VENDOR/SUPPLIER REGISTRATION FORM VENDOR/SUPPLIER REGISTRATION FORM VENDOR REGISTERATION FORM "*" indicates required fields Step 1 of 3 33% COMPANY/BUSINESS INFORMATIONCompany Name*Business Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Business Phone*Business Email* Position/Title*Website (if applicable):PERSONAL CONTACT INFORMATIONPrimary Contact Name*Phone Number*Email Address* Your Address*Valid ID Card* NIN PASSPORT DRIVER LICENCE Upload Your ID Card*Max. file size: 10 MB.PRODUCTS/SERVICES DETAILSBrief Description of Products/Services*Industry Certifications (if applicable) Drop files here or Select files Max. file size: 15 MB, Max. files: 2. TIN Number (issued by FIRS or CAC)* BUSINESS DETAILSType of Business (Sole Proprietorship, LLC, Corporation, etc.)*REG Number*Years in Business*Number of Employees*REFERENCESClient References (if applicable)Company NameContact PersonPhone NumberEmail AddressSupplier References (if applicable)Company NameContact PersonPhone NumberEmail Address COMPLIANCE AND CERTIFICATIONInsurance Information (Attach Certificate of Insurance, if available)Type of InsurancePolicy NumberExpiry DateAttach Certificate of Insurance, if availableMax. file size: 15 MB.Are you in compliance with all relevant local regulations and licensing requirements?* Yes NO Health, Safety and Environmental Practices*Briefly describe any HSE practices your company follows.BILLING AND PAYMENTPreferred Payment Terms*Full Bank Account Details for Electronic Funds Transfer*Bank Address, City and State*Bank Account Currency* TERMS AND CONDITIONSAcceptance of Terms and Conditions*I, _________________________ acknowledge that I have read and agree to abide by the terms and conditions outlined in the vendor/supplier agreement.ATTACHMENTSAttached License/Certifications (if applicable)Max. file size: 512 MB.Attached Business CAC Registration*Max. file size: 512 MB.DECLARATIONI hereby declare that the information provided in this Vendor/Supplier Registration Form is accurate and complete to the best of my knowledge.INCIDENTAL DEPOSIT: A 20% REFUNDABLE DEPOSIT IS REQUIRED FROM THE THIRD PARTY VENDOR BEFORE ACCESS CAN BE GRANTED.* I agree to the policy.BEFORE ACCESS CAN BE GRANTED.Authorized Signature*Date*LinkedInThis field is for validation purposes and should be left unchanged. Δ