Vendor Due Diligence Form

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

1. Vendor Information

**Legal Company Name:** {{vendor_legal_name}}

**Trading Name (if different):** {{vendor_trading_name}}

**Company Registration Number:** {{vendor_registration_number}}

**VAT Registration Number (if applicable):** {{vendor_vat_number}}

**Registered Address:** {{vendor_registered_address}}

**Physical Address (if different):** {{vendor_physical_address}}

**Primary Contact Person:** {{primary_contact_name}}

**Primary Contact Title:** {{primary_contact_title}}

**Email Address:** {{primary_contact_email}}

**Phone Number:** {{primary_contact_phone}}

2. Business Overview

**Date of Establishment:** {{date_of_establishment}}

**Type of Business (e.g., Sole Proprietor, Pty Ltd, Close Corporation):** {{business_type}}

**Nature of Business/Core Activities:** {{nature_of_business}}

**Number of Employees:** {{number_of_employees}}

**Key Products/Services Offered:** {{key_products_services}}

3. Financial Information

**Bank Name:** {{bank_name}}

**Account Holder Name:** {{account_holder_name}}

**Account Number:** {{account_number}}

**Branch Code:** {{branch_code}}

**Annual Turnover (last financial year):** {{annual_turnover}}

**Please provide your latest audited financial statements or management accounts for the past two years.** (Submitted separately)

4. Legal and Compliance

**Does your company comply with all applicable local labour laws and regulations?** Yes [ ] No [ ]

**Has your company or any of its directors/shareholders ever been involved in any litigation or legal proceedings in the past five years?** Yes [ ] No [ ]

**If Yes, please provide details:** {{litigation_details}}

**Does your company have a Code of Conduct or Ethics Policy?** Yes [ ] No [ ]

**Does your company have an Anti-Bribery and Corruption Policy?** Yes [ ] No [ ]

**Are you compliant with relevant data protection regulations (e.g., POPIA in South Africa)?** Yes [ ] No [ ]

5. Insurance Coverage

**Please list your current insurance policies:**

- **Type of Insurance (e.g., Public Liability, Professional Indemnity, Worker's Compensation):** {{insurance_type_1}}

**Insurer:** {{insurer_1}}

**Policy Number:** {{policy_number_1}}

**Coverage Amount:** {{coverage_amount_1}}

- **Type of Insurance:** {{insurance_type_2}}

**Insurer:** {{insurer_2}}

**Policy Number:** {{policy_number_2}}

**Coverage Amount:** {{coverage_amount_2}}

**Please provide copies of your insurance certificates.** (Submitted separately)

6. References

**Please provide details of two (2) reputable business references.**

**Reference 1:**

**Company Name:** {{reference_company_name_1}}

**Contact Person:** {{reference_contact_person_1}}

**Email Address:** {{reference_email_1}}

**Phone Number:** {{reference_phone_1}}

**Reference 2:**

**Company Name:** {{reference_company_name_2}}

**Contact Person:** {{reference_contact_person_2}}

**Email Address:** {{reference_email_2}}

**Phone Number:** {{reference_phone_2}}

7. Declaration and Authorization

I/We, the undersigned, declare that the information provided in this Vendor Due Diligence Form is true, accurate, and complete to the best of my/our knowledge and belief.

I/We authorize {{company_name}} to conduct necessary checks and inquiries to verify the information provided.

**Vendor Representative Name:** {{vendor_representative_name}}

**Title:** {{vendor_representative_title}}

**Date:** {{date_of_declaration}}

Signature Block

_____________________________

Signature of Vendor Representative

_____________________________

Date