Supplier Registration Information Form

Version 6 – Mar 2018

Guidelines to complete the Form

This is a single standardized form applicable to all suppliers of Occidental Oil and Gas Corporation
or its Affiliates ("Oxy") that are invited to be registered in Oxy's system.
1. Complete all sections of the Supplier Registration Information Form and have a duly authorized
officer of your Company sign. In addition, submit the support documents listed in the table below as
applicable.
2. Oxy personnel will review and validate the information. Additional information and documentation
may be requested to support the registration.
3. If applicable, Oxy personnel will include the information in Oxy's system.
4. If the Supplier has access to the iSupplier Portal, changes will be visible on the Portal.

Country Mandatory Support Documentation applicable to Country-based Suppliers

* Registration at the Ministry of Commerce
* Registration at the Chamber of Commerce
Oman
* Registration at the Ministry of Commerce - Computer Paper
* Registration at the Omani Tax Authority provided with their tax number
Qatar *Commercial registration at the Ministry of Economy and Commerce in Arabic and in English
translation.
*Commercial License from Ministry of Municipal Affairs & Agriculture *Registration in
Chamber of Commerce
*Tax Registration and Tax Card from Director of Public revenue & Taxes Department.
* Commercial License
United Arab * Registration at the Chamber of Commerce and Industry
Emirates * VAT Registration Certification
United States of * W-9 (must include all names doing business under – DBA)
* Zero Dollar Invoice (sample invoice)
America
Colombia *Copy of Tax number identification - RUT
*Original Bank certification including the Tax Id number
*If you are beneficiary of any tax incentive, the legal documentation that s upports it (i.e. tax
exemption due to law of small business, hotel services, etc.)
Additional, only for Legal Entities:
*Certificate from the Chamber of Commerce (issued les s than two months before).
*Copy of valid Tax Authority resolution issued to act as Large tax payer, or Self -withholder
for income tax or VAT.
*If it is a non-profit organization, copy of the resolution issued by the applicable Authority.
Additional, only for “Persona Natural“.
*If you are a sole trader, Form “Decreto 1070 de 2012” filled in.
Bolivia **Registration at Registro de Comercio (FUNDEMPRESA) or License
*Certificate of Incorporation or Power of Attorney registered at Fundempresa (Alternatively,
Commercial Background)
*Registration at the National Tax Service (Copy of Número de Identificación Tributaria,NIT)
*Registration at health insurance
*Certificate of registration at the pension fund administration (AFPs)
*Copy of registration at the Ministry of Labor (ROE)
*Municipal License
Others *Applicable equivalent documentation to the Country of the Origin

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 Supplier Registration Information Form
Version 6 – Mar 2018

Contact Person to verify the form information

Full Name Teodora Gorski

Job Title Managing Director MENA

Phone Number +971 55 787 6427

Email Address teo.gorski@kpiinstitute.com

TAX INFORMATION

Legal Entity Name Connected Performance Training Institute

Taxpayer ID (*) VAT (TRN) 100389623800003

Legal Structure

(*) Omani Suppliers: Commercial Registration Number

Colombia based Suppliers

Taxpayer ID Type

Taxpayer ID Validation Digit

Main Business Activity

(RUT)

CIIU Code - Arauquita

CIIU Code - Arauca

CIIU Code - Barrancabermeja

VAT Común No Responsable Simplificado

Resolution
Large Taxpayer YES NO
and date:
Resolution
Tax Withholder - Income YES NO
and date:
Resolution
Tax Withholder - VAT YES NO
and date:
Resolution
Non-Profit Organization YES NO
and date:

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 Supplier Registration Information Form
Version 6 – Mar 2018

CONFIDENTIALITY AND RELEASE AGREEMENT

In consideration for Occidental Oil and Gas Corporation and its Affiliates (“Oxy”) allowing the
undersigned (referred to as the “Supplier”) to access the Oxy iSupplier Portal, the Supplier agrees
to execute this Confidentiality and Release Agreement (referred to as this “Agreement”).

