Instructions

Requestor will work with the supplier to get the required forms completed. They will email the complete file/forms

Form Completed by
Supplier Request Form FMC Requestor
Registration Form Supplier
Qualification Form Supplier
Raw Material Qualification Supplier
Raw Material Financial Health Supplier
Contractor Qualification Supplier
Contractor OSHA Safety Metrics Supplier
t the required forms completed. They will email the complete file/forms to the GPSC at GPSC.Masterdata@fmc.com

Comments

All new vendors

All new vendors
If Industry Key is Chemical (High Risk).
If Industry Key is Chemical (High Risk) and is required
If Industry Key is Contractor and Contractor is preforming high risk services
If Industry Key is Contractor and Contractor is preforming high risk services and doing business in the United States
 Supplier Request Form

Supplier Information
1.1 Supplier Legal Entity Name (Please use CAPITAL Latin Letters) *
1.2 Contact First Name *
1.3 Contact Middle Initial
1.4 Contact Last Name *
1.5 Contact Email *
1.6 Contact Phone *
Type of Supplier Request
2.1.2 Additional information regarding the request (add any comments)
2.1.3.1 Purchasing Organization
2.1.3.5 Company Code for Purchase Organization
Industry Key Details
2.2.1 Category/Industry Key (select only one)
2.2.2 If a Contractor, is the contractor providing high-risk mechanical or construction services on site?
2.3 Search term/keyword for the supplier (enter the search term in CAPITAL letters as: First 7 letters of vendor, hyphen, first 3
 Registration Form
(Please use Latin Characters only)

Company Name *

  1   Supplier Details
  1.1   Address details *
(For State/Region, please put 2 character region code. Ex: PA)

  1.2   Street 2
  1.3   PO box
  1.4   PO Box postal code
  1.5   Contact First Name *
  1.6   Contact Middle Initial
  1.7   Contact Last Name *
  1.8   Ordering Email Address *
  1.9   Country of Telephone Number 1 *
  1.10   Contact Telephone number 1
  1.11   Contact Telephone number 2
  1.12   Does your company have a Fax Number? *
  1.13   Country of Fax Number (Required if answered 'yes' to question 1.12)
*
  1.14   Contact Fax number (Required if answered 'yes' to question 1.12) *

  1.15   Preferred communication language for PO form *

  1.16   Do you require your address in your local language? *
(Please disregard for US and BR. International address version is not
applicable. Information should be entered in the general address
fields)

  1.17   Supplier Address in Local Language

  1.17.1   Specify Local Language *

  1.17.2   Name/Legal Entity *

  1.17.3   Street *
  1.17.4   Street 2
  1.17.5   City*
  1.18   Country *
1.18.1 Tax ID/Vat ID Country *
 Tax ID / VAT ID Number (optional)

  1.19   Tax ID Certificate

  1.20   DUNS Credit Number
  2   Remittance Address
  2.1   Is the remittance address the same as the supplier address? *

  2.2   Name/Legal Entity

  2.3   Street
  2.4   City
  2.5   State/Province/Region
  2.6   Country
  2.7   Postal Code
  2.8   PO Box
  2.9   PO Box Postal Code
  2.10   Contact Name
  2.11   Contact Telephone Number
  2.12   Contact Fax Number
  2.13   Contact Email
  2.14   Tax ID/Vat Number
  3   Bank Information
  3.1   Bank Name *
  3.2   Bank Country *
  3.3   Bank Key/Routing Number *
  3.4   Bank Account Number *
  3.5   Bank Swift Code
  3.6   IBAN (if applicable)
  3.7   Currency *
  3.8   Supporting Bank Documentation *
(The following full-page PDF documents are acceptable: Bank
Statement, Voided
Check, Invoice or Company Letterhead with bank information. If there
is a change to
existing bank account information, must supply the old and new bank
account and a
verification phone call will be received from FMC)
tration Form
atin Characters only)
The National company for fertilizers and chemical
industries

Address: 57 Elhejaz Street – Floor 9 – Elmohandseen –

Giza – Egypt
Tele. No. : (+2) 02 – 33023697 / 33023619 / 33023589
Fax. No. : (+2) 02 33023598
P.O. Box: (12411) El Mohandseen

