Document No. PNLD-3-FRM-8-VENDOR REGIST-V2 Revision No : Page 1 of 32 Title : VENDOR REGISTRATION FORM Effective Date : 19 December 2014 PRIVATE & CONFIDENTIAL APPLICATION FOR VENDOR REGISTRATION WITH CYBERSECURITY MALAYSIA ( 726630-U ) Level 5, Sapura@Mines No. 7, Jalan Tasik, The Mines Resort City 43300 Seri Kembangan Selangor Darul Ehsan MALAYSIA Tel: +60 (0)3 8992 6888 Fax: +60 (0)3 8992 6841 Homepage: http://www.cybersecurity.my INSTRUCTIONS: 1. Please read the instructions carefully before filling up this form. 2. Form should be clearly type/handwritten and send to CyberSecurity Malaysia by hand or post together with the supporting documents and product catalogues/brochures for the attention of Procurement & Logistics Dept. 3. Incomplete Application Form will be rejected. 4. Registration does not guarantee vendors are automatically included in the tendering/quotation exercise. NOTE: YOUR VENDOR REGISTRATION FORM WILL ONLY BE ATTENDED IF COMPLETE WITH SUPPORTING DOCUMENTS.
32
Embed
APPLICATION FOR WITH CYBERSECURITY MALAYSIA ( … · 020302 02 - Perkakas Elektronik Dan Aksesori 020399 99 - Pembuat 04 Peralatan Dan Perkakas Domestik 020401 01 - Peralatan Dan
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Document No. PNLD-3-FRM-8-VENDOR REGIST-V2
Revision No : Page 1 of 32
Title : VENDOR REGISTRATION FORM Effective Date : 19 December 2014
1. Please read the instructions carefully before filling up this form.
2. Form should be clearly type/handwritten and send to CyberSecurity Malaysia by hand orpost together with the supporting documents and product catalogues/brochures for theattention of Procurement & Logistics Dept.
3. Incomplete Application Form will be rejected.
4. Registration does not guarantee vendors are automatically included in thetendering/quotation exercise.
NOTE: YOUR VENDOR REGISTRATION FORM WILL ONLY BE ATTENDED IF COMPLETE WITHSUPPORTING DOCUMENTS.
1) Type your policy reference nameat File-Properties-Subject2) Right click mouse button andchoose Update Field to display it
Document No. PNLD-3-FRM-8-VENDOR REGIST-V2
Revision No : Page 2 of 32
Title : VENDOR REGISTRATION FORM Effective Date : 19 December 2014
5. Registration categories (please tick where applicable) :
KOD BIDANG
01 PENERBITAN DANPENYIARAN
01 Penerbitan010101 01 - Bahan Bacaan Terbitan Luar Negara010102 02 - Bahan Bacaan010103 03 - Penerbitan Elektronik Atas Talian
01010404 - Bahan Penerbitan Elektronik DanMuzik/Lagu (siap cetak)
02 Kertas010201 01 - Kertas010299 99 - Pembuat
03 PeralatanPenerbitan/Percetakan
01030101 - Peralatan Percetakan SertaAksesori
01030202 - Peralatan Sistem Bunyi, PembesarSuara dan Projektor
01 - Bahan Peledak (belerang, pelaruthidrokabon dan beroksigen /gunpowder)
060202 02 - Bunga Api Dan Mercun060203 03 - Pencucuh/Alat Penghasil Nyalaan060204 04 - Gas (industri dan domestik)060205 05 - Pewarna/Pencelup/Lilin060299 99 - Pembuat
03 Bahan Bakar DanPelincir
060301 01 - Bahan Bakar060302 02 - Bahan Pelincir060303 03 - Bahan Api Nuklear060399 99 - Pembuat
221801 01 - Syarikat Insuran221801 02 - Broker Insuran221803 03 - Penyediaan Akaun dan Pengauditan
22180404 - Pengurusan Kewangan DanKorporat
221805 05 - Agensi Kredit Dan Pemfaktoran221806 06 - Syarikat pelelong awam
19 Barang Lusuh
22190101 - Membeli Barang Lusuh TanpaPermit
