ATHEER TELECOM IRAQ LIMITED "Zain Iraq"

BLDG, 47, STR.14, Dist.605, HAY AL-MUTANABI, AL MANSOOR, BAGHDAD-IRAQ

VENDOR REGISTRATION FORM

Section 1: Company Details and General Information

1. Name of Company:
2. Street Address: 3. P.O. Box and Mailing Address:
Postal Code: City:
Country:
4. Tel: 5. Email:
6. Contact Person Name: 7. Job Title:
8. Parent Company (Full legal name)

9. Subsidiaries, Associates and/or Overseas Representative(s) - (attach list if necessary)

10. Type of Business (mark one only)

Corporate Limited Partnership: Other (specify):

11. Nature of business:

Manufacturer Authorized Agent
Trader Consulting Company Others (specify):
If you mark "Authorized Agent" or "Trader", please provide proof or certificate(s) from your

manufacturer that you are authorized to offer their products to Iraq.

12. Year established: 13. Number of Full-time Employees:

14. License No.: Registration Country/City:

15. VAT No./Tax I.D.

Please provide a copy of:

A. Company Profile.
B. Valid Registration Certificate.

C. Company Structure.

Section 2: Financial Information (Please attach a certified copy of recent balance sheet)

16. Annual Value of Total Sales for the last 3 years:

Year ____:USD _____million Year: ____:USD ____million Year ____: USD____ million

17. Annual value of Export Sales for the last 3 years:

Year ____:USD _____million Year: ____:USD ____million Year ____: USD____ million

18. Bank Name:

Address:

19. Bank Account Name :

20. Bank Account Number :

21. Swift Code :

22. IBAN Number :

23. Please attach a listing of reference sources for services rendered by your firm within the last

12 months. Please also indicate phone numbers and contact person for your reference sources.
Name of Company Address/Phone # Contact Person Name

1) ______________ __________________ _________________ __________________

2) ______________ __________________ _________________ __________________

3) ______________ __________________ _________________ __________________

Sign & Stamp

Please return signed, stamped, completed form to:

Haider Ali Abdilhusain Noor Qassim Mohammed

Procurement Officer Procurement Senior officer
Business-IQ@iq.zain.com Business-IQ@iq.zain.com
Atheer Telecom Iraq Ltd (Zain Iraq) Atheer Telecom Iraq Ltd (Zain Iraq)
Baghdad Baghdad
Iraq Iraq
D "Zain Iraq"
OR, BAGHDAD-IRAQ

nd Mailing Address:

ist if necessary)

icate(s) from your

ecent balance sheet)

_: USD____ million

_: USD____ million

y your firm within the last

n for your reference sources.

Contract Value

__________________

__________________

__________________