Letterhead
{{company_name}}
{{company_address}}
Phone: {{phone}}
Email: {{email}}
Supplier Information
Supplier Legal Name: {{supplier_legal_name}}
Trading Name (if different): {{trading_name}}
Registration Number (e.g., Company Reg. No., VAT No.): {{registration_number}}
Date of Establishment: {{date_of_establishment}}
Physical Address: {{physical_address}}
Postal Address: {{postal_address}}
Country: {{country}}
Primary Contact Person: {{primary_contact_person}}
Contact Person's Title: {{contact_person_title}}
Contact Email: {{contact_email}}
Contact Phone: {{contact_phone}}
Website: {{website}}
Banking Details
Bank Name: {{bank_name}}
Account Name: {{account_name}}
Account Number: {{account_number}}
Branch Name: {{branch_name}}
Branch Code/SWIFT Code: {{branch_code_swift}}
Goods/Services Offered
Please describe the goods or services your company provides: {{goods_services_description}}
Key Product/Service Categories: {{product_service_categories}}
Capacity/Volume of Supply: {{capacity_volume}}
Compliance and Declarations
Do you comply with all relevant labour laws in your operating country? (Yes/No): {{labour_law_compliance}}
Do you have a valid tax clearance certificate? (Yes/No): {{tax_clearance_certificate}}
Please attach copies of relevant certifications (e.g., quality, industry-specific): {{certifications_attached}}
Declaration: I/We hereby confirm that the information provided above is true and accurate to the best of my/our knowledge and belief. I/We understand that any false information may lead to the rejection of this application or termination of any future agreements.
Terms and Conditions Agreement
By signing below, the supplier agrees to abide by the standard purchasing terms and conditions of {{company_name}}, which will be provided separately upon successful onboarding. The supplier also agrees to adhere to all applicable laws and regulations in their operations, including those related to ethical conduct and environmental sustainability.
Any disputes arising from this agreement shall be resolved through negotiation, and if unsuccessful, through arbitration or the courts of {{country_of_dispute_resolution}}.
For Internal Use Only
Reviewed By: {{reviewer_name}}
Date Received: {{date_received}}
Approval Status: {{approval_status}}
Notes: {{internal_notes}}
Signature Block
_____________________________
Supplier Representative Name: {{supplier_representative_name}}
Title: {{supplier_representative_title}}
Date: {{signature_date}}
_____________________________
Authorised Signature (for {{company_name}})
Name: {{company_authoriser_name}}
Title: {{company_authoriser_title}}
Date: {{company_signature_date}}
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