Application for Vendor Accreditation

Application for Vendor Accreditation ... Management _____ Supervisory_____ Rank and File_____ ... Certificate of Membership in Industry Organization (...

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_ Application for Vendor Accreditation Instruction:

Please accomplish this form completely and submit together with the required accreditation documents (listed on page 3) to:

The Head, Materials Planning and Control Department Maynilad Water Services, Inc. MWSS Compound, Katipunan Road Balara, Quezon City Note: Bring original documents for authentication.

Date Filed Company Name Previous Business Name

Date of Name Change

Complete Address (Office)

Telephone No.

Lot Area

Fax No.

Floor Area

Website Complete Address (Warehouse/Plant)

Owned

Telephone No.

Lot Area

Fax No.

Floor Area

Rented

Owned

Rented

ORGANIZATIONAL DATA Single Proprietorship Name of Owner

Partnership Name of Partners

Corporation Board of Directors 1. Chairman: Directors: 2

1

2

3 4 5

President/Chief Executive Officer GeneralManager Chief Finance Officer/Treasurer Chief Operating Officer DTI Registration No.

SEC Registration No.

Date Registered Date Started Operations BIR Certificate of Registration No.

Tax Identification No. (TIN)

Date Registered

Business Permit No.

Date Registered

Valid Until

No. of Employees/Staff Contact Persons 1 2

Management _____ Position

Supervisory_____ Tel. No.

Rank and File_____ Mobile No.

Contractual_____ E-Mail Address

(for Technical) (for Admin./Finance)

MAYNILAD WATER SERV ICES, INC. | MWSS COMPOUND, KATIPUNAN AVENUE , BALARA 1105 QUEZON CITY, PHILIPPINES | TEL.+632 981-3333

_ Application for Vendor Accreditation PRODUCT / SERVICE DATA Nature of Business

Manufacturing

Trading

Service/Contractor

Product Lines Carried

Brand

Products Exclusively Carried

Brand and Principal/Manufacturer

Others (Specify)____________

Services Offered

MACHINERY / EQUIPMENT DATA Machineries

Equipment

Tools

CUSTOMER / CLIENT DATA Name of Customer

Address

Contact Person/Tel.No.

1 2 3 4 5

BANK INFORMATION Name of Bank

Address

Contact Person/Tel.No.

Country of Origin

Product

1 2 3

For INDENT SUPPLIERS only: Name of Principal 1 2 3

MAYNILAD WATER SERV ICES, INC. | MWSS COMPOUND, KATIPUNAN AVENUE , BALARA 1105 QUEZON CITY, PHILIPPINES | TEL.+632 981-3333

_ Application for Vendor Accreditation ACCREDITATION DOCUMENTS SUBMITTED (Original documents presented for authentication) Certificate of Registration

SEC

DTI

Incorporation Papers, By-Laws and Articles of Partnership/Incorporation Audited Financial Statements for the last three (3) years (Balance Sheet/Profit and Loss Statement) Annual Income Tax Return (BIR Form 1701 or 1702) Business/Mayor’s Permit BIR Certificate (BIR Form 2303) Distributorship Agreement (updated) Government Permit/Accreditation

DOLE

DENR

LLDA

DTI

Others (specify) ___________

Certificate of Membership in Industry Organization (Eg. IATA, PADPAO) ISO Certificate The undersigned, duly authorized to sign in behalf of ___________________________________ hereby declares that the foregoing are true and correct.

________________________________ Signature over Printed Name

________________________ Position

______________ Date

MAYNILAD WATER SERV ICES, INC. | MWSS COMPOUND, KATIPUNAN AVENUE , BALARA 1105 QUEZON CITY, PHILIPPINES | TEL.+632 981-3333