VENDOR PRE-QUALIFICATION & REGISTRATION FORM

Part A - Company Profile

A1. Company Name

A2. Company Address

A3. Business Registration Number and

Food Manufacturing License
Number for food vendor (Please
attach copy of the above document)

A4. Year of Establishment

A5. Nature of Business Distributor

Please tick () Manufacturer
Service provider
Other. Please specify :
A6. Name of item or service supplied to
Plaza Premium Lounge

A7. Category of Item or service supplied Food Item Proceed to Part B0 and skip B1
to Plaza Premium Lounge. Food contact item Proceed to Part B0 and skip B1
Please tick ()
Non food item Proceed to Part B1 and skip B0
Service provider Proceed to Part B1 and skip B0

Part B - Quality Assurance Evaluation

B0. Is the company certified with a
quality and food safety management
system (FSMS)?
Please tick () and attach copy of
certificate or others supporting
document
B1. Is the company certified with a
management system or meet the
criteria?
Please tick () and attach copy of
certificate or others supporting
document
GMP, HALAL, ISO 9001, HACCP, ISO 22000, FSSC 22000 or equivalent
Requlatory compliance declaration statement
Laboratory test report
Internal quality or food safety management system in place
Others. Please specify :
ISO 9001, ISO 14000, ISO 18000 or equivalent
Requlatory compliance declaration statement
Laboratory test report
Internal management system in place
Others. Please specify:

Part C - Delivering Service

C1. Does the company have minimum Yes. Please specify :
order quantity or amount for goods No
delivering?
Please tick () Not applicable
C2. Delivery schedule i. State the day of delivery. Pick ()
Mon Tues Wed Thurs Fri Sat Sun

ii. Delivery availability on public holiday

Yes
No

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Part D - Contact Person Ordering Hotline Contact 1 Contact 2
D1. Name of Person In Charge

D2. Title

D3. Telephone No.

D4. Mobile No.

D5. Facsimile No.

D6. Email Address

Part E - Financial Detail

E1. Beneficiary Name

E2. Bank Name

E3. Bank Address

E4. Bank Account No.

E5. Bank Swift Code

(Applicable to oversea bank account only)

E6. Correspondent Bank Name

(Applicable to oversea bank account only)

E7. Correspondent Bank Swift Code

(Applicable to oversea bank account only)

E8 Payment term Standard Payment Term: 45 Days After Receipt Of Invoice

Part F - Personal Information Collection Statement

1 Plaza Premium Lounge will use the information provided for the purpose of processing this pre-qualification and registration form and
dealing with our procurement related matters.

2 Information will be kept confidential and will be used by Plaza Premium Lounge and its subsidiaries only.

Part G - Remarks

1 Vendors are required to submit Business Registration Certificate copy or other certificate to Purchasing Department once renewed.

2 Plaza Premium Lounge has the rights to visit vendors' companies, factories and warehouses for site inspection.
3 Food and beverage shall comply with local health and food safety authority's requirement.
4 All the supplied food and beverage shall be imported legally.

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 I declare that all information given in this form is, to the best of my knowledge, accurate and complete. If any false information is given, the
application is deemed to be invalid and I shallgive up my right to submit quotations and tender.
I understood and agreed to comply the attached "GENERAL TERMS AND CONDITIONS of [Purchase Order/Contract/Agreement] FOR PURCHASE
OF GOODS. (Please refer to Appendix 1)

Name :
Position Held :

Authorized Signature :

Company Stamp :
Date : D D / M M / Y Y Y Y

Attachment Checklist (For Internal Use Only) Recommendation

Part I - Requirements
1. Stamped & Signed Vendor Pre-Qualification & Registration Form
2. Stamped & Signed General Terms & Conditions of Purchasing Goods & Services
3. Copy of Business Registration Document
Accepted/Not Accepted
4. Copy of Bank Statement shows Bank Account no. & Beneficiary Name
5. Product List
6. Name Card
7. Job Reference

Part II - Optional Supporting Document

Food/ 1. GMP, HALAL, ISO 9001, HACCP, ISO 22000, FSSC 22000 or equivalent
Food 2. Requlatory compliance declaration statement Accepted/Not Accepted
Contact 3. Laboratory test report
Item
4. Internal quality or food safety management system in place
Non Food 1. ISO 9001, ISO 14000, ISO 18000 or equivalent Remark:
Item/ 2. Requlatory compliance declaration statement
Service 3. Laboratory test report
Provider
4. Internal management system in place

Prepared by Reviewed by Approved by

Signature

Name

Admin Specialist Head of HumanManager

Resources Finance Controller
Manager
Position Procurement Officer Procurement Financial

Date D D / M M / Y Y Y Y D D / M M / Y Y Y Y D D / M M / Y Y Y Y

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