Healthy Kitchen

SUPPLIER ACCREDITATION FORM

Date Submitted:
A. BACKGROUND INFORMATION
REGISTERED NAME OF THE COMPANY BUSINESS OPERATION STARTED:

Owner/Proprietor: Authorized Company Representative

Office Mailing Address Contact no.:

Office Fax No.:

Warehouse Mailing Address Contact no.:

Warehouse Fax No:

B. BUSINESS ORGANIZATION
Type of Business Organization: (Place an X mark) Type of Business Operation: (Place an X mark)
Single Proprietor Manufacturing
Partnership Genral Trading/Merchandising
Cooperative Exclusive Distributor
Corporation Service Company
Others, please sepcifiy : Others, please specify:

C. BUSINESS REGISTRY (Indicate existing permit numbers and attach photocopy of permits indicated.)
Permit Date Expiration
Type of Permit No. Issued. Date
Securities and Exchange Commission
Department of Trade and Industry
Board of Investment
Business Permit from the Office of the Mayor
Philippine Contractor's Accreditation Board
Vat Registry Number (BIR 2303)

D. MAJOR PRODUCT LINES/SERVICES (Attach product checklist and prices)

E. CREDIT POLICY
Credit Limit: Credit Terms: 30 days 60 days
40 days
F. ASSETS & LIABILITIES
(From most recent calendar year. Attach a photocopy of latest Audited Balance Sheet, Income Statement and BIR ______)

Total Equity Total Assets Total Liabilities Gross Income (Deficit)

Name and Signature Office Designation DATE

F. ADDITIONAL INFORMATION

How many years has your organization been in business as a contractor/supplier?

Company name indicated in your Offcial receipt:

Have you ever provided services/products to our company? If yes, what products/services?

Please list at least three (3) major projects done/contact person/contact numbers
to whom your firm is presently supplying services/products

Please list at least three major suppliers, contact person, & contact nos.:

Please list Trade References/ bank references & contact nos.:

 PUB EXPRESS
SUPPLIER ACCREDITATION FORM
Date Submitted:
A. BACKGROUND INFORMATION
REGISTERED NAME OF THE COMPANY BUSINESS OPERATION STARTED:

Owner/Proprietor: Authorized Company Representative

Office Mailing Address Contact no.:

Office Fax No.:

Warehouse Mailing Address Contact no.:

Warehouse Fax No:

B. BUSINESS ORGANIZATION
Type of Business Organization: (Place an X mark) Type of Business Operation: (Place an X mark)
Single Proprietor Manufacturing
Partnership Genral Trading/Merchandising
Cooperative Exclusive Distributor
Corporation Service Company
Others, please sepcifiy : Others, please specify:

C. BUSINESS REGISTRY (Indicate existing permit numbers and attach photocopy of permits indicated.)
Date Expiration
Type of Permit Permit No. Issued. Date
Securities and Exchange Commission
Department of Trade and Industry
Board of Investment
Business Permit from the Office of the Mayor
Philippine Contractor's Accreditation Board
Vat Registry Number (BIR 2303)

D. MAJOR PRODUCT LINES/SERVICES (Attach product checklist and prices)

E. CREDIT POLICY
Credit Limit: Credit Terms: 30 days 60 days
40 days
F. ASSETS & LIABILITIES
(From most recent calendar year. Attach a photocopy of latest Audited Balance Sheet, Income Statement and BIR _______)

Total Equity Total Assets Total Liabilities Gross Income (Deficit)

Name and Signature Office Designation DATE