General Information

Company Name:
Address (Head Office):
Year of Establishment: No. of Employees:
Telephone: Fax:
E-mail: Website:

Registration Details
Legal Status: Establishment Limited Liability Company Joint Venture Partnership Corporation

Nature of Business: Date of Registration:

Trade License No.: Issue Date: Expiry Date:

Chamber of Commerce: Issue Date: Expiry Date:

Proprietors/ Partners
Name of Proprietors/ Partners Nationality % Ownership Position Held Contact No.

As on Date:

Local Sponsor

Name:
Address:
Tel No.: Fax No.: Mob. No.:

Joint Venture (if applicable)

Name of the Joint Venture Company:

Address:

Related Companies
Company Name Address Line of Business % Shares
A Parent

B Subsidiaries
1
2
3

Auditors

Name:
Address:
ISO Certificates
Number Start Date Expiry Date

Legal Matters

1 Have you or your partners/ Shareholders/ Directors ever filed for bankruptcy? No
If yes, when:

2 Is your company subject to any legal proceedings? No

If yes, describe.

Bank References

1- Bank Name: Tel:

Address: Fax:
Relationship Mgr.: Mob.:
Bank Accounts: Current Savings Others, Specify E-mail:

2- Bank Name: Tel:

Address: Fax:
Relationship Mgr.: Mob.:
Bank Accounts: Current Savings Others, Specify E-mail:

Major Supplier References (Services and Materials)

1- Company Name: Tel:

Address: Fax:

Contact Name:
Credit Period: 0 30 (days)
Designation: Credit Terms: Credit
Mobile No.: Credit Limit: AED

2- Company Name: Tel:

Address: Fax:

Contact Name:
Credit Period: 0 30 (days)
Designation: Credit Terms: Credit
Mobile No.: Credit Limit: AED

List of On-going Projects

Client Name Project Developer Contract Value % Complete Finish Date
1
2
3
4
Total
Authorized Signatories to sign LPO
Full Name Designation Specimen Signature Email Address
1
2

Authorized Signatories Cheques/ Bill of Exchange/ Other Bank Documents

Full Name Designation Specimen Signature Email Address
1
2

Key Contact Persons for Payments Process

Full Name Designation Contact No. Email Address
1
2

Details of your Credit Requirement

Services Required: Value Credit Term Job Duration
Equipment Rental
Dewatering Works
Sheet Piling
Others
Specify:

Please Attach the Following Documents:

1 Copy of Trade License
2 Copy of Chamber of Commerce Certificate
3 Copy of Passport(s) of Owners
4 Copy of Passport Local Sponsor
5 Copy of Passport(s) of Authorized Signatory for Contracts & Payments
6 Copy of Bank Mandate showing the Authorized Signatories for Payments
7 Copy of 3 years signed Audit Report
8 Copy of Valid Zakat and VAT Certificate
9 Company Profile
10

We apply to have a credit facility extended to us and undertake to settle the full amount on or before the due date for the credit period given
to us and understand that this credit facility will be automatically suspended if payment is not made on time or any cheque is dishonored by
the bank due to lack of funds.

Furthermore, we hereby declare that the above information is true and correct. We authorize ACTION to conduct credit investigation including
contacting our trade references and banks as well as obtaining credit reports. We also authorize our trade references and banks and credit
reporting agencies to disclose to ACTION all financial and credit information of our company.

Name and Signature

Authorized Signatory
Designation:
Date: (Company Stamp)