UNHCR VENDOR REGISTRATION FORM

(Please refer to the ADDITIONAL INFORMATION FOR COMPLETION on page 4.)

Section 1: Company Details and General Information

1. Company name (full legal name):

2. Street Address: 3. P.O. Box and Mailing Address:

Postal Code: City:

Country:

4. Tel: 5. Fax:

6. Email: 7. Company Website:

8. Contact Name and Job Title:

9. Email:

10. Parent Company (Full legal / officially registered company name):

11. Names of owner(s) and principals – Subsidiaries / Affiliates / CEO / Managing Director / Managing Member and those with controlling interests if
applicable (attach a List if necessary):

12. International Offices/Representation (Countries where the Company has local Offices/Representation):

13. Type of Business (Mark one only):

Corporate/ Limited: Partnership: Other (specify):

14. Nature of Business:

Manufacturer: Authorised Agent: Trader: Consulting Company: Other (specify):

15. Year Established1: 16. Number of Full-time Employees:

17. Licence no./State where registered and validity date: 18. VAT No./Tax I.D:

Section 2: Banking Information – OPTIONAL – to be provided only if payment from UNHCR is expected

19. Bank Name (and Bank ID if any): 20. Branch Name (and Branch Code if any):

21. Branch Address: 22. Tel. number:

23. Fax number:

24. Bank Account Number: 25. Account Name2:

26. Account currency3: 27. Swift/Bank Identifier Code (BIC):

28. International Bank Account Number (IBAN):

29. Routing Bank details (if applicable): full details to be provided as per above

1 3 years of operation is a minimum.

2 The Account name is the Name that the Bank uses for the Company. It should be the same as the Company Name as stated in section 1 above. A copy of a Bank Statement matching Vendor Name
and Address should be provided.
3 If multiple bank accounts exist that may be relevant to UNHCR (e.g. in different currencies), please provide full details for each account. A separate proof for each Account should be provided.

Payments will only be made to accounts included here. Only one Bank Account per currency can be accepted.

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Section 3: Technical Capability and Information on Goods / Services Offered
30. For Goods only, do those offered for supply conform to National/International Quality Standards?

Yes No

31. List below up to a maximum of ten (10) of your core Goods/Services offered:

Description (one Line for each Item) National/International Quality Standard to which Item conforms

Section 4: Experience

32. Recent Contracts with the UN and/or other International Aid Organizations:

Organization: Value: Year: Goods/Services Supplied: Destination:

USD ________________________ _

USD ________________________

USD ________________________

USD ________________________

33. Do you have outstanding bankruptcy, judgment or pending legal action that could impair operating as a going concern? Yes No

If available, please provide Credit Rating by Dun and Bradstreet or equivalent:

34. Please list any Disputes and Bankruptcy your Company has been involved in with UN Organizations over the last 3 Years:

Section 5: UN Global Compact Initiative

35. Is your company aware of the UN Secretary General’s Global Compact initiative, which can be viewed at http://www.unglobalcompact.org?

Yes No

If yes, have you signed up to this initiative or are you going to sign up to? Please state:

Section 6: Environment
36. Does your Company have a written Statement of its Environmental Policy? (If yes, please attach a Copy)

Yes No

37. Does your organisation hold any accreditation such as ISO 14001 related to the environment?

Yes No If yes, please attach a copy.

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Section 7: UN Supplier Code of Conduct

38. Vendor who wish to do business with UNHCR are required to comply with the UN Supplier Code of Conduct. Please download and read the UN
Supplier Code of Conduct.

I accept the UN Supplier Code of Conduct.

Section 8: Official not to benefit

39. By signing this VRF, potential vendors confirm that they have read, understood and will comply with the UNHCR policy on the “zero tolerance” that
strictly prohibits the acceptance of any type of gift and/or hospitality by UN staff members participating in the procurement process. Please confirm.

Yes No Any breach of this clause may lead to the termination of all contracts your Company may have with
UNHCR and removal from the approved vendor database.