If the Supplier has executed a contract with Oxy containing a confidentiality provision, then the
Confidential Information (as defined below) shall be covered by that confidentiality provision. If
the Supplier has not executed a contract that will protect the Confidential Information, then this
paragraph will protect the Confidential Information. The Supplier on behalf of itself, its Affiliates
and each of their employees hereby agrees and undertakes that it will keep any and all information
and data (whether written or verbal and regardless of form or medium), e-mails, correspondence,
discussions, communications, negotiations, clarifications, well logs, intellectual property, reports,
scopes of work, surveys, images, documents, instruments, contract drafts, tenders or tender
updates, received from or on behalf of Oxy (collectively, the "Confidential Information")
confidential, except to the extent disclosure is: (a) required by a regulatory or judicial authority
having proper jurisdiction over the Supplier, provided that the parties are first notified of such
disclosure before the Confidential Information is disclosed, (b) to any employee, Affiliate, Affiliate's
employee, counsel who has a legitimate commercial need to know such Confidential Information,
and so long as such persons or entities are bound by a written confidentiality undertaking
substantially similar in all material respects to this one, or (c) made after such information becomes
publicly available other than as a result of a breach of this Agreement. The term Confidential
Information shall also be deemed to include all information or data (regardless of form or medium)
developed or produced by the Supplier that is based on the Confidential Information. The
Confidential Information (and all copies thereof) shall remain the property of Oxy, and the Supplier
agrees, upon receipt of request, to promptly destroy or return to Oxy all Confidential Information
(including all copies thereof); provided, that the Supplier may retain an archived copy of any Portal
work product and correspondence subject to the obligations set forth in this Agreement. For
purposes of this Agreement, "Affiliate" means, with respect to any party, any legal entity that
directly or indirectly controls, is controlled by or is under common control with such party, with
"control" meaning the ownership, directly or indirectly, of more than 50% of the voting shares or
voting rights of such legal entity.

The Supplier acknowledges and agrees that Oxy and its Affiliates and each of their employees,
agents, contractors or representatives shall have absolutely no responsibility or liability
whatsoever to the Supplier or its Affiliates or its or their respective employees, agents, contractors
or representatives (collectively the "Supplier Group") in connection with the Portal or any
negotiations, bid tenders, or offers, including, without limitation, liabilities relating to (i) the failure
of the Supplier to open e-mail attachments or receive Portal updates or other Portal-related
documents; (ii) any decision or action taken in connection with the Portal, whether by Oxy, the
Supplier Group or any third party, and (iii) any decision or action taken in connection with any
tender, bid, or negotiations whether by Oxy, the Supplier Group or any third party . The Supplier,
on behalf of itself and the Supplier Group, hereby releases and agrees to hold harmless Oxy and
its Affiliates from any and all claims or causes of action that the Supplier Group may have, now or
in the future, with respect of the Portal.

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 Supplier Registration Information Form
Version 6 – Mar 2018

Assignment of the Supplier's "iSupplier portal" Security Administrator

Supplier designates the following "iSupplier portal" Security Administrator and alternate.
Supplier Security administrator Alternate

Country United Arab Emirates Romania

First Name Teodora Andreea

Last Name Gorski Suciu

Job Title Managing Director MENA Logistics Specialist

Phone +971 55 787 6427 +40746734506

Number

Email teo.gorski@kpiinstitute.com andreea.suciu@kpiinstitute.com

Address

The "iSupplier portal" Security Administrator will be the person responsible for managing other
Supplier's Users access and responsibilities in the Portal; and maintain accurate accesses and up-
to-date information. The Supplier shall assign a responsible alternate person for co-administration.
"iSupplier Portal" is a user-friendly website that does not require special skills. Oxy suggests that
your company assigns an Oxy Account Manager or Responsible person as one of the iSupplier
Security Administrators within the form. Supplier agrees to immediately execute or communicate to
Oxy any modification of these assignments by completing and submitting the Supplier Registration
Information Modification form at http://isuppliersupport.oxy.com

Assignment of the Supplier's "iSupplier portal" delegate responsible for entering

Invoices

Supplier designates the following "iSupplier portal" Invoice entry responsible and alternate.
Invoice Entry Primary Alternate

Country United Arab Emirates

First Name Teodora

Last Name Gorski

Job Title Managing Director MENA

Phone Number +971 55 787 6427

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 Supplier Registration Information Form
Version 6 – Mar 2018

Email Address teo.gorski@kpiinstitute.com

Oxy will grant the "iSupplier Portal" Security Administrator/Invoice Entry Delegator and an
Alternate access to the "iSupplier portal".

