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AccountantGeneral

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

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