UBA CAMEROON

VENDOR REVIEW AND DISCLOSURE OF

CONFLICT OF INTEREST

YEAR 2023
SN PARAMETER DETAILS
1 Name of company
2 Address
3 Telephone No
4 Nature of the firm(Please tick) Sole Proprietor-Registration Certificate
Partnership -Partnership Deed and registration certificate
Private Limited company-Certificate of registration, MOA and
AOA
Name(s) of partner(s)or directors of
5 the firm
Date of establishment of the
6 firm/company
In case of a rented premises, please
7 provide name and address of owner
Are any of your affiliates /close
relatives involved in providing some
service to UBA (please furnish full
8 details)
Are any of your relatives of the
partners/directors in your firm
working with UBA (Please provide
details like name location
9 designation, etc)
Have you or any close relative of
yourself or the partners/ directors in
your firm have at any one point of
time been an employee of UBA or its
group company? If yes, please
10 furnish. us with full details.
Is the firm involved in any legal
dispute? (Give details of the issues
11 and parties involved)

______________________ ______________________
AUTHORISED NAME AUTHORISED SIGNATURE

DATE: STAMP/COMPANY SEAL