Supplier Registration

Please complete the following form and mail or fax to UNFPA. If you need assistance with completing the form, please contact Marcia Henry: Tel: +1 (212) 297-5397, Fax: +1 (212) 297-4916. E-Mail: henry@unfpa.org

Company Information
1.	Name of Company	4.	Tel.
2.	Street address	5.	Fax
	Postal Code City	6.	E-mail
	Country	7.	WWW address
3.	P.O. Box and Mailing Address	8a.	Contact Name
		8b.	Contact Title
9.	Parent Company (Full legal Name)
10.	Subsidiaries, Associates and/or Overseas Representative(s)
11.	Type of Business	11a.	If other, specify:
	Corporate/Limited Partnership Other
12.	Nature of Business	12a.	If other, specify:
	Manufacturer Authorised Agent Trader Consulting Company Other
13.	Year Established	14.	Number of Full-Time Employees
15.	Licence No./State where registered	16.	VAT No./Tax I.D.
17.	Technical Documents available in:
	English French Spanish Russian Arabic Chinese Other
	If other, please specify:
18.	Working Languages:
	English French Spanish Russian Arabic Chinese Other
	If other, specify:

Financial Information
19/ 20.	Annual Sales Value for the last 3 years: Year Total Sales (USD) Export Sales (USD)
21a.	Bank Name:	21b.	Swift/BIC Address:
21c.	Bank Address:
22a.	Bank Account Number:	22b.	Account Name:
23.	Please mail a copy of the company's most recent Annual or Audited Financial Report. If available, please provide Credit Rating by Dunn and Bradstreet or equivalent.

Technical Capability and Information on Goods/Services Offered
24.	Quality Assurance Certification (e.g. ISO 9000 or Equivalent) (Please Fax or Mail a Copy of your latest Certificate)
25.	International Offices/Representation (Countries where the Company has local Offices/Representation)
26.	For Goods only, do those offered for Supply conform to National/International Quality Standards? Yes No
27.	List below up to fifteen (15) of your Core Goods/Services offered: UNCCS Code UNCCS Description National/International Quality Standard to which Item conforms

Experience
28.	Recent Contracts with the UN and/or other International Aid Organizations Organization Value Year Goods/Services Supplied Destination
29.	To which countries has your company exported and/or managed projects over the last 3 years?

Other
30.	Does your Company have a written Statement of its Environment Policy? (If yes, please Mail or Fax a Copy)	Yes No
31.	Please list any Disputes your Company has been involved in with UN Organizations over the last 3 Years:
32.	List any National or International Trade or Professional Organizations of which your Company is a Member:
33.	Certification (A hard copy of this form along with relevant documentation should be forwarded by mail): I, by pressing the submit button, hereby accept the basic UN General Conditions, a copy of which has been provided to me and warrant that the information provided in this form is correct, and in the event of changes details will be provided as soon as possible.

NOTE: Please be informed that UNFPA has decided not to do business with companies or any of their affiliates or subsidiaries, which engage in any practice inconsistent with the rights set forth in the convention on the Rights of the Child, regarding certain protection applicable to children performing work, or engage in the sale or manufacture of anti-personnel mines, or any significant component produced primarily for the operation thereof.