Ref :

Date :

TABRIZ PETROCHEMICAL COMPANY (TPC) Attach :

Customer Registration Form

Tabriz Petrochemical Co.

Please fill out this form completely and return it signed within one week with supporting
documents and attachments:

Important Notice:
All emails must be sent from domain of your company. Personal emails or such domains as yahoo,
Gmail or Hotmail are not acceptable.

1. Company Incorporation Information

1.1. Company Name

1.2. Type of Company

1

1.3. scope of activity

1.3.Country

1.4 Date of Incorporation

1.5. Please furnish shareholders of the company with their share percentage and their
signature samples

Full name share percentage signature sample

shareholder #1

shareholder #2

Shareholder #3

Shareholder #4

Factory : Tabriz Petrochemical complex special Rd , Off Km 3 Bakeri Freeway , Kasaei Highway End , Tabriz – Iran
P.O.Box : 51745-354 Tel : +98 411 428 0000 Fax : +98 411 420 1487 www.tpco.ir E-mail : info@tpco.ir
 Ref :

Date :

TABRIZ PETROCHEMICAL COMPANY (TPC) Attach :

2. Company management information

2.1. Please furnish the following information about company’s managers:

Position Full name Email Address

CEO

Sales Manager

2.2. Please attach copy of passports or National ID Cards of CEO and Chairman of Board
to this form.

2.3. List of Authorized signatures

Full name Position Email Address signature sample

3. Contact Information
3.1. Company Address

3.2. Telephone Number

3.3. Fax Number

3.4. Mobile Numbers for receiving tender

notices

Factory : Tabriz Petrochemical complex special Rd , Off Km 3 Bakeri Freeway , Kasaei Highway End , Tabriz – Iran
P.O.Box : 51745-354 Tel : +98 411 428 0000 Fax : +98 411 420 1487 www.tpco.ir E-mail : info@tpco.ir
 Ref :

Date :

TABRIZ PETROCHEMICAL COMPANY (TPC) Attach :

3.4. Does your company have any representative in Iran? (Yes/ No)

If yes, Please complete the table below:

Full name Position Email Address

4. Trading Experience Information

4.1. Does your company have experience in trading of petroleum products and
petrochemicals with origin of Iran? (Yes / No)

If yes, please mention top 4 Iranian companies that you have traded with in last year:

Company Name Product description Year

Seller #1

Seller #2

Seller #3

Seller #4

4.2. Please attach your letter of Intent (LOI) to this form. Please make sure that the (LOI)
includes products that you like to trade in detail.

4.3. Please attach company resume or catalogue to this form.

5. List of desired products

No. Name of Products Destination Market Estimated Volume per month

Factory : Tabriz Petrochemical complex special Rd , Off Km 3 Bakeri Freeway , Kasaei Highway End , Tabriz – Iran
P.O.Box : 51745-354 Tel : +98 411 428 0000 Fax : +98 411 420 1487 www.tpco.ir E-mail : info@tpco.ir
 Ref :

Date :

TABRIZ PETROCHEMICAL COMPANY (TPC) Attach :

Declaration

I, , on behalf of company_ _, hereby, declare that the details furnished in

costumer registration form are true and correct and it undertakes to inform Tabriz Petrochemical
Company of any changes therein, immediately. In case, any of the information is founded to be false or
untrue or misleading or misrepresenting, the company is aware that it shall be held liable for it.

After registration, we (I and the foreign company) hereby represent and pledge to Tabriz
Petrochemical Company the followings and shall ensure and procure with full responsibility that our
affiliates, employees, agent, contractors, or any other legal entity or natural person involved in
performance of Agreements/Contracts (“Associated Persons”) shall be bound by the same pledge:

1.We undertake that in performing any of our obligations and responsibilities under our
Agreement/Contracts, neither we nor any of Associated Persons will commit any criminal offence
and/or infringement of mandatory legal requirements applicable to its performance of Agreements
/Contracts and it agrees to undertake all necessary measures to prevent any such offence and / or
infringement from incurring.

2.We and the Associated Persons shall not commit corruption, breach of confidentiality, falsification of
documents or data, offering, promising or conferring benefits to any civil servant, official or other
person bound to carry out public service duties and / or any employees of a contractual partner, any
violation of an application law , including collusive agreements on prices or prices or price elements,
prohibited price recommendation or collusive agreements regarding the submission or non-submission
of bids and any profit sharing and payments to other bidders to extent such acts and / or omissions are
qualified as criminal offence or infringements of mandatory legal requirements under the respective
laws which are applicable to such acts and / or omission, or any form of money-laundering or fraud
under any relevant jurisdiction.

3. We and the Associated Persons fully commit to and observe the Iranian ban on any form of trade or
transaction with the “so-called state of Israel” as well as any Israeli legal or natural persons in respect
of products purchased.

4. We and the Associated Persons represent and warrant that none of the aforementioned improper or
illegal acts have occurred as of the date of preparation of this form.

5.Any breach of the above representations, warranties, pledges, undertakings and commitments shall
make us liable under the law and the contract towards Tabriz Petrochemical Company for all costs,
damages, penalties, or any form of adverse consequences to witch we shall indemnify Tabriz
Petrochemical Company and hold it harmless, without prejudice to our liability under the laws
towards the respective authorities.

Authorized Signature and seal: Date and place:

Factory : Tabriz Petrochemical complex special Rd , Off Km 3 Bakeri Freeway , Kasaei Highway End , Tabriz – Iran
P.O.Box : 51745-354 Tel : +98 411 428 0000 Fax : +98 411 420 1487 www.tpco.ir E-mail : info@tpco.ir