Form : PU-IMS-P-VPC-F-TR

Rev No: 1

VENDOR REGISTRATION FORM

INTRODUCTION

We welcome your interest in becoming part of the Penang Port Supplier Community.

To become a potential vendor, you are required to fill in the details about your esteemed company and
sign Penang Port’s Ethics.

In case of successful registration, you will receive a system generated Registration Number. This number
will be required for reference in all future communication.

Registration is only a preliminary process in doing business with Penang Port and as such, does not fully
guaranteed a business transaction with us. Penang Port will establish contact based on the requirements
of similar products, and per your company profile.

Standard Clause on Ethics

1. The BUSINESS ASSOCIATE (or Name of party signing the contract) agrees to conduct all of its dealings
with Penang Port, its management, employees, and other business associates in an ethical manner.

2. Penang Port, in its Ethics strictly prohibits its employees from demanding/accepting any payment
or illegal gratification in the form of bribes or kickbacks either monetary or in-kind in the course of
all their dealings with outside parties.

3. Penang Port also requires the BUSINESS ASSOCIATE, to refrain from giving or attempting to pay
illegal gratification/bribes/kickbacks to any employee of the company. Any attempts to provide such
personal gratification to any Penang Port employee will be viewed in a very serious manner and
where there is confirmation of such instances, it may lead to:
• Cessation of all business dealings with Penang Port.
• Blacklisted by Penang Port and its associates for any future business.
• Levy of a financial penalty.
• Reporting of matter to law enforcement agencies.
• Appropriate legal action, where necessary.

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 4. The BUSINESS ASSOCIATE will provide all possible assistance to investigate any possible instances
of unethical behaviour or Ethics violations by an employee of Penang Port or an employee of the
BUSINESS ASSOCIATE.

5. The BUSINESS ASSOCIATE will disclose forthwith any breach of the Penang Port Ethics that comes
to their knowledge.

6. All BUSINESS ASSOCIATES are expected to confirm their compliance towards Ethical dealings by
signing the declaration below to the effect that the business associate has complied with the
Penang Port Ethics in all their dealings with the Company.

I/We agree to the aforesaid Ethics Policy. I/We declare that the particulars given are correct and I/We
fully understand that no consideration will be given to our company if any of the particular is found
incorrect. I/We will be liable for de-registration without notice if:

• Any particulars found incorrect subsequent to our registration as your Approved Vendor.
• We are in breach of or in conflict with your company’s business principal.
• We are in breach of your ‘General Terms & Conditions of Purchase Order’ and/or of the specific
terms in the individual purchase orders.
• We fail to immediately notify your company of any change in the Shareholding and/or any major
changes in our service to you.

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I/We further declare that:

Please
No Description
Tick (√)
1 None of the Directors of the Company are related to any senior Position in Penang Port. ✔
2 Director and shareholders are not bankrupt for the past three years. ✔
None of the Directors / shareholders have any record in the Corruption Offenders
3
Database of MACC ✔
4 None of the company (ies) within MMC Group has called parental guarantee. ✔
5 We are not involved in any litigation cases with any company (ies) within MMC Group. ✔
6 None of the company (ies) within MMC Group has invoked/redeemed performance bond. ✔
We are not involved in any litigation cases which may impact financial standing going
7
forward. ✔
We are not being issued with a ‘show cause / warning / termination / suspension /
8 reprimand’ letter by any company (ies) within the MMC Group in relation to performance ✔
as of the vendor for the past 3 years.

Signature and company stamp

Name :
ROZAIRY BIN BASHARUDDIN

Designation : MANAGER

Contact Number : +6011 3309 7724

Date :
18/10/2024

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VENDOR SUPPLY CODE

Please refer to Vendor Supply Code.

