Vendor Registration Questionnaire Vendor Registration Questionnaire Business Name:* Pin No.* Company Registration No.* Building Street / Road City / Town* What type of business is your company*Sole ProprietorPartnershipRegistered CompanyYour Name in Full* Nationality* Country of Origin* HiddenCitizenship Details* Citizenship Details*Their name in full, nationality and Citizenship details. *If Kenyan Citizen, indicate under “Citizenship Details” whether by Birth, Naturalization or RegistrationGive details of Partners:*The response should include for each partner: Their name in full, nationality, Citizenship details and shares. *If Kenyan Citizen, indicate under “Citizenship Details” whether by Birth, Naturalization or RegistrationType of Registered Company*Please check one box only. Private Public Give details of all directors:*The response should include for each director: Their name in full, nationality, Citizenship details and shares. *If Kenyan Citizen, indicate under “Citizenship Details” whether by Birth, Naturalization or RegistrationCategory applied for* Item description* Organisation and StaffHave you previously dealt with BWI?*YesNoPlease state the nature of your previous business with Bentworth*If the category you are registering for requires personnel for the provision of service, kindly expound on the skills/competence or experience that your personnel have*FinanceBank name* Bank account number* Bank address* Specify the amount of business you can handle at any one time*This should be a monetary value HSEPlease provide the organization’s HSE policy/procedure(if applicable):Note maximum file size is 2MB.Max. file size: 1 GB.Past ExperiencePlease provide at least three major supplies/projects/assignments you have undertaken relevant to the goods/services performed over the last three years.Reference 1Client name (organisation)* Address* Telephone number* Contact Person* Position in the organisation* Value of contract* Duration of contract and dates* Reference 2Client name (organisation)* Address* Telephone number* Contact Person* Position in the organisation* Value of contract* Duration of contract and dates* Litigation HistoryName of contractor/supplier contractors/suppliers should provide information on any history of litigation or arbitration resulting from contracts executed in the last five years or currently under execution.Is there any past of current litigation or arbitration?*YesNoYear* Award for or against* Name of client cause of litigation and matter in dispute*Disputed amount (current value, Kshs. equivalent)* Add more litigation / arbitration* Yes No Year* Award for or against* Disputed amount (current value, Kshs. equivalent)* Name of client cause of litigation and matter in dispute*Add more litigation / arbitration Yes No Year Award for or against Disputed amount (current value, Kshs. equivalent) Name of client cause of litigation and matter in dispute Please continue on to the: Declaration Form
