Vendor Empanelment Form
Vendor Empanelment Form
Vendor Empanelment Form
1. Name of Company:
2. Street Address: 3. P.O. Box and Mailing Address:
If you mark "Authorised Agent" or "Trader", please provide proof or certificate(s) from your
manufacturer that you are authorized to offer their products to the UNFCCC.
Section 2: Financial Information (Please attach a certified copy of recent balance sheet)
Address:
30. Please attach a listing of reference sources for services rendered by your entity within the last
12 months. Please also indicate fax numbers and contact person for your reference sources.
Name of company Address Phone # Fax #
1) ______________ __________________ _________________ __________________
Section 3: Other
32. Please list any current legal disputes in which your company may be involved.
33. List any national or International Trade or Professional Organisations of which your Company
is a Member.
34. Certification:
I, the undersigned, warrant that the information provided in this form is correct, and in the
event of changes details will be provided as soon as possible.
Signature: Date: