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TREASURYDEPARTMENT
VendorAuthorizationFormForBUSINESSES
New:Update:
PleaseReadCarefullyandCompleteinBlockLetters
*TaxId.Number
(TIN):
Registered
BusinessName:
Address:
EmailAddress:
PhoneNumber:
BankorCredit
Union:
Account#:
(Asprovidedbybankcompletewithbranchcodewhereapplicable)
AccountHolder's
Name:
(Asitappearsonbankrecords)
Comments:
NoteandDisclaimer
>Thisformistobesignedbytwo(2)**authorizedrepresentativesfromthebusinessthatwishesbeaddedtotheSmartStream
PayablesVendorListinordertoreceivepayment(s)fromanyGovernmentofBelizeMinistry/Department.
>Attimes,informationforvendorsneedstobeverifiedandbusinesseswillberequiredtoresubmitdocumentsalready
providedbeforeapaymentisexecuted.Businessesshouldbereadytoprovidesuchwhenrequired.
>Bysigningbelowthebusinessrepresentativescertifythatthebankinginformationprovidedisaccurate,belongstothe
businessandassumefullresponsibilityintheeventamountssenttotheindicatedaccountresultsinpaymentbeing
rejected***orissenttoanaccountwhichdoesnotbelongtothebusinessandforwhichtheGovernmentofBelizeshallnot
haveanyliabilitywhatsoever.
Signature: Signature:
PrintName: PrintName:
JobPosition: JobPosition:
Date: Date:
*MustbeRegisteredwithG.S.TorIncomeTaxDepartmentTINisprovidedbythose
entities.
**IfSoleProprietorship,pleaseindicatesoincommentsandowneristosign.
***Ineventthatinnacurateaccountinformationisprovided;anewformwillneedtobe
completed
AccountantGeneral
TREASURYDEPARTMENT
VendorAuthorizationFormForPERSONS
New:Update:
PleaseReadCarefullyandCompleteinBlockLetters
SocialSecurity*#
(mustbecomplete9DigitnumberCopyofSSCardMUSTtobesubmitted)
FULLName:
(asseenonSSCard)
TaxId.Number
Jr./Sr.? (TIN):
Address:
EmailAddress:
PhoneNumber:
BankorCredit
Union:
Account#:
(Asprovidedbybankcompletewithbranchcodewhereapplicable)
AccountHolder's
Name:
(Asitappearsonbankrecords)
Comments:
NoteandDisclaimer
>ThisformistobecompletedbythepersonwhowishestobeaddedtoSmartStreamPayablesVendorListinorderto
receivepayment(s)fromanyGovernmentofBelizeMinistry/Department.
>Attimes,informationforvendorsneedstobeverifiedandinsuchcasespersonswillberequiredtoresubmitdocuments
alreadyprovidedbeforeapaymentisexecuted.Personsshouldbereadytoprovidesuchwhenrequired.
>Bysigningbelowthepersoncertifiesthatthebankinginformationprovidedisaccurate,belongstohim/herandassumes
fullresponsibilityintheeventamountssenttotheindicatedaccountresultsinpaymentbeingrejected**orissenttoan
accountwhichdoesnotbelongtohim/herandforwhichtheGovernmentofBelizeshallnothaveanyliabilitywhatsoever.
Signature:
PrintName:
Date:
*Forforeigners,acopyofpassportwillbeacceptedallBelizeannationals/citizensaretouseSSCards.
**Ineventthatinnacurateaccountinformationisprovided;anewformwillneedtobecompleted