‫بسم ال الرحمن الرحيم‬

‫شركة نفط الكويت )ش‪.‬م‪.‬ك‪(.‬‬
‫طلب إدراج مقاول ضمن قوائم المقاولين المعتمدين‬
‫الجزء أ – تفاصل عامة‬
‫‪ :1-1‬اسم المقاول )كما هو مسجل في السجل التجاري(‬
‫ـــــــــــــــــــــــــــــــــــــــــــــــ‬
‫ـــــــــــــــــــــــــــــــــــــــــــــــ‬
‫رقم السجل التجاري ــــــــــ رأس المال ــــــــــــــ دينار كويتي‬
‫عنوان المكتب المسجل ــــــــــــــــــــــــــــــــــــــــــــــــــ‬
‫الرمز البريدي ــــــــــــــــــــــــــ‬
‫رقم الهاتف ـــــــــــــــــ رقم الفاكس ــــــــــــــــــ‬

‫‪ :1-2‬اسم المالك ‪ /‬أسماء الشركاء‪ /‬رئيس مجلس الدارة ‪/‬العضو المنتدب‬
‫كما هو مقيد في السجل التجاري و حيثما ينطبق‬
‫‪(1‬‬
‫‪(2‬‬
‫‪(3‬‬
‫‪(4‬‬
‫‪(5‬‬

‫الســــــــــم‬
‫ــــــــــــــــــ‬
‫ــــــــــــــــــ‬
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‫ــــــــــــــــــ‬

‫المسمـــى الوظيفــي‬
‫ـــــــــــــــــ‬
‫ـــــــــــــــــ‬
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‫‪ :1-3‬المدير أو الممثل المقاول المفوض لتوقيع العقود نيابة عنه ‪-:‬‬
‫نموذج التوقيع‬
‫الجنسية‬
‫المسمـى الوظيفـي‬
‫الســــــــم‬
‫__________‬
‫______‬
‫______________‬
‫‪_____________(1‬‬
‫__________‬
‫______‬
‫______________‬
‫‪_____________(2‬‬
‫__________‬
‫______‬
‫______________‬
‫‪_____________(3‬‬
‫__________‬
‫______‬
‫______________‬
‫‪_____________(4‬‬

‫‪1‬‬

‬‬ ‫‪ 2-5‬شهادة تسجيل من لجنة المناقصات المركزية ‪.‬‬ ‫‪ 2-3‬شهادة غرفة التجارة ‪.‬‬ ‫‪ 2-4‬تقرير السنة المالية الخيرة يكون صادرًا ومصدقًا من قبل مؤسسة تدقيق معترف بها ‪ ) .‫‪ :1-4‬أسماء الشركات الجنبية المرتبطة مع المقاول بموجب اتفاقيات وكالة أو شراكه‬ ‫‪ 1-4-1‬اتفاقيات وكالة __________________________________‬ ‫__________________________________________________‬ ‫__________________________________________________‬ ‫‪ 1-4-2‬اتفاقيات شراكه _________________________________‬ ‫__________________________________________________‬ ‫__________________________________________________‬ ‫‪ :1-5‬أسماء الشركات المرتبطة مع المقاول لتقديم الدعم الفني أو اية مساعدات أخرى‪.‬‬ ‫مع بيان تفاصيل هذه المساعدة‬ ‫________________________________________________________‬ ‫________________________________________________________‬ ‫‪ -2‬على المقاول إرفاق الشهادات التالية على الطلب‪:‬‬ ‫‪ 2-1‬عقد التأسيس و النظام الساسي ‪.‬‬ ‫‪2‬‬ .‬‬ ‫‪ 2-6‬صورة عن عقدين تم النتهاء العمال بها خلل العشر )‪ (10‬سنوات الماضية لك تصنيف مراد‬ ‫تسجيل به ‪.‬‬ ‫‪ 2-2‬شهادة السجل التجاري ‪.‬باللغة‬ ‫النجليزية( و إذا لم يتوفر الجراء يرجى ذكر السباب ‪.