Section 9: Others

40. Is your company already registered with the United Nations Global Marketplace (UNGM)? If so, please provide registration number.

41. Certification:
I, the undersigned, hereby accept the UNHCR General Conditions, a copy of which has been provided to me, and warrant that the information
provided in this form is correct and, in the event of changes, details will be provided as soon as possible:

42. Self-Declaration: I, the undersigned, declare that:

(a) Our company is not involved in any fraudulent or corrupt activities and has not been in the past, and is not currently under any investigation for
any such activities which would render our company unsuitable for business dealing with UNHCR.

(b) Our company is not on, or associated with a company or individual, groups, undertakings and entities that are on the consolidated list
established and maintained by the committee established by the UN Resolution No. 1267 (www.un.org/sc/committees/1267/consolist.html).

(c) Our company is not on, or associated with a company or individual that are subject to the list of Independent Inquiry Committee into United
Nations Oil-for-food programme (www.iic-offp.org).

(d) Our company is not currently removed, invalidated or suspended by any other UN Headquarters, or Field Offices or any other UN Agencies
(including the World Bank)

Name: Functional Title:

Stamp and Signature: Date:

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ADDITIONAL INFORMATION FOR COMPLETION
The form should be typewritten in uppercase and completed clearly and accurately ensuring that all questions are answered. The numbers below
correspond to item numbers on the registration form:

Section 1:

11. Please provide, on a separate sheet if necessary, names and addresses of all subsidiaries & associates if any.

12. Please provide countries where the company has local offices or representation.

15. Year Established: 3 years of operation is a minimum.

17. Provide the license number under which the company is registered, or the State where it is registered and copy of certificate of registration or
incorporation.

Section 2:

25. Name under which the bank account is held (important: this should be the company name). Following UNHCR payment policies, any decisions to
permit third party payment are at the sole discretion of UNHCR and are subject to detailed scrutiny and special approval. Any proposed different
names on the bank account should be clearly explained and fully justified. A copy of a Bank Statement matching Vendor Name and Address
should be provided.

26. If multiple bank accounts exist that may be relevant to UNHCR (e.g. in different currencies), please provide full details for each account. A separate
proof for each Account should be provided. Payments will only be made to accounts included here. Only one Bank Account per currency can be
accepted.

27. Bank Identifier is transit number for US and Canada and Swift code for Europe and the rest of the world.

28. International Bank Account Number (IBAN).

29. Should a routing be required for international payments, please provide full details of intermediate bank(s).

Section 3:

30. Indicate whether the company's products conform to national/international standards. If yes please attach copies of the certificates.

Section 4:

32. Enter the name(s) of UN organizations which your company has dealt with recently. Provide the value and the year of the contract, the
goods/services supplied and the country of destination of each contract.

Section 5:

35. Please confirm if your company is aware of the UN Global Compact Initiatives – ten universally accepted principles of Human Rights, Labour,
Environment and Anti-Corruption – by marking Yes or No. Also, please state if you have signed up to this initiative or you intend to do so.

Section 6:

36. The Earth Summit, held in Rio de Janeiro in 1992, emphasised the necessity to protect and renew the earth's limited resources. Agenda 21 was
adopted by 178 governments and lays an emphasis for the UN to exercise leadership, i.e. towards promoting environmental sensitive procurement
policies for goods and services. Please indicate whether your company has a written statement of its Environmental Policy and, if so, please
provide a copy.

Section 8:

39. Official benefits: UNHCR adopted “zero tolerance” policy that strictly prohibits the acceptance of any type of gift and/or hospitality by UN staff
members participating in the procurement process. Please confirm your acceptance by answering Yes or No if otherwise.

Section 9:

41. Please read carefully the enclosed UNHCR General Term and Conditions, as signing of the form signifies acceptance. The form should be
stamped and signed by the person completing it and their name and title should be typed, along with the date.