BUSINESS PARTNER CHANGE FORM (Feb 03 2020)

Our Company's Data Privacy Commitment

MUST BE COMPLETED BY AUTHORIZED SUPPLIER/VENDOR CONTACT

Please fill out this “Business Partner Change Form” correctly in capital letter, please type answers, and return to your
Merck or MSD Business Partner (physically, by email or fax). If returning by email, please save completed form as a non-
editable PDF. Note all fields related to the requested change(s) are required. If the change request involves a name
change a new local tax certificate and notice on company letterhead are required to support the name change. The
supporting documentation is MANDATORY.

SECTION I – CHANGE NAME

ADD NEW NAME

New Vendor Name* (Local Language): KCR PLACEMENT SP. Z O.O.

Reason for change:

REMOVE EXISTING NAME

Previous Vendor Name*

SECTION II – CHANGE ADDRESS

ADD NEW ADDRESS
Vendor Name* (Local Language):

Reason for change:

Address* (Physical Address and PO Box, if available):

Country*: Region (Argentina only) & Postal Code*:

REMOVE EXISTING ADDRESS

Vendor Name*:

Address* (Physical Address and PO Box, if available):

Country*: Region (Argentina only) & Postal Code*:

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 BUSINESS PARTNER CHANGE FORM (Feb 03 2020)

SECTION III – CHANGE EMAIL ADDRESS

ADD NEW EMAIL ADDRESS
Email address for purchase order: Email address for workflow/remittance advise*:

REMOVE EXISTING EMAIL ADDRESS

Email address for purchase order: Email address for workflow/remittance advise*:

SECTION IV – CHANGE BANK ACCOUNT*

One of the below Supporting Documentation to evidence the following vendor information must be included with the
completed Business Partner Change Form. The supporting documentation is MANDATORY, and the account/payment(s)
will not be processed without supporting documentation. Examples of Supporting Documentation: Bank Approval
Letter - Bank Confirmation Letter - Bank Certification - Cancelled Check – Copy of Bank Book

ADD NEW BANK ACCOUNT

Payment Method*
Electronic – complete bank information
If other non-standard payment method is required, please provide method and reason we cannot pay with preferred
Electronic Method:
Payment Information IBAN (May only be applicable to certain countries)
Bank Account Number*: 56 1090 1056 0000 0001 3645 5921 IBAN:PL56109010560000000136455921
Account Holder Name* KCR PLACEMENT SP. Z O.O.
SWIFT (BIC) Code*: WBKPPLPP

Bank Name and Address*:

SANTANDER BANK POLSKA S.A.
AL. JANA PAWLA II 17, 00-854 WARSAW

Bank Identifier Number* (i.e. Bank Key/Routing/Transit/Sort/ABA#) 10901056

Bank Account Check Digit:
Bank Account Currency*: PLN Bank Account Type*: Checking Savings
Other (Specify)
Bank Country*: POLAND Region:
Is there an intermediary bank? Yes No *If Yes, please include intermediary and beneficiary bank instructions on
company letterhead in supporting documentation*
Is this bank account to be added IN ADDITION to an existing bank account? (Multiple bank accounts on existing vendor’s profile)
Yes No

Is this bank account to REPLACE an existing bank account on file? (Vendor no longer uses previous account)
Yes No

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 BUSINESS PARTNER CHANGE FORM (Feb 03 2020)
EXISTING BANK ACCOUNT (To be completed in all cases)
Please provide current bank account details in the fields below
Payment Information IBAN (May only be applicable to certain countries)
Bank Account Number*: IBAN:
Account Holder Name*
SWIFT (BIC) Code*:
Bank Name and Address*:

Bank Identifier Number* (i.e. Bank Key/Routing/Transit/Sort/ABA#):

Bank Account Check Digit:
Bank Account Currency*: Bank Account Type*: Checking Savings
Other (Specify)
Bank Country*: Region:
Should this existing bank account be deleted? Yes No
Should the existing bank account be replaced by new account? Yes No If Yes or No, please complete fields below
Should this existing bank account be maintained for future payments? Yes No

SECTION V– AUTHORIZATION*

Name of Individual Requesting Change: ANETA SZEWCZYK

Title of Individual Requesting Change: PROXY

Email Address of Individual Requesting Change: aneta.szewczyk@kcrcro.com

Signature of Individual Requesting Change: Date: 26 November 2020

Aneta Szewczyk Digitally signed by Aneta Szewczyk

Date: 2020.12.03 09:30:42 +01'00'

AUTHORIZED INDIVIDUAL CANNOT BE A MERCK/MSD EMPLOYEE OR CONTRACTOR

Only Government agencies are exempt from signature.