SUPPLY CODE
* Please insert the Sub Code

1
E P P 8
2

PLEASE DESCRIBE BRIEFLY ABOUT YOUR PRODUCTS/SERVICES THAT YOUR COMPANY RENDERS TO PENANG PORT

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COMPANY PARTICULARS

Company Registered Name DQIS ENTERPRISE

Registered Address No.49, LORONG SERI INDAH 7,

TAMAN SERI INDAH, 13200 KEPALA BATAS.
Correspondence Address

New: Old:
Business Registration No.
PG-0241056
Date of Incorporation of the Company 02-04-2009
Office No.: Handphone No.:
Telephone Number
+6011 3309 7724
Contact Person
(Principal officer with whom PPSB will ROZAIRY BASHARUDDIN
make contact)

Email akabeowulf@gmail.com

Website none
TAX INFORMATION

TIN (Tax Identification Number)

SST No.: GST No.:
SST / GST REGISTRATION NUMBER

Malaysia Standard Industrial

Classification (MSIC) Code
*Please refer to IRBM E-Invoice Catalogue*

BANK PARTICULARS

Bank Name
Bank Account Number
Swift code
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CIDB AND /OR MOF REGISTERED CONTRACTOR
Registration with Statutory Bodies / Authorities.
Please attach the supporting document e.g registration certificate from Ministry of Finance / CIDB.

1. CIDB REGISTRATION

Registration No.

Registration Certificate Grade

Please tick
B : CE :
Category
ME : OTHER : ____________

2. MOF REGISTRATION

Registration Number

Expiry Date

TYPE OF BUSINESS PROFILE

Please tick

Public Company Partnership Others (Please specify)

Private Company Sole Proprietor __________________

ENTERPRISE

BUMIPUTERA STATUS

Status (please tick)

* Bumiputera Non-Bumiputera
✔

*Please attach copy of the registration certificate from Ministry of Finance.

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COMPANY DIRECTORS

Latest particulars of Proprietor/Partners/Directors/Shareholders as declared in the SSM.

Name Present Position Race % of Holding

LIST OF EXPERIENCE

Completion
Project Name Owner Contract Price
Date

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OCCUPATIONAL SAFETY, HEALTH & ENVIRONMENT (HSE)

Instruction: Please tick (/) your answer in the box.

1. Do your company have Safety Policy and Safety Procedures?

✔ Yes
No
*If yes, please provide the attachment
(Safety policy signed and approved by the company’s CEO and latest Organization Chart)

2. Do you have HSE Officer or Competent Personnel in your company?

Yes
✔ No
*If yes, please provide the attachment
(Attendance certificate, Pass Exam Result Certificate, Certification of Safety and Health Officer)

a. Required documents for Safety and Health Officer

• Certificate of Safety and Health Officer by Department of Occupational Safety and Health
• Appointment letter from the company
• Working experience (years of experience if available)
b. Required documents for Site Safety Supervisor
• Certificate of Site Safety Supervisor by Department of Occupational Safety and Health
• Appointment letter from the company
• Working experience (years of experience if available)

3. Are your company certified on HSE related certification? (e.g., ISO 45001). If yes, please attach
certificates
Yes
✔ No
*If yes, please attach certificates

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DOCUMENTS CHECKLIST

Corporate Information from Suruhanjaya Syarikat Malaysia (SSM e-info)

Form 9 / Section 17 (Notice of Registration)

Form 24 / Section 78 (Return of Allotment of Shares)

Form 49 / Section 58 (Particulars of the Directors, Secretary)
Memorandum and Articles of Association

Latest Bank Statement / Bank Details (past 3 months)

Audited Financial Statement (past 3 years)
Registration with Ministry of Finance (if any)

“Sijil Akuan Pendaftaran Syarikat Bumiputera” from Ministry of Finance (if any)

CIDB Registration

Custom’s SST Registration Confirmation Form

Company Profile

HSE related certification (if Any)

