Supplier Registration Form

Doc ID: SUPS.PROC.FOR.0016 Issue Date: 15.04.13 Rev. Date: 24.01.14 Rev #: 03 Page 1 of 3

1. Company Detail and Contact Information Suppliers Code:___________________

Company Trading Name:(In capital letters)

Registered Office Address

P.O Box

City Country

Telephone number Fax No

Web site details Company email

Contact PersonLanguage

First Name Last Name Job Title

Telephone Mobile Email address

2. Trade License / Articles of Association / Memorandum of Association

Trade License /AOA /MOA Number( Mandatory, attach a copy) Expiry Date

Issuing Authority

Business Activities

Other Licenses/ Legal Document Authority License No.

( Attach a copy)

3. Products & Service Categories

Please select your business profile

Supplier (materials and products) Contractor (Works & services)

Please list products and/or service categories providedProducts Services

Supplier Registration Form

Doc ID: SUPS.PROC.FOR.0016 Issue Date: 15.04.13 Rev. Date: 24.01.14 Rev #: 03 Page 2 of 3

4. Bank Details [Mandatory]Bank Name

Bank Code

Bank Branch Name

Bank Branch Code

Bank Address

Bank Account number

Bank SWIFT Code

IBAN [Mandatory]

Contact details of Accounts Receivables –Manager/Executive

First Name Last Name Job Title

Telephone Mobile Email address

5. Payment Method

Check Electronic Currency

Cheque to be issued in favor of:

6. Duly Authorized Company Approval

Name Position

DateSignature &

Stamp[Mandatory]

Supplier Registration Form

Doc ID: SUPS.PROC.FOR.0016 Issue Date: 15.04.13 Rev. Date: 24.01.14 Rev #: 03 Page 3 of 3

7. Your References

Year Client Product or service provided Approximate Value (AED)

8. Declaration (Finance Manager/Authorized Signatory)

We declare that the information provided in this Registration Document is reliable and true

Name Position

Date Signature & Stamp[Mandatory]

9. For GCAA Finance Use Only

Reviewed By:

Name Position

Date Signature

Approved By:

Name Position Director Finance, Admin & Procurement

Date Signature