FCS 106

SUPPLIER REGISTRATION FORM Version 11

21.07.17

Place an "X" to perform the procedure: NEW REGISTER UPDATE

NATIONAL FOREIGN

GENERAL INFORMATION
COMPANY OR PERSONAL NAME (AS CONTAINED IN LEGAL
CERTIFICATION):

TYPE OF IDENTIFICATION: NIT C.C C.E IDENTIFICATION NUMBER:

ADDRESS: COUNTRY: PROVINCE/ CITY:

STATE:
EXT: CELL EMAIL
PHONE NUMBER:: PHONE: ADRESS:
EXT:
LEGAL REPRESENTATIVE: N° IDENTIFICATION:
LEGAL REPRESENTATIVE (S), MEMBER (S) OF THE BOARD OF DIRECTORS AND / OR PARTNER (S) ARE PEOPLE POLITICALLY EXPOSED (PEPs)? YES: NO:
If yes, please attach name (s), identification (s) and link with the entity.
CONTACT PERSON IN THE PORT: AREA AND/OR POSITION:
PHONE
COMMERCIAL ADVISOR: EMAIL ADRESS:
NUMBER:

* I _______________________________ acting as legal representative of _________________________________, declare that: a) all attached and background
information is true and formulated as an affidavit, b) all our operations fully comply with regulations against money laundering assets of the current regulations
in Colombia, c) accept and commit to ensuring that my employees comply with the regulations of the SPRB and other group companies, as well as other rules
and regulations of entry, movement and development activities, d) we are in compliance with all labor laws, environmental and port, applicable to Ports and
Maritime matters, especially those of SPRB e) We agree to update the information and notify to SPRB of any changes of the information registered in this form.
right index finger

SIGNATURE AND
REPRESENTATIVE NAME:
STAMP:

INSTRUCTIONS
This document and its annexes duly completed must be sent legible to the email compras@puertodebarranquilla.com
The receipt of this form by the SPRB It does not imply inclusion in our register of suppliers.
The information contained in this form and its annexes should be updated when changes (legal trading conditions, tax and / or business) on the supplier or the SPRB submitted
and group companies as they required.

Read carefully and thoroughly the following authorization:

* You authorize the Sociedad Portuaria Regional de Barranquilla S.A. ("SPRB") , Gran Puerto S.A.S. (GRP), Operadora de Servicios Integrales Trademar S.A.
(OSI TRADEMAR) and Sociedad Portuaria Rio Grande S.A. (SPRG) collects, use, transmits, transfers or performs any operation on your personal data in order
to: (i) subscribe the supplier registration formats to pay and fulfill other obligations to suppliers; (Ii) carry out security and money laundering studies; (Iii) report on
events and loyalty programs suppliers; (Iv) the other purposes stated in our information processing policy, which can be consulted in this link on our website. * You
accept that the SPRB deducts from your bill the sum of COP $ 2,420 for Bancolombia accounts and COP $ 5,050 for the rest of banks.
* You acknowledge that you have been informed by SPRB and its affiliates of your rights to access, rectify, update and delete your personal data, as well as to
revoke your authorization, provided there is no legal or contractual duty limiting that right. Any queries about the use that SPRB is giving to your personal data or
claims can be directed to our customer service area at www.puertodebarranquilla.com through the PQRS section, selecting the reason Habeas Data. By
subscribing to this authorization, you grant your prior, express and informed consent in the terms set forth herein and declare to be aware of the policy of
processing the information of Grupo Empresarial Puerto de Barranquilla. "

DOCUMENTS TO BE ATTACHED TO THIS FORM

NATIONAL SUPPLIER
1. Copy of legal representation or equivalent document, not older than 60 days.
2. Updated RUT.
3. Copy of identification of person with legal representation.
4. Original Bank Certificate, not older than 60 days.
5. Letter of authorization for payment of transfers, signed by the Legal Representative.
6. Certifications of quality, environment, Industrial safety and occupational health (ISOH-SISO) and sectoral, if applies.
7. Financial statements the last accounting period together with notes, by timely request by the SPRB.
8. Two (2) Certificates of experience as a supplier of goods or services, to timely request by the SPRB.
9. NATURAL PERSON: Diploma or its equivalent . People registered as "common regime" by DIAN system, must to attach Financial statements.

FOREIGNER SUPPLIER
1. Document of Incorporation or Business Registration issued by the relevant authority.
2. Copy of identification of person with legal representation. (Passport  or its equivalent).
3. Tax identification of the country of residence or address.
 FOREIGNER SUPPLIER
1. Document of Incorporation or Business Registration issued by the relevant authority.
2. Copy of identification of person with legal representation. (Passport  or its equivalent).
3. Tax identification of the country of residence or address.

For more information, please call the following telephone number: Supplier Registration: (+57) (5) 3716200