When an iSupplier Portal Supplier Security Administrator/Invoice Entry Responsable and/or

Alternate are registered in the iSupplier Portal by Oxy, an automatic email is sent to the user with
the user account name and a temporary password. Log into the iSupplier Portal within 14
days of receiving your credentials. If you do not log in within 14 days, your account will be locked.
Use the Login Assistance Hyperlink in the iSupplier Portal Login Screen to reset the password.

If you have additional people who will be entering invoices, your iSupplier Portal Supplier
Security Administrator will be able to set them up as needed and provide them with invoice entry
access by giving them the iSupplier User – e-Invoicing responsibility. If, in the future, the people
named above are no longer entering invoices, your Supplier Security Administrator will be able
to deactivate them as needed.

IMPORTANT: After the assigned iSupplier Portal Security Administrators log in to the
iSupplier Portal, they have to add any Oxy-related key contact as iSupplier Portal user. An
iSupplier User is any person who participates in commercial processes such as request for
information or quotation, purchasing or contracting, contractual documentation submission, invoicing
or payments, etc.. For instructions, please call Supplier Help Desk 800 699 7680 - Option 2 for Supply
Chain.

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 Supplier Registration Information Form
Version 6 – Mar 2018

Purchasing Entity and Addresses

Supplier designates the following Purchasing Addresses to receive Sourcing and Purchasing
Documents (Contracts, Purchase Orders, etc.). If your company needs to designate additional
addresses, please complete and submit as many forms as necessary.

Legal Entity Name for

Purchasing Documents (*)
Connected Performance Training Institute

Taxpayer ID VAT (TRN) 100389623800003

Purchasing Address(**) Regalia Business Center, 1st floor, Office 101, Suite 11,
City Dubai
State
Country United Arab Emirates
Postal Code/Zip Code PO Box 213297
Contact Teodora Gorski
Phone +971 55 787 6427
Fax
Email (***) teo.gorski@kpiinstitute.com

Legal Entity Name for

Purchasing Documents (*)
Connected Performance Training Institute

Taxpayer ID VAT (TRN) 100389623800003

Purchasing Address (**) Regalia Business Center, 1st floor, Office 101, Suite 11,
City Dubai
State
Country United Arab Emirates
Postal Code/Zip Code PO Box 213297
Contact Teodora Gorski
Phone +971 55 787 6427
Fax
Email (***) teo.gorski@kpiinstitute.com

Note:
(*) Supplier Name to be indicated as a party to the agreement. W-9 registered Legal Entity Name in USA or equivalent
outside USA.
(**) Purchasing Address: Address where your company will receive sourcing and/or purchasing documents.
(***) Email address: Required. Oxy will electronically communicate applicable transactions.

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 Supplier Registration Information Form
Version 6 – Mar 2018

Invoicing Company Name and Addresses

Supplier designates the following Invoicing Company Name and Payment Addresses to remit
payments to. If your company needs to designate additional addresses, please complete and
submit as many forms as necessary.

Same as Purchasing
YES (Skip this section) NO (Provide information below)
Address
Remit-to Company Name
(*)
Taxpayer ID
Payment Address (**)
City
State
Country
Postal Code/Zip Code
Contact
Phone
Fax
Email (***)

Remit-to Company Name

(*)
Taxpayer ID
Payment Address (**)
City
State
Country
Postal Code/Zip Code
Contact
Phone
Fax
Email (***)

Note:
(*) Remit to Supplier Name stated in Invoices. Legal Entity Name (Preferable) or W-9 registered DBA Name in USA or
equivalent outside USA.
IMPORTANT: if invoicing company is different from the legal entity name, attach the support documentation to
demonstrate the relationship with the legal entity.
United States based Supplier: In addition, attach signed W-9 Tax ID form and Zero Dollar Invoice (sample invoice)
Non United States based Supplier: In addition, attach the applicable documentation.
(**) Payment (Remit-to) Address: Required. In addition, provide banking information in the next section for electronic
payments. Oxy's preferred method of payment is electronic.
(***) Email address: Required. Oxy will electronically communicate applicable transactions.

