VENDOR REGISTRATION APPLICATION
THIS FORM MUST BE COMPLETED AND MAILED TO THE MAIL ADDRESS: procurement@igmh.gov.mv
NOTE: THE FORMS WHICH ARE INCOMPLETE/ CONTAINS FALSE INFORMATION WILL BE REJECTED.
Please fill the form in BLOCK LETTER
GENERAL INFORMATION
Public Limited Company Sole Trader/ Local Investment Cooperative
Private Company Partnership Individual
Name of the business/ instituition
Trading name
Name of the sole trader/ Individual
Name of the Reporting instituition/ Parent Company
(Where applicable)
Nationa ID card No./ Passport No.
Registration Number
Country of incoporate
Contact person
Designation
Mobile number
Tax ID
Date of Commencement of Business
Date of Incoporation
CONTACT DETAILS
Telephone No. Email address
Fax No. Website
Registered Address House/Building Street Name
Name
Flat No./ Floor Post code
Island Atoll/ City
Country
House/Building Street Name
Name
Flat No./ Floor
Correspondence Address
(if different from the above Island Atoll/ City Post code
mentioned address)
Country
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SUPPLY GROUP
Please tick (✓) the relevant box/boxes ( please provide relevant information on your business)
□Medical Equipment □ Stationaries □Repair & Maintenance
□Medical Consumables □ Security Services □Pharmaceuticals
□Office Furniture □ Medical Gas □Housekeeping
□Fuel & Lubricants □ Hardware
□Others (please specify):
ACCOUNT DETAILS FOR FOREIGN TANSFER
Prefrred Payment Method □ Cheque □ Account Transfer
Credit payment (specify period)
Bank Name Branch
Address
Country SWIFT Code
ABA/BSB/BLZ/ Sort
Code
DETAILS OF BENEFICIARY
Account No./ IBAN No.
Name
Address `
National ID Card No./ Contact No.
Passport No.
DECLARATION
I/ WE HEREBY AGREE THAT:
THE INFORMATION PROVIDED IN THIS FORM IS CORRECT
ALL COPIES OF RELEVENT INFORMATION
ANY CHANGES/ UPDATE TO THE INFORMATION PROVIDED IN THE REGISTRATION FORM, WILL BE SUBMITTED TO THE EMAIL ADDRESS PROVIDED /
procurement@igmh.gov.mv
AUTHORISED SIGNATURE:…………………………………… SEAL:…………………………………… DATE:……………………………………..
DOCUMENTS TO BE SUBMITTED
□ Business registration certificate/ Business Permit □ Business profile □ National ID card copy of Owners
□ Bank Details □ Sole/ Authorized/ Authorized partnership/ Authorized reseller distributorship letters*
Procurement /IGMH | office +960335254 , +960335105, +960335349 email: procurement@igmh.gov.mv
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