221902 02 - Membeli Barang Lusuh Perlu Permit20 Editorial,Rekabentuk Grafik,Seni Halus Dan HartaIntelek
22200101 - Media Elektronik (tidak termasukkerja-kerja percetakan)
22200202 - Media Cetak (tidak termasuk kerja-kerja percetakan)
222003 03 - Bill Board222004 04 - Penulisan – Semua Jenis Penulisan222005 05 - Mereka-Cipta Dan Seni Halus222006 06 - Penterjemahan222007 07 - Pengkomersilan222008 08 - Hak Harta Intelek (patent)222009 09 - Lain-lain Media Pengiklanan222010 10 - Perkhidmatan Fotostat
21 PerkhidmatanPerladangan,Perikanan, Haiwan DanHidupan Liar
222101 01 - Perikanan Dan Akuakultur
Document No. PNLD-3-FRM-8-VENDOR REGIST-V2
Revision No : Page 19 of 32
Title : VENDOR REGISTRATION FORM Effective Date : 19 December 2014
222102 02 - Hortikultur222103 03 - Ternakan
222104
04 -Pertanian/Tanaman/Ladang/Taman/Hutan Dan Ladang Hutan
330201 01 Arkitek330202 02 Ukur Bahan330203 03 Ukur Tanah330204 04 Penilaian Harta330205 05 Hiasan Dalaman330206 06 Arkitek Lanskap330207 07 Perancang Bandar Dan Wilayah330208 08 Kajian Alam Sekitar
33020909 Ukur Bangunan (Institut JuruukurMalaysia)
330210 10 Pengurusan Nilai Fizikal
Document No. PNLD-3-FRM-8-VENDOR REGIST-V2
Revision No : Page 21 of 32
Title : VENDOR REGISTRATION FORM Effective Date : 19 December 2014
34 PERKHIDMATANPERUNDING BUKANFIZIKAL
34000001 SOSIO EKONOMI
340101 01 Kajian Organisasi
34010202 Kajian Penswastaan danPengkomersilan
340103 03 Kajian Ekonomi340104 04 Kajian Kemasyarakatan340105 05 Kajian Pemasaran dan Penyelidikan340106 06 Kajian Sumber Manusia340107 07 Kajian Pelancongan340108 08 Kajian Keselamatan340109 09 Pengurusan Nilai Bukan Fizikal340100
02 PENGANGKUTAN340201 01 Kajian Rangkaian Pengangkutan340202 02 Kajian Trafik340000
TELEPHONE NUMBER : ( ) ____________________________
FACSIMILE NUMBER : ( ) ____________________________
VENDOR INFORMATION ( I )
Document No. PNLD-3-FRM-8-VENDOR REGIST-V2
Revision No : Page 24 of 32
Title : VENDOR REGISTRATION FORM Effective Date : 19 December 2014
6. TYPE OF VENDOR :
( Please tick where appropriate )
*Company are required to submit a certified true copy of the Memorandum and Articles ofAssociation together with the Certificate of Incorporation. Partnership and Sole Proprietorare to submit a certified true copy of the Business Registration Form.
7. DATE OF INCORPORATION : _________________________________________________
8. DATE OF COMMENCEMENT OF BUSINESS OPERATION : ________________________
9. INCOME TAX FILE REFERENCE NOS. : __________________________________________
10. PLACE OF INCORPORATION : ________________________________________________
11. BUSINESS / COMPANY REG. NO : _____________________________________________
B. ORGANIZATION AND EMPLOYMENT STRUCTURE
1. PRINCIPAL OWNERS / SHAREHOLDERS(A certified true copy of Form 24 must be enclosed)
2. BOARD OF DIRECTORS(A certified true copy of Form 49 must be enclosed)
3. CURRENT EMPLOYMENT STRUCTURE(A copy of Organization Chart must be enclosed)
4. KEY PERSONNEL(A list of key personnel must be enclosed)
PUBLIC COMPANY
PRIVATE COMPANY
PARTNERSHIP
SOLE PROPRIETOR
OTHERS (to specify)
Document No. PNLD-3-FRM-8-VENDOR REGIST-V2
Revision No : Page 25 of 32
Title : VENDOR REGISTRATION FORM Effective Date : 19 December 2014
C. FINANCIAL INFORMATION
1. CAPITAL STRUCTURE (Please state the currency)
Note : For Sole Proprietor or Partnership, please specify your company’s capital paid-up.
