TMHS Supplier Registration Form

Basic Company Information

 
Company Name  
Trading name (if different)  
   
Legal form of business  
Country of Registration  
Year of Registration  
Number of full-time employees  
  Year Currency & Amount
Revenues    
     
Business License number*  
Certificate of Incorporation number*  
Tax payer Identification Number (TIN)*  
VAT Registration number*  
   
* Please provide Copies of certificates with submission of form
 Contact Information & Address
 
Postal Address (PO Box)  
City | Postal Code (ZIP)    
Country  
     
Physical Address of head office*  
City | Postal Code (ZIP)    
Country  
     
Telephone numbers    
Fax number    
General email address    
Web site Address  
     
Name of Contact Person (Management)    
Email address    
Position    
Mobile phone number    
     
Name of Contact person (Sales)    
Email address    
Position    
Mobile phone number    
     
Name of Contact person (Finance)    
Email address    
Position    
Mobile phone number  
* Physical address is mandatory
Banking Information (1)
 
 
Bank Name    
Branch Name    
Branch Code    
Physical Adress    
City | Postal Code (ZIP)    
Country    
     
Account Type    
Account Number (IBAN format)    
Bank Swift code    
     
Banking Information (2)
Bank Name  
Branch Name  
Branch Code  
Physical Address  
City | Postal Code (ZIP)  
Country  
     
Account Type    
Account Number (IBAN format)    
Bank Swift code    
Every applicant must sign a "consent form"for verification of the relevant documents submitted with Banks, TRA, BRELA etc.

(If you don't have 2 accounts, use only one box above)
Trade & Commercial Information
     
Commodities for which you want to You can register for a maximum of 3 commodities* only
register?
Commodity 1  
Commodity 2  
Commodity 3  
* Please refer to enclosed overview and explanatory notes (check Data tab)

(IF    
representing any major brand,
please indicate below)
Major brands represented Medical Services. Eg. Medical Supplies and  
Consultations Services.
Kindly enclose brochures of brands you    
represent in Tanzania
   
   
   
    
     
   
Due to the high risks involved with handling cash money TMHS actively discourages cash (pre)payments of purchase orders. Please
indicate here if you will accept payment of your invoice between 14 and 30 days after the invoice date & receipt of goods or
services.

 YES  NO

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