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 Supplier Registration Information Form
Version 6 – Mar 2018

Invoicing Company Banking information for electronic payments

Oxy's payment method is ACH (electronic direct deposit). Banking Information will be required
for payment. Please provide the information needed below. If your company needs to designate
additional account, please complete and submit as many forms as necessary.
Remit-to Company Name Connected Performance Training Institute

Taxpayer ID VAT (TRN) 100389623800003

Bank Account Number 1025294587802

Bank Account Type Saving Checking
Electronic payment types
allowed for this account
ACH Wire Both

Bank Account Name CONNECTED PERFORMANCE TRAINING INSTITUTE

Bank Name EMIRATES NBD
Bank Branch Name BUSINESS BAY BRANCH
Ground Floor, Bldg. # 2, Bay Square, Al Asayel Road, Business
Bank Branch Address
Bay - Dubai
Country UNITED ARAB EMIRATES
Account Currency USD
Email for remittance advice teo.gorski@kpiinstitute.com
Bank Type (*) ABA -United States SWIFT CHIPS Other
Branch Type Number (**)
(Routing Number)
IBAN Number AE870260001025294587802

SWIFT Number EBILAEAD

Sort Code (UK Banks)

Comments

Note: (*) If selecting "Other", please explain it in the "Comments" field.

(**) Populate the Branch Type Number (9-digit ABA Routing Number, etc.)
IMPORTANT: Colombian based Bank Account - This page must have the bank's stamp to certify the provided
information.

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 Supplier Registration Information Form
Version 6 – Mar 2018

SUPPLIER REGISTRATION AGREEMENT

In consideration for being registered in the Occidental Oil and Gas Corporation or its Affiliates ("Oxy") and/or
given access to its iSupplier Portal, the Supplier listed below, on behalf of itself and its affiliates ("collectively,
the "Supplier"), agrees to the following:
(i) The Supplier's participation in the Supplier Registration and Qualification process does not
imply that Occidental Oil and Gas Corporation or its Affiliates ("Oxy") intends to sign a
contract or purchase goods or services from the Suppli er.
(ii) Supplier agrees to acknowledge the following policy:
a. Oxy Code of Business Conduct
http://www.oxy.com/investors/Documents/code_of_business_conduct.pdf.
(iii) Supplier agrees to abide by the following policy:
a. Oxy Drugs, Chemical and Controlled Substances, Alcohol, and Dangerous Materials
Requirements.
(iv) EXPORT CERTIFICATION – W hen required by Oxy, Supplier will furnish to Oxy any
information requested by Oxy for compliance with Governmental Requirements and
regulations related to the materials and/or services, including, but not limited to, "Schedule B
numbers," "export control classification numbers (ECCN) ", and types of licenses issued by
the United States Bureau of Industry and Security.
(v) Supplier has executed and agrees to the terms and conditions of the CONFIDENTIALITY AND
RELEASE AGREEMENT.
(vi) Supplier shall provide true and correct information in its Registration and Pre-Qualification.
Oxy reserves the right to require Supplier to undertake any other internal policies or procedures or to provide
any additional information which, at its sole discretion may deem necessary for its registration process.

Legal Entity Name CONNECTED PERFORMANCE TRAINING INSTITUTE C

Taxpayer ID (*) VAT (TRN) 100389623800003

Signature

Job Title Managing Director MENA

Print Full Name Andra Teodora Gorski

Date 11.047.2019
The form must be signed by a duly authorized officer or employee of the Supplier, and the following
documentation may be later required by Oxy:

 If the signer is a Company's officer, evidence of the registration of the last Board of Directors.

 If the signer is an Attorney-in-fact, copy of the Power of Attorney.

If the signer is the owner of the Company, appropriate documentation.
(*) Omani Suppliers: Commercial Registration Number

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