Annexure 1b

VENDOR APPLICATION FORM/CHANGE FORM

I. Vendor Details
Trade Name: TAAQEEM TECH FOR SERVICES AND TRADING
Street: FEREEJ ABDEL AZIZ

Building Name: LE MIRAGE SUITES

P.O. Box No: 22000 City: DOHA Country: QATAR
Trade License No: 183777 Date of Issue : 9/8/2020 Expiry Date : 3/8/2024
MPORTANT CHEMICAL MATERIAL RELATED TO CLEANING
License Activity:
AND DETERGENTS, EXTERNAL CLEANING BUILDINGS ,ACTIVITIES OF CLEANSING AND EXTERMINATION OF INSECTS A
Commercial Registration No: 144008Duns & Bradstreet No.*
annual
VAT Registration (applicable for GCC): VAT Registerd business
VAT/TRN No. * <375K AED Withholding Tax No.*

L
Legal Type : Sole Others, please
✘ L
Proprietorship specify:
* required only for applicable countries C
II. Partners/Sponsors

Name Occupation Nationality Contact No.

MOHAMED AHMED A A AL-THANI QATAR
ABDULAZIZ AHMED A A AL-THANI QATAR
AHMED ABDULAZIZ A A AL-THANI QATAR
HAMAD AHMED A A AL-THANI QATAR
ABDULLA AHMED A A AL-THANI QATAR
LE MIRAGE REAL ESTATE QATAR

Declaration:-
Do you have any relationship with(family, friend, others) employed at Al-Futtaim who is having business relationship with your company
Y
e ✘ No If 'Yes' please specify
s

III. Contact Details (Sales/Accounts)

Contact Person (Sales) Contact Person (Accounts)
Name : Mr. Mazen Baassiri Mr. Ramzi Muhammed
Designation: Buisness Development Manager Assistant Accountant
Tel. No. (Office) : 44190000 44442202
Mobile No. 31666434 30445849
Fax : 44351529 44351529
Email : mazen@taaqeem.qa ramzi@lemirage.qa
IV. Bank Details
Account Name : TAAQEEM TECH FOR SERVICES AND TRADING
Account No. : 222-989502-001-0010-000
Bank Name : DOHA BANK
Branch : CORPORATE BRANCH
IBAN : QA06DOHB022209895020010010000
Swift Code :
*Payment will proceed (through bank transfer/Online Payment) only after the receipt of original Document as per items 3 in the attached
documents section V.

Payment Information
Payment Terms : Payment Curr. :

V. Required Attachments Local Vendor Overseas Vendor

1) Valid Trade License Copy * (All pages including information about owners) X
2) Duly filled Vendor Application Form X X

3) Vendor Cancelled Cheque with bank Details on Vendor Letter Head or Certiffied by Vendor Bank X
duly stamped and signed
4) Original invoice / original proforma invoice containing bank details or bank details on original letter X
head of supplier duly stamped and signed.
5) Country’s relevant registration certificate X
6) Valid Tax Card Copy (Relevant countries where Withholding Tax is applicable) X X
7) VAT Registration certificate X
8) Sample copy of your Tax Invoice X
9) Duly signed Al Futtaim Code of Ethics X X
* If free zone registered company any government issued document containing owner information
VI. Authorized Signatories:
Authorized Person 1* Authorized Person 2*
Name :
Designation :
Signature :
Contact number :
Date :
Company Seal :
* this is not required if it is filled by our staff

Supplier master