‬‬ ‫)‪(Register Of Commerce No.‫‪ -3‬نوافق على حق الشركة بالرجوع إلى الجهات التالية للستفسار عنا ‪-:‬‬ ‫‪ -1‬أسماء الفراد أو المؤسسات أو الشركات ) جهتان على القل(‬ ‫‪________________________________________ -1‬‬ ‫‪________________________________________ -2‬‬ ‫‪________________________________________ -3‬‬ ‫‪________________________________________ -4‬‬ ‫البنــــك‬ ‫‪-2‬‬ ‫الفـــــرع‬ ‫الســــــم‬ ‫________________‬ ‫___________________________‬ ‫________________‬ ‫___________________________‬ ‫‪ -4‬للتصال بغرض متابعة الطلب‬ ‫السم ـــــــــــــــ رقم الهاتف ــــــــــــ‬ ‫‪ -5‬نوافق على إخطار شركة نفط الكويت بأية تغييرات قد تطرأ على هيكل المؤسسة‪ /‬الشركة سواء فيما يتعلق‬ ‫بالشخاص ‪ ،‬أو المعدات و الدوات التي نمتلكها ‪ ،‬أو المكاتب و الورش وغيرها ‪.Contractor’s Name ( as recorded in the Register of Commerce):‬‬ ‫_________________________________________________________________________________________‬ ‫‪3‬‬ . 21835‬‬ ‫‪Application For Inclusion On Lists Of Approved Contractors‬‬ ‫)‪Part A: General Details (Type or Print legibly‬‬ ‫‪1.‬‬ ‫‪ -2‬عدم التقيد بأي متطلبات أعله يمكن أن يكون سببًا لرفض الطلب ‪.S. Particulars‬‬ ‫‪1.‬‬ ‫بســم ال الرحمــن الرحيــم‬ ‫‪In The Name OF Allah Most Gracious Most Merciful‬‬ ‫)‪Kuwait Oil Company (K.‬‬ ‫جميع المعلومات المرفقة على هذا الطلب أو أية معلومات أخرى تحصل عليها الشركة‬ ‫‪-3‬‬ ‫ستعامل بسرية‪.1 .‬‬ ‫التوقيع __________________________ المالك‪/‬الشريك‪/‬المفوض‪/‬‬ ‫رئيس مجلس الدارة‪/‬العضو المنتدب‬ ‫عن شركة ‪ /‬مؤسسة _________________________________________‬ ‫التاريخ ____________________‬ ‫خـتم المقـاول‬ ‫ملحظات‬ ‫‪ -1‬على المقاول تعبئة نموذج الطلب الصلي الصادر من قبل الشركة ‪ ،‬و ذلك بصورة واضحة جلية ‪.C.

Trading Name ( If different from above): _______________________________________________________ Registered Of Commerce No.3. Name of foreign companies with which contractor has: (i) Agency Agreements: _______________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ (ii) Partnership Agreement: _____________________________________________________________ ___________________________________________________________________________________ (iii) Joint Venture Agreement: ___________________________________________________________ 1._____________________________________ Fax No.2. 4 . Name(s) of owner\partners\chairman of board\managing Director as the case may be and as registered with the register of commerce: Name Designation 1) 2) 3) 4) 5) 1. Name of manager or Representative(s) Authorized to sign Contracts or legal Documents on behalf Of Contract Designation Nationality Specimen Signature 1) 2) 3) 4) Part A: General Details (Cont’d) 1. ______________________ Registered Office Address____________________________________________________________________ __________________________________________ Postal Code:____________________________________ Mailing Address (If different from above): ______________________________________________________ __________________________________________ Postal Code : ___________________________________ Telephone No. Names of any associated companies from whom the contractor obtains technical or other assistance . _______________________________ Capital: KD.4. Particulars (Cont’d) 1.5._________________________________ 1. give details of such assistance .