Khairy
Ahmed
Elleithy
export@nfert.com
Eygpt
00201000090636
(+2) 02 – 33023697
Yes
Eygpt

(+2) 02 33023598

English
No

Below fields required if answered 'yes' to question 1.16

English
The National company for fertilizers and chemical
industries
57 Elhejaz Street
Elmohandseen
Giza
Eygpt
Eygpt
474-487-032

Please submit attachments

Yes

Banque Misr
Eygpt

281 012 000 0000 610

BMISEGCXXXX
IBAN (USD)EG860002028102810120000000610
USD
Please submit attachment
 Qualification Form
(Please use Latin Characters only)
1   Supplier Code of Conduct
Please refer to FMC Corporation's "Supplier Code of Conduct" which has been established to provide a guideline of FMC’s expectations fro
URL: http://www.fmc.com/AboutFMC/FMCSuppliers/FMCPurchasingValues/SupplierCodeConduct.aspx.   

By submitting this document, I certify that the information supplied is accurate, FMC will be informed if there are any changes in the answe
transacted with FMC will be in compliance with FMC's "Supplier Code of Conduct".     

     1.1   Do you agree to comply with the FMC Supplier Code of Conduct?   *
     1.2   Do you have your own Supplier Code of Conduct? *
     1.3   Please provide a copy for our review if you answered yes to question 1.2 *
     1.4   Are you a member of the United Nations Global Compact? *
2   Please answer the following Responsible Sourcing questions
Completion of the questions are required for all companies excluding; Government Agencies, Non-Profits, Direct payments to In
Vendors), Charities and Commissions.

     2.1   Does your company treat all employees with respect and refrain from using corporal punishment, violence
or threats of violence or other forms of physical coercion or harassment? *
     2.2   Does your company oppose and not engage in harmful child labor of any type? *
     2.3   Does your company oppose and not engage in the trafficking or involuntary servitude of any worker or
employee? *
     2.4   Does your company comply with the U.S. Foreign Corrupt Practices Act (FCPA) and any other national or
local laws pertaining to the bribery or corruption of government officials, making it illegal for companies to
influence anyone, directly or indirectly, with any personal payments or rewards to assist in obtaining or retaining
business, and all otherwise applicable country laws dealing with the bribery of government officials? *

     2.5   Does your company train its employees on compliance with your company’s policies addressing items (1)
through (4) above? *
     2.6   Does your company do business with any companies or persons based in Cuba, Iran, North Korea, Syria,
Crimea, or any other country/region subject to comprehensive US sanctions or dealings with prohibited persons? *

     2.7   Comments: (provide explanation if any "No" answers to questions 2.1-2.6).
3   Are you an INTERNATIONAL Vendor who will ship goods into the United States or across country borders,
i.e. import goods from Canada, Mexico, or any other country into the US, to an FMC site? *

4   Briefly describe the material or services you will supply. *

5   Country Details
     5.1   Please select your country: *
     5.2   Brazil
         5.2.1   I declare and agree that FMC accounts payable operates only via bank transfer method and the
payment only can be done in the proper bank account mentioned in this form. I also declare that the bank account
informed belongs to the same company referred in this document. *
         5.2.2   Does your company operate as part of "simple tax charge! Governmental program? *
     5.3   United States
         5.3.1   Are you a Minority Owned company? *
         5.3.2   Select your Minority Indicator. *
         5.3.3   Attach your certificate. *
     5.4   Performing Business in the United States
         5.4.1   Are you a US based vendor or INTERNATIONAL vendor performing business in the United States?
*
         5.4.2   Attach a copy of your W8/W9. *
6   Ownership
     6.1   Is this a publicly owned company? *
     6.2   If NO, not Publicly Owned, provide the FULL NAME of any owners holding over 25% ownership of the
Company.  If an owner is an individual, please provide FIRST, MIDDLE, AND LAST/SURNAME.  If an owner is
a separate legal entity, please provide FULL LEGAL NAME of the entity. If there are no owners holding more
than 25%,  then enter “Not Applicable” on line 1 below. *

7   Management
     7.1   Provide the FULL NAME of the CEO, Chief Executive Office or equivalent top executive AND the CFO,
Chief Financial  Officer, or equivalent top financial officer of the Company. If you are a consultant, provide your
full name. *
s only)

a guideline of FMC’s expectations from its suppliers.  

