Vendor Accreditation Form - 071318 Revised PDF

1
CENTRAL PROCUREMENT DEPARTMENT

VENDOR ACCREDITATION FORM CHECKLIST
Date: ___________________
GENERAL INFORMATION
Registered Name of the Company
Office Mailing Address
Office Telephone Numbers Office Fax Numbers
Name of the Owner/Proprietor Telephone Number
Email Address
Authorized Company Representative/s Website
Designation/Position Email Address
BUSINESS ORGANIZATION
Type of Business Organization Type of Business Operation
Single Proprietorship Cooperative Manufacturing Exclisve Distributor
Partnership Corporation General Trainig of Merchandizing Service Company
Others, please specify Others, please specify
DESCRIPTION OF THE PRODUCTS OR SERVICES OFFERED (Attach separate sheet for list of products/services offered if necessary )
Complied Pending Reference No. Date Issued Remarks

BUSINESS PERMITS write "NA" if not applicable
Securities and Exchange Commission (SEC)
Department of Trade and Industry (DTI)
Cooperative Development Authority (CDA)
Mayor’s Permit
BIR Business Registration (2303)
Authority to Print OR from BIR
Philippine Contractor's Accreditation
Board (if any)
Complied Pending Reference No. Date Issued Remarks
OTHER REQUIRED DOCUMENTS (if applicable)
Latest Income Tax Return
Financial Statement (2 years)
Vehicle Certificate of Registration
Vehicle Official Receipt of Registration
Copy of Comprehensive Insurance Policy
BLOWFATCH Inspection Certificate
Vehicle Certificate of Road worthiness
Certificate of Appointment as Exclusive
Distributor or Dealership from Principal
(either local or foreign) for each brand of
specific product line being carried.
Copy of any Agreement or Technical

Service Support & Assistance.
Certificate of Safety Data Sheet (product
applicable)
Certificate of Safety Inspection by the
Chief,Fire Dept./Unit of the City (for Fire
Extinguisher)
REFERENCES
List of at least three (3) of the company's major clients
Name of Client/Project Contact Person Contact Numbers
1
2
3
List of at least three (3) of the company's major suppliers
Name of Supplier Contact Person Contact Numbers
1
2
3
List of at least two (2) of the company's bank reference

Name of Bank Contact Person Contact Numbers
1
2
Vendor Accreditaiton Form_071917
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CENTRAL PROCUREMENT DEPARTMENT

VENDOR ACCREDITATION ON SUSTAINABILITY
Date: ___________________
QUALITY & ENVIRONMENTAL MANAGEMENT
Do you have a documented Quality Management System (QMS)? Yes No

If Yes please submit a copy of the certificate.
If No, do you operate your own internal QMS ? Yes No

If Yes, please supply a copy of your in-house quality procedures/systems.
Do you have a documented Environmental Management ? Yes No

If Yes submit a copy of your environmental policy, sustainable procurement policy.
Do you have a policy on Hazardous Waste Disposal? Yes No

If Yes submit a copy of your Hazardous Waste Disposal policy.
Do you have a policy on Non-Hazardous Waste Disposal? Yes No

If Yes submit a copy of your Non-Hazardous Waste Disposal policy.
HEALTH AND SAFETY
Do you employ a H&S adviser, consultant ? Yes Yes No

If yes please submit the name, qualifications and experience of the persons.
Do you have a H&S policy manual? Yes No

If yes please supply a signed and dated copy of the H&S policy statement.
The undersigned hereby certify that the foregoing information is true and correct. I hereby autorize De La Salle Lipa (DLSL) to obtain
pertinent information from my clients, suppliers, banks and any other source in relation fo our application for accreditation. I also declare
that the owners and mangers of our company are not employee of DLSL or related to any employee of DLSL up to third degree of
consanguinity and affinity.
I hereby authorize DE LA SALLE LIPA, INC. to obtain pertinent information from clients, banks and any other source necessary for the
objective of evaluation for this application. The undersigned also authorizes the release of any information as needed by DE LA SALLE
LIPA, INC. from any of the above listed source of information.
Signature over printed name Designation
REMINDERS:
1) The application should be completed by all vendors/contractors seeking accreditation. This however does not guarantee business
with DLSL.
2) All the required supporting documentation must be submitted together with the Accreditation Form.
3) DLSL reserves the right to reject any incomplete Application Form accompanied by insufficient information.
4) DLSL reserves the right to accept or reject any application without being obliged to give any reasons in this respect.
5) All vendor/ contractor information will be treated with strict confidentiality.
6) The completion of Vendor Accreditation Form is compulsory. Failure to complete this section will result in your application not being
considered.
7) DLSL reserves the right to validate the accuracy of information presented. Any misinterpretation of facts will lead to disqualification
and potentially being restricted to do business with other spheres of government and/or other organs of state.
8) Faxed and email documents will not accepted.
RECEIVED BY: APPROVALS:
/ /
Signature over Printed Name/Date Signature over Printed Name/Date
Vendor Accreditaiton Form_071917

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1

CENTRAL PROCUREMENT DEPARTMENT

Complied Pending Reference No. Date Issued Remarks

Copy of any Agreement or Technical

List of at least two (2) of the company's bank reference

CENTRAL PROCUREMENT DEPARTMENT

Do you have a documented Quality Management System (QMS)? Yes No

If No, do you operate your own internal QMS ? Yes No

Do you have a documented Environmental Management ? Yes No

Do you have a policy on Hazardous Waste Disposal? Yes No

Do you have a policy on Non-Hazardous Waste Disposal? Yes No

HEALTH AND SAFETY

Do you employ a H&S adviser, consultant ? Yes Yes No

Do you have a H&S policy manual? Yes No

Signature over printed name Designation

RECEIVED BY: APPROVALS:

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