E-Business Registration Form

1. General Information*

Company/ Establishment’s Name (in Full):

Commercial Registration No:
Type: Contractor Supplier Manufacturer

Do you have Previous Registration in KOC?:* No If Yes, provide Vendor Code:

Has the company’s name been changed previously? No If Yes, provide old Name Below:

2. Primary bank Account Details (as attachment please send a scanned copy of the bank letter)*

Bank Name: Bank Branch / Address:

Account Number: Currency:

IBAN**: Swift***:
**- Mandatory field for Kuwaiti companies
***- Mandatory field for overseas companies
3. Address Information*

Country: City: Street:

P.O. Box: Telephone: Fax:

eMail: Web site:

Address Type (HQ, Main Office overseas / Workshop / Showroom)
4. Company Primary Contact*

Name: Position:

Telephone: Email: Fax:

5. Company Primary Contact (contact will have an admin role in eBusiness portal for the specified company)*
User Name: Email:

First Name: Last Name:

Contact Phone:
6. We have read and agree with “Terms and Conditions for eBusiness Portal”
And confirm that the informaition secified in this form is correct.

* Mandatory data

Signature Stamp Date