spx.   

if there are any changes in the answers provided, and any business

Yes

If applicable, please provide attachment

Non-Profits, Direct payments to Individuals (not Purchasing

Yes

Yes
Yes

Yes

Yes

No

Yes

we are producer and exporter for specialized

fertilizers

Other

If applicable, please provide attachment

If applicable, please provide attachment
 Raw Material - High Risk Qualification Form
1   Financial Health
     1.1   Dun and Bradstreet D&B Number:
     1.2   Dun and Bradstreet Rating:
     1.3   Type of Organization: *

     1.4   If a Privately Held Company, please provide your information based on the
last two years audited financial statement. *
     1.5   Are there any judgments, claims or suits pending or outstanding against your
company? *
     1.6   Are there now or have you ever been involved in any bankruptcy or
reorganization proceedings? *
2   Quality Management / Systems
     2.1   Is your company ISO 14001 Environmental Management systems certified?
*
     2.2   Is your company ISO 9001 certified? *
     2.3   If your company is NOT ISO 9001, complete questions 1-19 below. Does your company:
         2.3.1   Define Management Quality Responsibility
         2.3.2   Conducts Internal Quality Audits
         2.3.3   Conduct Reviews of Order
         2.3.4   Control Suppliers
         2.3.5   Control Product identification / Tracebility
         2.3.6   Have documented procedures for
             2.3.6.1   Document Control
             2.3.6.2   Process Control
             2.3.6.3   Inspection and testing of products
             2.3.6.4   Handling, Storage, Packaging, Delivery

         2.3.7   Calibrate, Inspect and Test Equipment as directed by Manufacturer

         2.3.8   Control Non-conforming Materials
         2.3.9   Conduct Corrective Actions
         2.3.10   Maintain Quality Records
         2.3.11   Provide Training
         2.3.12   Use Statistical Techniques to monitor and improve quality
         2.3.13   Have a system in place to handle all customer complaints
         2.3.14   Have Food Handling/Waste Control Practices
         2.3.15   Have a documented cleaning program for all equipment
         2.3.16   Have a pest control program
         2.3.17   Do you use off-site storage facility

         2.3.18   Are they Controlled, inspected, segregated by products/equipments

     2.4   FMC may wish to audit your manufacturing and any packaging facility to
ensure adequate standards are met in respect of your Quality Management System.
Please indicate your agreement to such an audit.
     2.5   Company Certifications

List any "significant" certifications your company holds and the agencies or
customers involved (e.g. ISO Quality Management 9001, ISO 14001 Environment
Management System, Goods Manufacturing Practice (GMP), National Association of
Chemical Distribution(NACD), Responsible Distribution Certified, EN16001 Energy
Management, etc).
 List any "significant" certifications your company holds and the agencies or
customers involved (e.g. ISO Quality Management 9001, ISO 14001 Environment
Management System, Goods Manufacturing Practice (GMP), National Association of
Chemical Distribution(NACD), Responsible Distribution Certified, EN16001 Energy
Management, etc).

         2.5.1   Certification

             2.5.1.1   Certificate Name
3   REACH Question
     3.1   Will your company be IMPORTING chemicals into Europe to a FMC
affiliates/sites/subsidiaries?   *
     3.2   Only Representative (OR) - if you answered yes to question 3.1, all questions below are required
         3.2.1   Do you have an Only Representative (OR)
         3.2.2   Would you consider entering into an Only Representative (OR)
agreement with FMC to fulfil the REACH obligations for the material imported
into the EU  by FMC European affiliates?
         3.2.3   Provide the name of your Only Representative (OR)
         3.2.4   Would you be willing to establish an Only Representative (OR) to
fulfil the REACH obligations for the material imported into the EU by FMC's
European affiliates?
4   Responsible Care - Environmental, Health and Safety

     4.1   Is your company an American Chemistry Council (ACC) member or other
domestic or international Responsible Chemistry Programs (Canadian Chemical
Producer Association (CCPA)), Society of Chemical Manufacturers and Affiliates
(SOCMA) committed to the Responsible Care Program? *
     4.2   Does your company have a written safety, health & environmental policy,
guiding principles or other document? *

     4.3   Does your company have a process of developing information on potential
hazards & risks associated with the manufacture and use of its products? *