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 VENDOR SUPPLY CODE
SUB
MAIN CATEGORY CATEGORY TICK
CODE
001. Furniture and fixtures A 001
002. Stationary and reading material A 002
CODE: APP8 003. Photocopier, Printers Equipment A 003
004. General Electrical and Electronic Appliances A 004
ADMINISTRATIVE 005. Photography peripheral, visual aid and accessories A 005
AND OFFICE
006. Sports and Gym Equipment A 006
SUPPLIES
007. Gifts, Souvenirs, Calendar and Diaries A 007
000. Repair and Maintenance A 000
001. Fire Control Systems and Equipment B 001
002. CCTV B 002
003. X-Ray Equipment B 003
CODE: BPP8 004. Road Safety and Traffic Control Equipment B 004
005. Security Guards Service B 005
FIRE, SAFETY AND
006. Firearms, Ammunitions and Explosives B 006
SECURITY
007. Bullets / Explosives Proof Protection B 007
008. Safety Systems and Equipment (PPE) B 008
000. Repair and Maintenance B 000
CODE: CPP8 001. Telephone, PBX System Equipment and Components C 001
002. Radio and Wireless Telecommunication Equipment and
C 002
TELEPHONE AND Components
COMMUNICATION 003. Voice Telco Service Provider C 003
EQUIPMENT 000. Repair and Maintenance C 000
CODE: DPP8 001. Uniform, Shoes, Accessories and Tailoring D 001
002. Textiles Based Supplies (Other Than Uniforms) D 002
UNIFORMS,
TEXTILES AND 003. Leather Based Supplies D 003
LEATHERS 000. Repair and Maintenance D 000
CODE: EPP8 001. Pantry Supply (Wet/Dry/Tin/Bottled Groceries) E 001
002. Medicine and Other Medical Supply E 002
FOOD,
BEVERAGES AND 003. Catering Service E 003
MEDICINE 004. Medical Devices E 004
CODE: FPP8 001. Weight Equipment F 001
002. Measurement Equipment F 002
WEIGHTS /
003. Testing Equipment F 003
MEASUREMENT /
TESTING 004. Calibrations and Certification Service F 004
EQUIPMENT 000. Repair and Maintenance F 000
CODE: GPP8
001. General Worker G 001
MANPOWER
SUPPLY 002. Specialized / Professional Workers G 002
001. Motorcycle H 001
002. Passenger Vehicle Curb/ Kerb Weight 3 Tonne and Below H 002
CODE: HPP8 003. Passenger Vehicle Curb/ Kerb Weight Above 3 Tonne H 003
004. Tractor, Forklifts and Sweeper H 004
VEHICLES, HEAVY 005. Fire Truck and Other Fire Services Vehicle H 005
MACHINERY AND 006. Ground Services Equipment and Machinery H 006
COMPONENTS 007. Fuel, Lubricant and Other Petroleum Based Supply H 007
008. Spare parts H 008
000. Repair and Maintenance H 000

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 001. General Tools, Machinery and Spare Parts I 001
CODE: IPP8 002. Specialized Tools, Machinery and Spare Parts I 002
003. General Civil Construction Raw Material Supplies I 003
CIVIL 004. General Civil Construction Contractors I 004
ENGINEERING 005. Waterproofing Specialist I 005
MACHINERY, 006. Interior Designs / Decorations / Renovation I 006
TOOLS AND 007. Plumbing / Piping I 007
SUPPLIES 008. Jetty / Wharf / Yard I 008
000. Repair and Maintenance I 000
CODE: JPP8 001. General Tools, Machinery and Spare Parts J 001
002. Specialized Tools, Machinery, Fabrication and Spare Parts J 002
MECHANICAL, 003. Conveyor Belting System and Components J 003
ENGINEERING
004. Passenger Loading Bridge System and Components J 004
MACHINERY,
TOOLS AND 005. Retrofitting works J 005
SUPPLIES 000. Repair and Maintenance J 000
001. Motor, Transformer and Power Generator and Spare Parts K 001
002. Power Sub-Station, Components and Spare Parts K 002
CODE: KPP8 003. Power/Electrical Cables and Supplies (Low Voltage) K 003
004. Power/Electrical Cables and Supplies (High Voltage) K 004
ELECTRICAL 005. General Lights and Fittings and Electronics Components K 005
ENGINEERING 006. Aircraft Ground Lighting System and Components K 006
MACHINERY, 007. Air Conditioning Equipment and Components K 007
TOOLS AND 008. Lift and Escalators K 008
SUPPLIES 009. Public Announcement System and Components K 009
010. Sensor and Instruments K 010
000. Repair and Maintenance K 000
CODE: LPP8 001. Personal Computer and Related Peripheral L 001
002. Server and Related Peripheral L 002
COMPUTER / 003. Application Software Product L 003
SERVER 004. Networking Products L 004
EQUIPMENT AND 005. Computer Security Products L 005
ACCESSORIES 000. Repair and Maintenance L 000
001. Transportation M 001
002. Heavy Machinery / Vehicle M 002
003. Events / Stage / Exhibition Organizer M 003
004. Videography and Photography M 004
005. Car Park M 005
006. P.A System / Sound & Lights / Musical Instruments M 006
CODE: MPP8 007. Training / Coaching / Courses M 007
008. Pest Control / Flies / Termite M 008
RENTAL / 009. Scaffolding M 009
MANAGEMENT / 010. Land Surveyor / Topography M 010
SERVICES 011. Branding and Communication M 011
012. Audit / Accounting / Secretarial / Tax / Certification /
M 012
Accreditation
013. Insurance M 013
014. Advertising M 014
015. Haulage M 015
016. Land Valuer M 016

