if credit, what is credit time? ...... 18. How the business is financed: Self financed Credit line/Loanete O 19. Do you have any credit limit with bank, if so, please provide name of the bank: 20. Gross annual turnover : Current year estimate (Pak RS. ..... ) Last year (PAK RS. ose coseeseeen) 21._Annual export tumover (if any): paeber a ous.) Section 3: Business Activities 22. Previous supply contracts (during the last 3 years) with United Nations/International or Governmental Organizations/Private Companies, for products/services: Date Value Product Organization Nameladdress (provide at least three references): Rona 23, Product/Services offered (please provide company brochure or profile with product detail): 24. Local representation (if multinational company): Please attach list of countries where your local representative will provide warranty services on products purchased from you- provide complete addresses of your subsidiaries/agent, where applicable Page 3 of 4Section 4: Other Information 25. Do you have display center or retail outlet. Please provide address and detail 26. Warehouse capacity in sq. feet...........and location ... 27. Ownership of warehouse: rented O leased O owned O 28. Logistics arrangements :Do you supply goods on Ex-gowdon basis Ex site basis 29. Do you have owned or contracted transportation system or particular vehicle for special goods: ...... Tap ga TTATAS 30. Quality assurance policy: ISO registration Yes O No O (Please provide type of certification and attached certificate copy) 31. Membership of National/intemational Associations? (Tick as appropriate Yes 1No C1 (ifyes, please provide a copy of relevant document) 32. Are you license holder of any supply/goods: Yes C1 No O) (Please detail) (Mandatory for medicine suppliers and other licensed items) 33. Type of insurance obtained by your company: ...........-00 34. Do you provide warrantee & technical support: Yes CINo O (if yes, please provide detail) 35. Packaging and dispatch facilities: Owned Ci Rented COutsourced 0 36. Are you aware of UNICEF approved packing system (specially woodpacking) 37. Provide list of major client alongwith certificate of completed contracts (We may independently verify the performance from the client) I hereby certify that the information provided above and in all the annexes is correct and thet no person in any connection with this establishment, as a supplier for providing material, supplies or services, or as a principal or employee, is employed by UNICEF, or barred by UNICEF. Name: Title:...... me Co os 3} Date:.. iS & 89 LP ‘Signature:. Page 4 of 4