     4.4   Does your company have safety, health and environmental training programs
for all employees based on job responsibilities in place? *
     4.5   Does your company have written procedures in place to ensure compliance
with country, state and federal safety, environmental and health laws and regulations?
*

     4.6   Does your company have procedures to communicate hazards and risk
information on your product to employees, customer and local communities? *

     4.7   Does your company survey contract manufacturers, suppliers, customers
and/or distributors regarding their commitment to responsible care? *
     4.8   Does you company evaluate the safety programs and performance of your
suppliers? *

     4.9   Do you have an accident/incident reporting and investigation procedure? *

     4.10   Is there a formal system for reporting unsafe condition/situation by
employees? *

     4.11   Does your organization have an emergency medical plan providing
measures to be taken in case of potential emergency situation? *
     4.12   Does your company have a full-time Responsible Care individual(s) ? *
     4.13   Do you have a full-time safety professional? *

     4.14   Would your company allow FMC personnel or its agents to audit and see
the facilities and documents related to products supplied to FMC? *
     4.15   European Union (EU) and European Economic Area (EEA)

         4.15.1   Do you belong to European Union (EU) and European Economic Area
(EEA)? If answered yes to question 4.15.1, all questions below are required

         4.15.2   Does your program satisfy your responsibility under the law of
ensuring employees follow the safety rules for the facility and in particular the
directive 89/391/EEC on the introduction of measures to encourage improvements in
the safety and health of workers at work
         4.15.3   Does your program satisfy your responsibility under the law of
advising the owner/operator of any unique hazards presented by the contractor's work
and any hazard found by the contractor

         4.15.4   Does your program satisfy compliance with Workplace, Equipment,
Signs, Personal Protective Equipment Regulations and applicable EU Directives
         4.15.5   Does your program satisfy compliance with the exposure to chemical
regulations and EU directives
         4.15.6   Does your program compliance with physical hazards regulation and
applicable EU Directives
         4.15.7   Does your program satisfy compliance with the biological agent's
regulations and their applicable EU Directives

         4.15.8   Does your program satisfy compliance with workload, ergonomical and
psychosocial risk regulations and their applicable EU directives

         4.15.9   Does your program satisfy the compliance with sector specific and
work related provisions, regulations and their applicable EU directives
5   Safety and Health Performance
     5.1   Does your company do business in the United States and other US
jurisdictions? *

     5.2   If yes, complete the safety and health performance fields *
Number of Department of Transportation reported transportation incidents
OSHA Total Recordable Injury Incident Rate
6   Transportation Security Programs

     6.1   Are you an International supplier who ships into the United States or across
country borders (i.e import from Canada or Mexico into the United States, or any
other foreign country into the United States) to any FMC site? *

     6.2   Is your company a member of CTPAT (Customer-Trade Partnership Against

Terrorism) or an equivalent Program Name i.e. European Union Authorization
Economic Operator? Required if answered yes to question 6.1.
     6.3   If a member of CTPAT, provide your SVID number. Required if answered
yes to question 6.1.
     6.4   If an Equivalent Program Name, provide the program name and the attach a
proof of membership. Required if answered yes to question 6.1.

     6.5   Please note that you will be contacted by FMC Logistics to complete a
CTPAT questionnaire. Provide your company's responsible CTPAT contact name
and email. Required if answered yes to question 6.1.
7   Sanction Compliance

     7.1   Does your company have any business dealings in "Sanctioned Country", i.e.
a country that is subject to comprehensive U.S. Sanctioned Laws (Currently in Cuba,
Iran, North Korea, Sudan, Syria and the Crimea region of Ukraine)? Such dealings
might include, but are not limited to, business presence in a Sanctioned country. *

     7.2   Does your company source products from a Sanctioned Country? *

     7.3   Does your company have a process for screening third party suppliers against
relevant Prohibited Parties Lists? *
     7.4 If yes to 7.1, list all the applicable countries and the nature of your operations
involving such Sanctioned Countries.
         7.4.1   Country