Give reasons if you do not have audited account: ____________________________ _____________________________________________________________________________________ (e) Certificate of Registration with the central tenders committee.(Cont’d) (b) Bank Name Branch 1)_______________________________________________________________________________________ 2)_______________________________________________________________________________________ 3)_______________________________________________________________________________________ 4)_______________________________________________________________________________________ 4. Contractor agrees that reference may be made to the following:(a) Names of individuals. firms or companies (minimum two) 1)_______________________________________________________________________________________ 2)_______________________________________________________________________________________ 3)_______________________________________________________________________________________ 4)_______________________________________________________________________________________ Part A: General Details (Cont’d) 3. Contact for follow-up of Application: Name: __________________________________ Telephone No. Chamber of Commerce Certificate.____________________________________ 5 . (f) Copy of two (2) completed contracts for each category of work you wish to apply for. Latest Audited annual financial balance sheet / statement of account duly certified by recognized auditing firm.______________________________________________________________________________________ ______________________________________________________________________________________ 2. 3. Register of Commerce Certificate. Attach with this Application the following Certificates:(a) (b) (c) (d) Memorandum and articles of associated ( If any) .

CATEGORIES OF WORK (SPECIALIZED SERVICES) Category Type of work C 1 Tanks A 2 Pipelines & Associated Works B 6 Section Maintenance.e. offices. etc. Repair. (III) All information supplied by the contractor with the application or obtained by reference shall be treated as confidential. chairman or managing director) For and on behalf of :_______________________________________________________________________ Date : _____________________________________ Contractor Stamp Note: (I) Application shall be submitted on the original stamped form issued to applicant. personnel. Authorized partner. Part B: Category Of Work For Which Approval Is Sought Select from the following category(s) you wish to apply for by crossing in the relevant box provided. Registered Signed :_________________________________ (Owner. plant. (II) Failure to comply with any of these requirements may be cause for rejection of your application. We agree to notify you of any change in our organization. Minor Manifold Construction and Associated . tools and equipment. Painting and Fiberglass Treatment to Tanks (Including Dislodging & Cleaning) Pipelines Exceeding 12” Diameter. i. Major Manifold Construction and Associated Pipelines not Exceeding 12” Diameter.. workshop.5.

Switchgear and Cabling Overhead Transmission Lines A B Supply and Installation Maintenance 5 6 Cabling Installation ( Telecommunication) 7 Installation and Maintenance of Instrumentation & Control Systems 8 Plant Maintenance-Production Facilities 9 Applied Air-Conditioning & Refrigeration System 10 MARINE WORKS Repairs and Painting of Marine Structures. Pier Decking and Heavy Timber Works 11 General Inspection Services 7 .C Pipelines and Manifold Maintenance 3 Air. Water and Domestic Gas Mains Upto and including 4” Diameter 4 Mechanical Engineering and Plant Installation & Maintenance A B C Major Installation Minor Installation Process Plant Piping Electrical Installation & Maintenance A B Plant.

8 . applicant must fill in and submit separate set of part B per each Category indicating thereof relevant detail to such Category.) The below section was created to select contractors from Central Tender Committee lists of civil contractors CATEGORIES OF WORK (CIVIL WORKS) Category Description Civil – 1 Contractors Approved under CTC Category 1 Civil – 2 Contractors Approved under CTC Category 2 Civil – 3 Contractors Approved under CTC Category 3 Civil – 4 Contractors Approved under CTC Category 4 Civil – L For Low Value Contracts Note: In the event of applying for more than one Category of work.Part B: Category Of Work For Which Approval Is Sought (Cont.

