VENDOR REGISTRATION FORM

(1)

(RC20001628)

(Incorporated in Brunei Darussalam)

VENDOR REGISTRATION FORM

Note: TICK the selected items or where applicable. Submit the documents against the ‘Vendor Registration Document

Checklist’ together with the completed registration form. INCOMPLETE SUBMISSION of documentations will be

automatically rejected.

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_{SECTION A}

VENDOR/CONTRACTOR DETAILS

Company name

Company type

Public Company Private Limited Company Partnership Sole Proprietor

Cooperative International Joint Venture Bumiputera

Company registration no

Country of incorporation

Date of incorporation

Address

Post code

City

State

Country

Correspondence address

Post code

Contact

Email

Office no

Mobile no

Other no

Fax no

Website

DETAILS OF CONTACT PERSON 1

Name

Designation

Email

Contact no

Mobile no

DETAILS OF CONTACT PERSON 2

Name

Designation

Email

Contact no

Mobile no

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SECTION B

PARTICULARS OF PROPRIETORS/OWNERS/SHAREHOLDERS

Name

IC no (colour)

Citizenship

Current address

Designation

% owned

(2)

PARTICULARS OF DIRECTORS

Name

IC no (colour)

Citizenship

Current address

Designation

PLEASE COMPLETE THIS SECTION:

Questions

Yes

No

Please confirm that the owners of your company are actively managing the day-to-day operations of your company.

Please confirm if your company have any debt with a bank or financial institution or other entities or companies as of to date of this registration?

If yes, please confirm the status of the debt: ________________________________________________________ ____________________________________________________________________________________________ Does your company have any pending legal proceedings as of to date of this registration?

If yes, please provide details including status of the proceedings: _______________________________________ ____________________________________________________________________________________________

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_{SECTION C}

COMPANY PROFILE

Note:

Please provide:

a. Company profile including organizational structure

b. Proof of document from the Industry and Business Ecosystem for Business Reporting c. Project references or past experience

d. (include on-going and completed projects)

e. Any certifications, qualifications and accreditations (if any) f. HSE (Health Safety & Environment) documents

g. Copy of Letter of Agency/Representation and letter of support from Original Equipment Manufacturer (OEM) or principal h. Material or product catalogues or brochures

i. Material Specification Date Sheet (MSDS) (if any) j. Copy if letter from Manufacturer stating warranty (if any)

Business scope

Number of employees

Local

Non-Local

(3)

LIST OF PROJECTS OR TRACK RECORDS

Note:

Please provide:

a. Other supporting documentation(s) for project involvement and execution evidence i.e. Purchase Order, Letter of Awards, Photographs, Completion Certification, etc.

b. Official Appointment Letter by the principal (if applicable)

c. Partnership with, such as letter of appointment from the authorised suppliers, etc. (if any)

(4)

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_{SECTION D}

DECLARATION OF CONFLICT OF INTEREST WITH MUARA PORT COMPANY SDN BHD EMPLOYEES (ANY RELATIVES/

SHAREHOLDERS)

MPC employee name

Department

Relationship

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SECTION E

VENDOR/ CONTRACTOR BANK DETAILS

Note:

Please provide:

a. Copy of bank statement header for verifying account details b. Copy of Letter of Authorised Signatories from your bank

Bank name

Bank address

Bank country

Account no

Swift code

A/C currency

This declaration is to be read and signed by the owner of this company

1. I declare that all information provided in this form and all the attached documents are authentic at the time of

application.

2. I hereby authorised Muara Port Company Sdn Bhd to request any further information required from my

bank/financial institution at any time.

3. I hereby authorised Muara Port Company Sdn Bhd to visit my premises/company and examine any document

required.

4. I hereby authorised Muara Port Company Sdn Bhd to conduct interview or refer to any party related to my

company.

5. I understand that failure to follow any of the above mentioned shall cause my application to be rejected and any

approval granted shall be revoked.

SIGN

HERE _Date Name

Designation

Please send the form back to MPC

Muara Port Company Sdn Bhd

Ground Floor, Ports Building, Jalan Pelabuhan Muara BT1728, Negara Brunei Darussalam orEmail:[email protected]

(5)

Vendor Registration Document Checklist

Please provide the following documentations where applicable:

= It is a mandatory requirement. Failure to provide these documents will not be entertained to register.

Type of Company

DOCUMENTATIONS PUBLIC COMPANY /PRIVATE LIMITED

COMPANY

PARTNERSHIP & SOLE

PROPRIETOR COOPERATIVE INTERNATIONALCOMPANY

Copy of Certificate of Incorporation

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Copy of Form X



Copy of Memorandum & Articles of Association

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Copy of Return on the Allotment of Shares (Section 45)



Copy of Notice of Change in the situation of the Registered Office

(where applicable)

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Copy of Company's latest list of Members to Accompany Annual Return

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Copy of Share Certificates

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Copy of IC or Passport of Shareholders/Partners/Proprietor

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Copy of latest audited financial statement or account

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Copy of Corporate Income Tax Payment and Registration Certificate

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Copy of Certificate of Registration of Business Name (Section 16 & 17)

OR Copy of Section 16 & Business Name Extract (applicable to

companies formed after August 2014 onwards)

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Copy of Particulars of Directors or Managers

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Copy of Certificate of Registration

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Copy of Constitution

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Copy of Certificate of Incorporation or Official Confirmation Letter of

Incorporation



Copy of an official documentation stating the name of Director or

Manager of the Company



Company profile including organizational structure



Proof of document from the Industry and Business Ecosystem for

Business Reporting



Project references or past experience

(include on-going and completed projects)



Any certifications, qualifications and accreditations (if any)



HSE (Health Safety & Environment) documents



Copy of Letter of Agency/Representation and letter of support from

Original Equipment Manufacturer (OEM) or principal



Material or product catalogues or brochures



Material Specification Date Sheet (MSDS) (if any)



Copy if letter from Manufacturer stating warranty (if any)



Other supporting documentation(s) for project involvement and execution evidence i.e. Purchase Order, Letter of Awards, Photographs,