SUPPLIER ACCREDITATION APPLICATION FORM (SAAF)

GENERAL INFORMATION (to be filled up by supplier)

Business/Company Name: Date of Establishment:
Tax Identification Number:
Business/Company Address: Company Email:
Company Tel. No. Company Fax No.
Company Website:
Contact Person/s Telephone No. Mobile No. Fax No. Email Address

TYPE OF ORGANIZATION (to be filled up by supplier)

 Corporation  Cooperative  Partnership  Sole Proprietorship  Others (please specify)___________
BIR 2303 LINE OF BUSINESS (to be filled up by supplier)

PAYMENT TERMS OFFERED TO RLC (to be filled up by supplier)

 15 Days  30 Days  45 Days  60 Days  Others (please specify)___________
OWNERSHIP/MANAGEMENT PROFILE
(indicate stockholders with 20% and above interest and principal officers [i.e., President and Treasurer]
(to be filled up by supplier)
NAME POSITION % OWNED CONTACT NOS. EMAIL ADDRESS

CUSTOMER REFERENCE

COMPANY NAME CONTACT PERSON POSITION PERIOD COVERED CONTACT NOS. EMAIL ADDRESS

SUPPLIER REFERENCE

COMPANY NAME CONTACT PERSON POSITION PERIOD COVERED CONTACT NOS. EMAIL ADDRESS

BANK REFERENCE
BANK/BRANCH CONTACT PERSON POSITION CONTACT NOS. TRANSACTIONS

MANDATORY DISCLOSURE
(disclose immediate family members** of your business’ officers/ owners/ representatives who are employed within the Gokongwei Group)*

NAME OF NAME OF
BUSINESS UNIT POSITION POSITION RELATIONSHIP
GOKONGWEI GROUP EMPLOYEE SUPPLIER’S EMPLOYEE

(disclose parent company, subsidiary or affiliate is a competitor of any business within Gokongwei Group)*
COMPANY NAME AFFILIATION OTHER COMMODITIES

Note: *- Use separate sheet for additional information as necessary. Write N/A if not applicable. DO NOT LEAVE BLANK SPACES.
**- Immediate family members refer to the spouse, parents, children, brothers and sisters, as well as the spouses of the children, brothers and sisters.

DECLARATION STATEMENT SUPPLIER’S AUTHORIZED SIGNATORY

1) I/We, in behalf of our company, shall comply with the policies and procedures of
JGSHI and its group and shall ensure that all business transactions be made through
the conglomerate’s authorized purchasing representatives.
2) I/We commit to maintain the highest standards of integrity as your business partner
in support of the conglomerate’s Code of Business Conduct and Conflicts of Interest
policy.
3) I/We submit that any anomalous transactions or indirect deals/arrangements
resulting to Conflict of Interest with employees of your company may lead to the
suspension or utmost cancellation of my application/accreditation.
4) I/We hereby attach the Supplier Documentary Requirements Checklist duly
supported with the pertinent documents to support information embodied in this
application.
5) I/We certify that all information provided herein is to the best of my/our knowledge
and belief complete and accurate and any misrepresentation or undisclosed information _____________________________________
may result to the outright disapproval of this application. Authorized Company Representative
FOR INTERNAL USE ONLY (to be filled up by Proponent)
Signature Over Printed Name / Date
Type of Accreditation: Received by: Date Received:
 Regular Accreditation _____________________________________
 Conditional Accreditation Company President / General Manager
 One Time Accreditation Signature Over Printed Name / Date
 Update / Change Name
Business Unit & Department

CRITERIA FOR ACCREDITATION (attach supporting rating sheet) _______________________

MAX POINTS SUPPLIER RATING
Name & Position / Date
Product/Service Quality and Reliability 20%
Price Term and Value of Offering 20%
Technical Support 10%
Sales and After Sales Support and Service 10%
TOTAL % POINTS PRODUCT/SERVICE EVALUATION 60%
Financial Status/ Credit Rating 20%
Background Check/ Track Record 20%
TOTAL COMPANY EVALUATION 40%
TOTAL % POINTS FOR ACCREDITATION
(rating should reach at least 75% before recommending Supplier for 100%
Accreditation)
FOR INTERNAL USE ONLY (to be filled up by RLC SAT)
Assessment ACCREDITATION DISPOSITION
 Regular Accreditation
 Conditional Accreditation
 One Time Accreditation
 Update / Change Name

Endorsed by: Approved by:

____________________________________________
__________________ ___________________________ ___________________________
Name & Position / Date Name & Position / DateName & Position / Date Name & Position / Date Name / Date

RLC SAT MEMBER RLC SAT MEMBER RLC SAT MEMBER BU GENERAL MANAGER President / EVP
 SUPPLIER ACCREDITATION APPLICATION FORM (SAAF)
MANDATORY DOCUMENTARY REQUIREMENTS (shall be submitted by supplier)
Sole Proprietorship / Individual Corporation / Cooperative Partnership
 Company Profile**  Company Profile**  Company Profile**
 DTI Certificate of Registration of Business Name  Articles of Incorporation / Cooperation**  Articles of Partnership**
 Mayor's/Business Permit  SEC / CDA Certificate of Registration  SEC Certificate of Registration
 BIR Registration/TIN  Notarized Board Resolution or Secretary’s  Notarized Board Resolution or Secretary’s Certificate**
 Audited FS for the last 2 years** Certificate**  Mayor's/Business Permit
 Robinsons Bank Account**  Mayor's/Business Permit  BIR Registration/TIN
 BIR Registration/TIN  Audited FS for the last 2 years**
 Audited FS for the last 2 years**  Robinsons Bank Account**
 Robinsons Bank Account**

** not applicable for one-time accreditation ** not applicable for one-time accreditation ** not applicable for one-time accreditation
OTHER MANDATORY DOCUMENTARY REQUIREMENTS (shall be submitted by supplier)
For Trucking
 Certificate of Public Convenience / Provisional Authority for the Trucks / Proof of ongoing renewal
For Contractors
 Valid PCAB License / Proof of ongoing renewal with Construction Industry Authority of the Philippines (CIAP)
For Hazardous Waste Haulers
 Transporter Registration Certificate
 Copy of Contract / MOA with a disposal facility
 Treatment, Storage, and Disposal Facility (TSD) Registration Certification of the Disposal Facility
For Hazardous Waste Disposal Companies
 Treatment, Storage, and Disposal Facility (TSD) Registration Certificate
 Transporter Registration Certificate
For Garbage Haulers
 Certificate of Public Convenience / Provisional Authority for the Trucks
 DENR Permit / Treatment, Storage, and Disposal Facility (TSD) Registration Certificate
 Permit-to-Dump from MMDA (for haulers within Metro Manila)
Manpower / Security Agency
 Certificate of Registration from DOLE under DO 174series of 2017
 Certificate of No Pending Case from DOLE (Current Year)
 Certificate of No Pending Case from NLRC (Current Year)
 Certificate of Membership from SSS, PhilHealth and Pag-Ibig / HDMF