YOUNG WOMEN CHRISTIAN ASSOCIATION
PRE-QUALIFICATION OF SUPPLIERS FOR GOODS AND SERVICES
FOR FINANCIAL YEAR 2024-2026
June, 2024
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PREQUALIFICATION OF SUPPLIERS APPLICATION FORM
1. We ……………………………………..…………………. hereby apply for pre-qualification as supplier(s)
(Full legal name of the company / firm)
of ………………………………………………………………………………………………………………………………………………
(Item/Service description)
Nature of business: Trade Authorised agent Company
Other (specify)………………………………………………………………………………………………………………………
Type of business: Company Partnership Sole proprietorship
Other (specify)………………………………………………………………………………………………………………………
Plot number and street …………………………………………………………………………………………………………
Name of building …………………………………………………………………………………………………………………..
Room / Office no ……………………………………………………………………………………………………………...….
Floor No……………………………………………………………………………………………….………………………………..
Telephone No.………………………………………………………Mobile……………………………….…………..………
Contact name ………...…...…………………………………………………………………………………….…………………
Title ………………………………………………………………………………………………………………………….……………
Other branch locations…………………………………………….………………………………………………..………….
Email address………………………………………………….………… Website address……………………………
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2. Management personnel
Chief Executive Officer (CEO)…………..……………………………………………………………………………...……
Directors………………………………………………………….……………………………………………………………………
General Manager …………………………………………..……………………….……………………………………………
Partnership (if applicable) ……………………………………………………………………………………………………
Name of partners (List):
3. Date incorporated ………………………………………………………………….…….
4. Under present management since……………………………………………………
5. State any technological innovations or specific attributes which distinguish you from other
competitors………………………………………………………….……………………………………………………………………
……………………………………………………………………………………………………………………………………………….…
6. Indicate terms of trade/sale………………………………………………………………………………………………….
(Cod,credit,cash)
7. Is the company duly registered with ZRA?
Yes No N/A
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8. Experience/referees – at least 3 most recent organisations / companies that your company has
done business with.
Organisation/company Contact details Value in ZMW YEAR Goods/service supplied
9. Bank details:
For payments by electronic funds transfer (bank wire transfer), please provide the following
information:
a) Only Kwacha accounts
………………………………………………………………………………………………………………...
Bank name
……………………………………………………………………………………………………...…………
Bank address
…………………………………………………………………………………………………..…………….
Branch name
…………………………………………………………………………………………………..…………….
Branch code
…………………………………………………………………………………………………..…………….
Account name
Account number …………………………………………………………………………………………………..…………….
b) Tax information:
TIN Number……………………………………………………………………………….......................................
Tax type registration (VAT/Turnover tax) ………………………………………………………………………
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Prequalification documents
1. Sealed application indicating category being applied for.
Yes No
2. Company profile
Yes No N/A
3. Certificate of incorporation or registration
Yes No
4. ZRA tax clearance certificate
Yes No
5. Copy of current trade license (if applicable)
Yes No N/A
6. Membership to professional body for professional services, if any
Yes No N/A
7. For IT services, suppliers should show proof of being accredited as either support centre or
solution providers for companies such as Microsoft, HP, Dell, Cisco, APC etc.
Yes No N/A
8. Applicants fee of ZMW 300 in cash.
Yes No
Applicants should only apply in their areas of expertise. An application form must be completed for
each category of products or services and the category must be indicated on the sealed EOI
envelop. If a company is submitting for more than one category, the company must submit
separate applications for each category with proof of capacity for each category
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10. Certification
I, the undersigned, warrant that the information provided in this application form is correct and,
in the event of changes, details will be provided as soon as possible. Further, we confirm that we
have enclose all the required documents and information required for the prequalification
evaluation.
Name: ………………………………………………………………… Functional title: ………………………………………
Signature: …………………………………………………………… Date: ………………………….………………………….
Please note that providing false information on this form shall lead to disqualification.