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 001. Building Cleaning (Interior and Exterior) N 001
002. General Cleaning (Interior) N 002
CODE: NPP8 003. Portable Toilet N 003
004. Cleaning Equipment and Supplies N 004
CLEANING 005. Sewerage Plant and Installation Treatments and Inspection N 005
SERVICES AND
006. Vehicle and Heavy Machinery Washing and Cleaning N 006
SUPPLIES
007. # Cleaning of Spillage of Dangerous Goods N 007
008. Special Purpose Cleaning Chemical Services and Supplies N 010
001. Rubber Tyre Gantry O 001
002. Quay Crane O 002
003. Transfer Crane O 003
004. Charlie Crane O 004
CODE: OPP8 005. Bulk Handling Crane O 005
006. Mobile Crane O 006
PORT CRANE & 007. Crawler Crane O 007
EQUIPMENT 008. Quay Transfer O 008
009. Level Luffing O 009
010. Container Reach Stacker O 010
011. Spare parts O 011
012. Repair and Maintenance O 012
CODE: PPP8 001. Landscaping (Hardscape / Softscape and Water Features) P 001
002. Interior Decoration P 002
AREA 003. Grass cutting P 003
BEAUTIFICATION 004. Repair and Maintenance P 004
001. Corporate Books, Diary and Calendar Q 001
CODE: QPP8 002. Name cards, Labels, Stickers and Rubber Stamps Q 002
003. Brochures, Posters, Buntings and Banners Q 003
PRINTING 004. Forms and Receipts Q 004
005. Controlled Item Printing Supplies (Safety Pass) Q 005
001. # Domestic and Industrial Waste R 001
002. Electrical, Electronic and ICT R 002
CODE: RPP8 003. Construction Waste R 003
004. Vehicle, Machinery and Equipment R 004
DISPOSAL
005. Hazardous / Toxic Waste R 005
SERVICES
006. RORO R 006
007. # Ship’s Debris R 007
CODE: SPP8 001. Wrapping and Packaging Materials S 001
002. Carton Box, Plastic Containers S 002
HANDLING,
STORAGE AND 003. Storage Racking System S 003
SUPPLIES 004. Pallets S 004
CODE: TPP8 001. Energy Saving Lighting Technology T 001
002. Alternative / Renewable Energy T 002
GREEN 003. Office System and Equipment T 003
TECHNOLOGIES 004. Consultancy Services T 004

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 001. # Bunkering U 001
002. # Fresh Water Supply U 002
003. Marine & Diving U 003
004. Marine & Tug Boat Supply U 004
005. Marine Equipment & Items U 005
006. Pilot Boat services U 006
007. # Mooring services U 007
008. Towage services U 008
CODE: UPP8 009. Marine Surveyor U 009
010. # Ship Supply and Repair & Maintenance U 010
MARINE SERVICES 011. Marine Services U 011
012. Shipping Services U 012
013. Marine Engineering Services U 013
014. Fenders U 014
015. Intelligent Pigging U 015
016. Marine/Offshore Instrumentation and Automation U 016
017. Gas Monitoring System/Gas Detector U 017
018. Bunkering U 018
019. Marine & Diving U 019
001. Civil consultant V 001
002. Environmental consultant V 002
003. HSE consultant V 003
CODE: VPP8 004. Geotechnical consultant V 004
005. IT consultant V 005
CONSULTANT
006. Marine consultant V 006
SERVICES
007. M&E consultant V 007
008. Town Planning Consultant V 008
009. Investment Consultant V 009
001. # Stevedoring W 001
002. Bulk Handling W 002
003. Ship Trimming W 003
004. # Stuffing & Unstuffing W 004
CODE: WPP8 005. # Lashing & Unlashing W 005
006. Offshore Inspection W 006
PORT SERVICES 007. Gearbox / Transmission W 007
008. # Ship Chandling W 008
009. # Tally Clerk W 009
010. # Cargo Survey W 010
011. # Diving W 011

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