Vendor Profile - Institution

SECTION 1

INSTITUTION INFORMATION

Company Name:

KJP Centar Skenderija d.o.o.

Parent Company Name (if applicable)

Web Site URL: (if applicable)

www.skenderija.ba

Street Address (No P.O. boxes)

Terezija BB
City
Sarajevo

State/Province/County
FBiH / Kanton Sarajevo

Postal Code
71000

Country
BIH

Contact Person (MAIN ADDRESS)

Telephone

Fax

E-mail Address

Name

+387 33 226 614

Title

SECTION 2

BENEFICIARY BANKING INFORMATION

Select your preferred method of payment :

Electronic Transfer (please complete information below)

Cheque (not available in the US)

Branch Name: Intesa Sanpaolo

Bank Name Intesa Sanpaolo Banka BH d.d.

Street Address: Obala Kulina Bana 9A
City
Sarajevo

State/Province
FBiH / Kanton Sarajevo

Account Name (name as it appears on bank account; must be the same as the institution/company
name):

Postal Code
71000

Country
BiH

Bank Account Currency

US$

Other (PLEASE INDICATE) BAM

KJP Centar Skenderija d.o.o.

Bank Account No. (enter with no punctuation, dots or dashes):
Account Type:

1540011100004705
For US banks only: (9 digit routing)

Checking

Savings

For non-US banks: SWIFT code (8 or 11 characters)

UPB KBA22

ACH :
IBAN code (European Banks):

Sort Code (UK Banks - 6 digits )

BA391540011100004705
Transit Code (Canadian Banks - 5 digit )

Branch ID (Canadian Banks 9 digits):

INTERMEDIARY / CORRESPONDENT BANK ( if applicable)

Name of Bank :

Address of Bank :

Bank Account No.:

(of beneficiary bank with intermediary bank)

SWIFT Code (8 or 11 characters):

FED WIRE NO. ( US BANKS ONLY)

I, Hajriz Beirovi, certify that I am an authorized signatory of KJP Centar Skenderija d.o.o. and confirm that the information above is correct.
Signature: ___________________________________________________

SECTION 4 (For UNIFEM Internal Use only)

UN INFORMATION
Date:

Requesting Person:

Atlas Vendor No:

UN Index No:

First Name / Last Name/Extension

VENDOR TYPE:

STAFF

SSA

SERVICE CONTRACT

MEETING PARTICIPANT

NGO

SUPPLIER

OTHER

BUYER NAME: _________________________________ BUYER SIGNATURE: _________________________________________________ DATE:_________________

APPROVER NAME:______________________________ APPROVER SIGNATURE: ___________________________________________

DATE: ________________

HR_VENDOR PERSON PROFILE UPDATE 1003.DOT]