Company DetailsCompany Name:Year Established:ABN No:Address:* Street Address Suburb State Postcode Postal address:* Street Address Suburb State Postcode Office Contact Details: Web page: Have a membership of any industry associations (eg MBA) Yes No If yes:Key PersonnelPrincipal Contact:Title: Financial background(Note: This information is essential for inclusion as an approved supplier)Account Name:Bank:BSB No:Account no:Attach a copy of either a Bank Deposit Slip or the header of a Bank Statement (document must detail BSB No., Account No. and Account Name) (Tick if attached) Payment will be made by EFT, 31 days from the end of month of invoiceCompany OverviewProvide a short description of your company’s history, agencies, products and services, special techniques, capabilities, core business activities etc; (please confine to around 50 words).Quality, Safety and Environmental OverviewDoes your Company have a Quality Management System Is it certified*? Yes No Certification body (if applicable)Standards appliedDoes your Company have a WHS Management System Is it certified*? Yes No Certification body (if applicable)Standards appliedDoes your Company have a Environmental Management System Is it certified*? Yes No Certification body (if applicable)Standards appliedIf certified*, please attach a copy of the certificate and details of any outstanding actions from the last audit.If No, are you in the process of Certification: Yes No Expected Completion Date:Insurance policies (copies of up to date certificates of currency must be provided)Public LiabilityExpiry Date Policy NoValue InsuredWorkers Compensation / Personal AccidentExpiry Date Policy NoValue InsuredMotor VehicleExpiry Date Policy NoValue InsuredProfessional Indemnity (if applicable)Expiry Date Policy NoValue InsuredCompleted by:Name:Positon:Signature:Date Comments:review (to be completed by the procurement officer and based on above assessment outcomes)Provider approved? Yes No Reviewed by:Positon:Signature:Date