(NS) if Not Started. Schedule I Experience in Similar works executed by Contractor Enter hereunder details of present/previous contracts in relevant works (associated with the category/section applied for) which are/were carried out by you independently ( if sub-contractor.Part B: Particular Details (Type or Print Legibly) CATEGORY NO. (SL) if Sublet. 9 Number of Manpower Required Crafts Foremen Eng. X 1000 Award Final * State the Following abbreviation(s) whichever applicable: (SC) if Sub-Contractor. (C) if Completed. Description Contract No. (WD) if Withdrawn. SL. to specify scope of subcontract) in the last ten (10) years and attach supporting documents/proof issued by clients or State Authorities for each contract/sub-contract stated. man (UP) if Under Progress. * .______________ Section_______________ Applicant must fill in separate sheet(s) for each category/section of work. No. Client Commencement Date Period for completion (Days) Actual Period of Completion (Days) Value KD.

(NS) if Not Started. (IF THERE IS INSUFFICIENT SPACE ADDITIONAL SHEETS MAY BE USED) 10 * . Client Commencement Date Period for completion (Days) Actual Period of Completion (Days) Value KD. (SL) if Sublet. (WD) if Withdrawn. man (UP) if Under Progress.Part B: Particular Details (Cont’d) Schedule I (Cont’d) SL. (C) if Completed. Number of Manpower Required Crafts Foremen Eng. Description Contract No. No. X 1000 Award Final * State the Following abbreviation(s) whichever applicable: (SC) if Sub-Contractor.

Schedule II Manpower Details Enter hereunder the required details of relevant manpower under your present sponsorship and payroll: I. No. Name Title Qualification and year of Certificate Total Years Of Experience With Contractor Previous Sr. Engineers/Supervisors/Foremen/Tradesmen/Labour Sr.______________ Section_______________ Applicant must fill in separate sheet(s) for each category/section of work. Of Projects Involved With as Stated in Schedule I Language Nationality Spoken (IF THER IS INSUFICIENT SPACE ADDITIONAL SHEET MAY BE USED) 11 Written . No.Part B: Particular Details (Type or Print Legibly) CATEGORY NO.

2.Part B: Particular Details (Cont’d) Schedule II (Cont’d) II.Vs for Engineers listed herein. C. (IF THER IS INSUFICIENT SPACE ADDITIONAL SHEET MAY BE USED) 12 . 3. Contractor’s Organization Chart ( if pace inadequate. provide your own chart as attachment) Attach with this application the following: 1. and total number employed. Valid sponsorship proof for each non-Kuwaiti personnel listed herein. Organizational chart describing the corporate structure of your organization by stating activities. Personnel name and designations.

SL. No.Part B: Particular Details (Cont’d) Applicant must fill in separate sheet(s) for each category/section of work. Plant. Equipment and tools: I. Plant. CATEGORY NO.______________ Section_______________ Schedule III Enter hereunder the required details and provide with this application ownership proof for major items of relevant Transport. Transport. Equipment and Tools Details Description Capacity Make/Year Quantity (IF THER IS INSUFICIENT SPACE ADDITIONAL SHEET MAY BE USED) Part B: Particular Details (Cont’d) 13 Remarks (State Maintenance Style) .

Authorized Partner. 1 To Part B: Particular Details 14 .Schedule III (Cont’d) II. Chairman or Managing Director) Contractor’s Stamp Attachment No. Premises and Workshop Facilities Address: Area {M²}: Describe here details of your offices and workshop facilities: Attach with this application: proof of ownership/lease of the above described offices and workshop (IF THER IS INSUFICIENT SPACE ADDITIONAL SHEET MAY BE USED) Signed:______________________________ For and on behalf of:______________________ Date:___________________________________ Registered (owner.

Time Taken (DAYS) Detailed Description (IF THER IS INSUFICIENT SPACE ADDITIONAL SHEET MAY BE USED) 15 . AND GIVE DETAILS. No. SR.WITH REFERENCE TO PAGES ______&______ OF 8.INDICATE IN THIS SHEET (S) WHETHER OR NOT YOU WERE INVOLVED IN DESIGN AND/OR MATERIAL PROCUREMENT OF EACH CONTRACT NO.

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