SECTION VI – GUIDANCE
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 BUSINESS PARTNER CHANGE FORM (Feb 03 2020)
Section I
Form Location Field Name Description and Information to be Entered
Vendor Name* Enter the name of the vendor as shown on the invoice/legal documentation.
(For China, RU, and Greece: Please also provide the equivalent English name if
vendor’s Name is provided in local language).
Address* Enter vendor address including city and region. If the vendor has both a street
and PO Box, enter both. Note: for Argentina the Region Code is mandatory to
provide. Note: Enter Region Code for India. For Greek vendors postal code
format is XXX XX
Country and Postal Code* Enter the country and postal code portion of the vendor address.
Section II
Form Location Field Name Description and Information to be Entered
Payment Method* Check the box that specifies what method (check, electronic) will be used to pay
the vendor. All vendors should be paid electronically, if possible. If check
payment method is required, provide an explanation for why the vendor may not
be paid electronically. If another non-standard electronic method is required on
an exception basis (Direct Debit, Manual Clearing, etc.), please specify and
explain why that is required.
(Note: Giro is only used for certain vendors in DK, FI & NO only)
(Note: ISR is only used for certain vendors in CH Switzerland), the ISR number
should also be provided and that ISR number will be entered on the general view
in the Payment Transactions screen in the ISR number field
(Note: Boleto, TED/DOC and Gov’t check boxes for Brazil only)
(Note: W – Domestic Check (World Link) is used in some Latin America
locations, such as Panama, Colombia)
(Note: All India vendors with a Payment Method of W or C the Supplement must
be MLDB option “5”)
(Note: Russia payment method is L except for Foreign vendors, Custom agents
that use the card and MRL custom agents where the payment method is Z
All Ru vendors must have the payment method supplement field filled in with the
priority code configured for Russia (from 01 till 06)
(Note: Greece vendors should be L, except the following cases:
Foreign vendors where payment method is T
MoH and Taxes vendors where payment method is LZ)
(Note: Cyprus vendors should be L, except the following cases:
Foreign vendors where payment method is T
X for utilities vendors (direct debit)
Z for MoH and public vendors)
Intermediary Bank* Vendor should provide supporting documentation outlining Intermediary Bank
details. Intermediary Bank information should consist of; Bank Name, Bank
Address, and Account Number and vendor should also include Beneficiary bank
details; Bank Name, Bank Account and Account Holder Name.
Vendor Email for Enter the email address that will be used to send Purchase Orders to the vendor.
Purchase Order* This is a required field for all vendors who have email addresses.
Vendor Email for Enter the email address that will be used to send workflow emails and remittance
Workflow/Remittance advices to the vendor. This is a required field for all vendors who have email
Advice addresses.
Special Payment Enter special payment instructions in this field.
Instructions In some countries Type of Business (Purpose Code) may be required for
payment. If there is an alternate payee that will receive all payments or a
permitted payee that may receive some of the payments, then please note the
vendor number of the alternate or permitted payee here with any other
applicable instructions.

(Note: Russia: some public vendors are paid using an alternative payee which is
called a Collector; Regular bank data is maintained in the collector (alternate
payee) master data, while the bank account for the principal vendor should be
999999999999999999 and in the account holder field further instructions need to
be provided.
As Collectors are not the vendor of record for the purchase, the address data of
the Collector (Alternate Payee) will typically be entered for such vendor as
follows:
Vendor Street in Cyrillic: Шаболовка ул
Vendor Street in English: Shabolovka street
City in Cyrillic: Москва
City in English: Moscow

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 BUSINESS PARTNER CHANGE FORM (Feb 03 2020)
Postal Code: 119049 )

(Note: Ukraine: For doctors following additional info is required:

Bank tax ID/BN that will be entered in SAP account holder field. For example,
23494714/BN (Alphabank) – only for doctors paid with card number. For all
doctors (whether paid with card number or directly paid) the Instruction for
creditor agent is always mandatory:
» In case paid with card number this is the format required:
(‘КАРТА’ or ‘KP’ plus digit ‘5168742013215938’) - vendor name in Cyrillic
(ex.:’САМСОН ОКСАНА ЯРОСЛАВІВНА’) - ENH of vendor (‘ІПН 2425502884’)
– a description in Cyrillic (‘ЗА ПОСЛУГИ ЗГ. ДОГ .ЦПХ НЕ ПОВ. З ПІДПР. Д-
ТЮ’)
» In case paid directly it is a fixed text in Cyrillic (two are the
possible different texts that are used)

Section III & IV

Form Location Field Name Description and Information to be Entered
Bank Information*: The Bank Account currency, type of account (please note whether the account is
a principal or checking account) and the Account Holder name associated with
the bank account is required for all vendors who are paid electronically.
The IBAN and SWIFT (BIC) code are required for bank accounts in most
European countries (SEPA countries with EURO bank account).
For countries that do not use IBAN/SWIFT, the vendor's bank account number,
bank name and address, and the number that uniquely identifies the bank and
branch are required. Optionally, some bank accounts will also require a check
digit.
Reconciliation account Note: Colombia, France, India, Peru, Russia, Saudi Arabia, South Africa and
Ukraine may use different reconciliation accounts than the global standard.

Contact your local finance representative if you are uncertain about which
reconciliation account to use for those countries. Please provide the RECON
account number if known.

For Russia: several reconciliation accounts are available for vendors, when
submitting the form, ensure the correct reconciliation account is chosen
Trade payables-reconciliation account 21001019
A/P-social taxes-payroll 21011610
AP Social Taxes Accident. 21011610
A/P-social taxes-health security 21011611
A/P-social taxes-personal income federal 21011603
A/P-social taxes-pension 21011612
A/P taxes – Moscow 21011601
Accounts Payable - 3rd party 21001000
A/P-reconciliation acct-foreign curr 7600 21001019
A/P-reconciliation acct-employee salaries 21001100
A/P Reconciliation Account -HCP 21001017
Accrued expense-VAT 21011602
A/P taxes - local taxes 21011601
Income taxes payable-national 21011600

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