             7.4.1.1   Country Name and Details - Required if answered yes to questions
7.1 and 7.2.

     7.5   Products sourced from a Sanctioned country by Name and Description. If
yes, Add Products sourced from a Sanctioned country by Name and Description (0)
         7.5.1   Product
             7.5.1.1   Products Name & Description
8   Responsible Sourcing
     8.1   Does your company have a policy that respects the protection of human
dignity, including human trafficking, involuntary servitude and endangerment of
children *
     8.2   Has your company ever had a human dignity violation? *
     8.3   Are any of your workers dependent on your company or an agent for basic
living needs? *

     8.4   Are the majority of your workers immigrants from another country? *

     8.5   Do you have a policy regarding minimum wage and overtime work? *

     8.6   Do you keep records of employee hours worked and pay rates? *
     8.7   Does your company have a policy covering diversity-related issues and
provide employees with  equal opportunities? *
     8.8   Do you have a code of conduct that you require your suppliers to adhere to?
*
     8.9   Have you undergone an audit or assessment of your suppliers against your
ethical sourcing standards or policy? *
     8.10   Does your company comply with the U.S Foreign Corrupt Practices Act,
making it illegal for companies to influence anyone with any personal payments or
rewards to assist in obtaining or retaining business, and all otherwise application
country laws dealing with the bribery of government officials? *
     8.11   Does your company train your employees on compliance with your
company's policies addressing all items above? *
     8.12   Do you certify that materials incorporated into your company's products
comply with laws in the country or the countries in which your company is doing
business? *
     8.13   Do you provide FMC with chemicals that contain conflict minerals (tin,
tungsten, tantalum, or gold)? *

     8.14   Please indicate the name and country of the smelter from whom you are
sourcing. Required is answered yes to 8.13.
9   Sustainability

FMC uses Global Reporting initiative (GRI) as a frame work and focus area are on innovation, operations and business practice. The FMC S
     9.1   Do you have a sustainability program? *
     9.2   If you have a website, do you post your policy on this website? *
     9.3   Do you publish a sustainability report? *
     9.4   Do you have a policy on sustainable manufacturing practices for the raw
materials you supply? *
     9.5   Do you have initiatives around sustainable packaging? *
     9.6   Do you have a system in place to protect related ecosystem, habitats,
biological diversity and wild life conservation in the growing areas of the raw
materials you buy or supply? *
     9.7   Do you evaluate your suppliers' sustainability performance? *
     9.8   Do you engage your suppliers on environmental standards? *
     9.9   Do you have goals/targets to reduce energy use, GHG emissions, water use
and waste? *

     9.10   Do you have goals/targets around environmental and social issues? *
10   Corporate Social Responsibility

     10.1   Are you a member of SEDEX (Supplier Ethical Data Exchange), the largest
collaborative program to assess suppliers Corporate social Responsibility (CSR)? If
yes, Please "initiate a relationship" or link with FMC in the SEDEX system. *
al - High Risk Qualification Form

n/a
n/a
Privately Held
If applicable, please fill out the Raw Materials_Financal Health Tab

No

No

Yes

Yes
below. Does your company:

ISO 9001:2015 - Quality management system

 ISO14001:2015 - Enviromental management system
ISO45001:2018 - Occupational health and safety management system
REACH (Registration no: 01-2119489441-34-0099

No
, all questions below are required
No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes
Yes
Yes

No

No

No

Please provide data for past 3 years below:

No

No
If applicable, please provide attachment

No

No

No

Yes
No

No

No

Yes

Yes

Yes

No

No
Yes

Yes

Yes

No

Yes
Yes
Yes

Yes
Yes

Yes
Yes
Yes

Yes

Yes

No
 If a Privately Held Company, provide the following information based on the last tw

Currency      
Units
BALANCE SHEET dd/mm/yr dd/mm/yr INCOME STATEMENT dd/mm/yr

Total Current Assets

      Total Sales Revenue      

Of which is Cash
and Cash             Cost of Goods Sold      
Equivalents
Total Long Term
Assets
            Operating Profit      
Short-Term Debt             Interest Expense      
Total Current
Liabilities
            Net Profit Before Tax      
Long-Term Debt             Tax Expense      
Total Long Term
Liabilities
           
Total Equity            

N/A
formation based on the last two years audited financial statement:

     

Cash Flow
dd/mm/yr dd/mm/yr
Statement dd/mm/yr dd/mm/yr

Net Cash from

            Operations
           

           

           
           
           
           

N/A