1.1 AUTHORISED CAPITAL : _____________________________________
1.2 PAID UP CAPITAL : _____________________________________
1.4 WORKING CAPITAL : _____________________________________
1.5 FINANCIAL FACILITIES (LOAN/OVERDRAFT/BANK GUARANTEE)(Please specify the type, amount and source. A true certified copy of the financial facilities document must be attachedwith this completed form)
1.7 NAME, ADDRESS OF BANKERSAND THE ACCOUNT NOS. : _____________________________________
_____________________________________
_____________________________________
YEAR AMOUNT
1.8 NET PROFIT / (LOSS) LAST : _________ : _______________________
3 YEARS _________ : _______________________
_________ : _______________________
• Please attach the certified true copy of audited accounts for the last 3 years
2. ACCOUNT DETAILS
2.1 BANKER’S NAME / ADDRESS : _____________________________________
_____________________________________
_____________________________________
2.2 ACCOUNT NUMBER : _____________________________________
2.3 TYPE OF CREDIT FACILITY : _____________________________________
Document No. PNLD-3-FRM-8-VENDOR REGIST-V2
Revision No : Page 26 of 32
Title : VENDOR REGISTRATION FORM Effective Date : 19 December 2014
3. EQUITY CONTENT
Bumiputra Contents : %
Non-Bumiputra Contents : %
Foreign Contents : %
3.1 STATUS (PLEASE CIRCLE) : BUMIPUTERA/NON-BUMIPUTERA/FOREIGN
4. COMPANY’s DIRECTORS
Nos. Name of Directors Designation Period
1)
2)
3)
4)
5)
(Note : Please use additional papers if the above space is inadequate)
5. COMPANY’s PERSONNEL
Nos.
Category ofCompany’sPersonnel
Total Nos. ofCompany’sPersonnel
Nos. ofBumiputraPersonnel
Nos. ofNon-Bumiputra
PersonnelNos. of Foreign
Personnel
i) Management
ii) Professional/Technical
iii) Support
Total :
Please attach the list of your company’s key management personnel and include the followingdetails.
(a) their designation and qualification.(b) their length of employment service with your company.
Document No. PNLD-3-FRM-8-VENDOR REGIST-V2
Revision No : Page 27 of 32
Title : VENDOR REGISTRATION FORM Effective Date : 19 December 2014
6. COMPANY’s CURRENT WORKLOAD
Please specify the contracts/projects that are currently ongoing at your company using thefollowing format.
Nos. Client’s Name Contract Description ContractValue
% Completed CompletionDate
1)
2)
3)
4)
(Note : Please use additional papers if the above space is inadequate)
7. Has and will any litigation, suits or court action be taken against your company?
Please answer YES or NO :
If YES, please provide the details below._________________________________________________________________________________________
8. Who is authorized to sign the ACCEPTANCE OF ORDER/AWARD and/or CONTRACT on behalfof your company :
(1) Name :
Designation :
(2) Name :
Designation :
(3) Name :
Designation :
9. We require a true certified copies of your company’s latest audited financial statementsincluding the preceding two (2) years and bank statement for the last three (3) months to beattached with this completed form. The financial statement shall include the followingdetails :-
(a) Director’s and Auditor’s Reports.(b) Balance Sheet, Profit & Loss Account.(c) Note to Account.
10. We also require your company’s profile and other printed business and technical informationdetailing the general capabilities, services offered and any information which would be helpfulin the analysis of your company. Please attach those details as an attachment to thiscompleted form.
Document No. PNLD-3-FRM-8-VENDOR REGIST-V2
Revision No : Page 28 of 32
Title : VENDOR REGISTRATION FORM Effective Date : 19 December 2014
A. REGISTRATION WITH STATUTORY AUTHORITIES / BODIES
( Please attached certified true copy of the registration )