APPENDIX A – NEW VENDOR QUALIFICATION FORM

A. Vendor Details:

Company Name: RIVERA & FRANCISCO LAW OFFICE

Company Registration Number (Attach certificate of Incorporation): N/A
Nature of Business: Law/Legal Services
TIN: 311-732-785-000
Address: No. 25, Magalang-Mabalacat Road, Brgy. Bundagul, Mabalacat City, Pampanga
Contact Person: Alfred Stalin P. Francisco
Email: alfred.stalin.francisco@gmail.com
Contact Number: +63 926-694-7376
Payment Terms (agreed with supplier): Php 10,000.00 monthly (15 days from billing date)
retainer fee excluding VAT
Currency: Philippine Peso
B. Bank Account Details (Attach letter from vendor on the bank details)

Beneficiary Bank Account Name: Alfred Stalin P. Francisco

Beneficiary Bank Name: Banco de Oro Universal Bank
Beneficiary Account Number: 010820172103
Beneficiary Bank Address: SM City Clark, Manuel A. Roxas Highway, Clark Freeport
Zone, Angeles City, Pampanga.
Beneficiary Bank Branch Code: N/A
Beneficiary Bank Swift Code: N/A
C. For Official Use

Vendor Master Updated by: Vendor Master Records Checked by:

Name: ____________________________ Name: ____________________________
Designation: _______________________ Designation: _______________________
Country: __________________________ Country: __________________________
Notes:

1. The completed form must be submitted to the Finance Office at least one week in advance of the date the e-PR
raised dates.
2. Incomplete forms without the required attachments (Vendor Certificate of Incorporation and Letter from the
Vendor on their Beneficiary Bank Details) will not be accepted.