Islamic Republic of Afghanistan MINISTRY OF FINANCE TREASURY DEPARTMENT

Vendor Registration Form

New Vendor Yes Amendment to existing Vendor Category of Vendor Business Afghanistan Registered Afghanistan Notregistered International ther rgani!ation "N# $ %%%& Tax)a'er Identifi(ation Num*er "TIN& or ID Num*er Bonded Trustee
Fathers Name Bonded Trustee

AFMIS Vendor ID Important Notes

Individual Afghan International Yes Bonded Trustee Salar' Transfer A((ount

Year ,sta*lished

Business ID + ISA Registered Name Business-Indi.idual Address "Street$ Nr%& Address " ther& Address "/it' - Town& Address "0ro.in(e& 0hone 1 "2& " ffi(e& ,mail Address Registered wner Name wner-Tas9ara N ID1 Num*er "su9oo9& Ban9 Name A((ount Name "Benefi(iar'& Ban9 A((ount Num*er International Ban9 A((ount Num*er Swift (ode /orres)ondent Ban9 Name /orres)ondent Ban9 Address /orres)ondent Ban9 A((ount Num*er /orres)ondent Ban9 Swift

Johns Hopkins University Bloomberg School of Public Health 615 ! "olfe St# Suite "11$1 Baltimore# %& '1'$5 Unite( States of )merica

Mar'land 324-523-6577

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0hone 1 "8& "/ell&

cess*+hsph!e(u Johns Hopkins University Bloomberg School of Public Health

M : T Ban9 Bran(h; ne M : T 0la!a

Johns Hopkins University Bloomberg School of Public Health , $ $ $ . $ . / . $ 6 1 0 ' . $

International Banking Information Complete Required Fields Only

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Re<uested B' Ministr'; Name; Title; Authorised Signature; 0u*li( >ealth Dr I*n Amin ?haled 0ro(urement >ead

Treasur' =se 0ro(essed *' Name; Date; Signature; Finan(ial /ontroller Signature

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