BUYER APPLICATION FORM Organisation Name: Postal Address: Country: Phone (Country Code, Number): Fax(Country Code, Number):

PRIMARY DELEGATE (primary contact): all information/updates from the Secretariat will Yes No IF yes please y Do you currently import products from Pacific Markets? be forwarded to this contact/address. You must ensure that updates are passed on to state which countries: other registered delegates.
y

Which sector are you currently operating in? First Name:

y Are you a bona fide wholesaler with evidence of a business license, printed brochure and Last Name: history of distribution record Yes (please attach copy of business license) No Designation: y As the Primary Delegate are you in a decision-making role to purchase/contract product Email: Yes No

Expected Date of Arrival: Applicant must be able to speak sufficient English to conduct business Expected Date of Departure:

Yes

No

Accommodation Details (Please provide the name of the hotel which you will be using) PRIMARY DELEGATE (primary contact): all information/updates from the Secretariat will be forwarded to this contact/address. You must ensure that updates are passed on to other registered delegates. ADDITIONAL DELEGATE #2 First Name: Last Name: Designation: Designation: Email: Expected Date of Arrival: Expected Date of Departure: Expected Date of Departure: Accommodation Details (Please provide the name of the hotel which you will be using) Accommodation Details (Please provide the name of the hotel which you will be using)

ADDITIONAL DELEGATE #2 First Name: Last Name: Designation: Email: Expected Date of Arrival: Accommodation Details (Please provide the name of the hotel which you will be using) ADDITIONAL DELEGATE #3 First Name: Last Name: Designation: Email: Expected Date of Arrival: Accommodation Details (Please provide the name of the hotel which you will be using) COMPANY BIOGRAPHY (no more than 100 words):

Please indicate what you industries you are looking to explore by ticking the relevant boxes Fisheries Forestry Manufacturing / Production Agriculture / Processing

Trade and Other Services: Please specify