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APPLICANT INFORMATION SHEET __________________________________________________________________ STRUCTURE AND ORGANIZATION ___________________________________________________________________ 1

Name of Company: Physical Address: (Indicate street (Number), Town or City, Country (if different from Uganda) Postal Address: Telephone Number(s) Telefax Number(s) E- Mail (official & functional): .. .

..

A brief description of the company s activities:

LETTER OF APPLICATION FOR EGISTRATION (Use your COMPANY/OFFICIAL Letterhead).


Date:

To:

The Chairman Procurement Committee, Lotus Technologies Ltd Plot 72 Office No.1 Kampala road. P.O. Box 5146, Kampala

Dear Sir/Madam, We the undersigned declare that;

a)

Having been duly authorized to represent and act on behalf of

(Insert

name of the Company), and having reviewed and fully understood all the registration information provided. b) We hereby apply to be registered as a supplier/service provider for the following works services and or supplies:

Category

Item No

Description of goods /services/works

c)

We undertake to abide by the code of Ethical conduct for providers during the procurement Process and the execution of any resulting contact.

d)

We our affiliates or subsidiaries, including any sub contractors for any part of the contract or Contracts resulting from this short listing process, have not been suspended by the Government of Uganda or its agents from participating in public procurement.

e)

We understand that qualification information will be subject to verification and/or regular update through a post qualification process as and when necessary. We agree that you or your authorized representatives hereby are authorized to conduct any inquiries or investigations or verify the statements, documents and information submitted in connection with this application, and to seek clarification from our bankers and clients regarding any financial and technical aspects. This letter of application also will serve as authorization to any individual or authorized representative of any institution referred to in the supporting information, to provide such information provided in this application, or with regard to resources, experience and competence of the applicant. This application is made on the full understanding that: y y Applicants will be subject to verification of all information submitted for registration. You reserve the right to: Amend the scope of requirement under this document. Reject or accept any application, cancel the registration process, and reject all applications for any type of goods or services or for all if in your opinion they do not meet your standards. y You shall not be liable for any actions and shall be under no obligations to inform the applicant of the ground for them.

f)

g)

The undersigned declared that the statement made and the information provided in the duly Completed applications are complete, true and correct in every detail.

Signed:

. (Signature of person whose name and capacity are shown below)

Name: (Full names of the person signing the document) For and behalf of (Insert Name of the Company)

Dated this

.day of .............................2010.

FORM A1: APPLICATION SUBMISSION SHEET

Date:

To: Opportunity Uganda Limited We, the undersigned declare that: a) We have examined and have no reservations to the short listing document, including Addenda No: .,(insert the number and issuing date of each Addenda); b) We hereby apply to be short listed for the following works, services or supplies:

Reference Number

Description of Works, Services or Supplies

c) We, including any subcontractors or providers for any part of the contract or contracts resulting from this short listing process, are eligible to participate in procurement; d) We undertake to abide by the Code of Ethical Conduct for Providers and providers during the procurement process and the execution of any resulting contacts; e) We, including any subcontractors or providers for any part of the contact or contacts resulting from this short listing process do not have any conflict of interest, and are not associated, nor have been associated in the past, directly or indirectly, with the consultant or any other entity that has prepared the design or technical specifications of the supplies; f) We understand that you may amend the scope and value of any contracts to be bid or cancel the short listing process at any time and that you are neither bound to accept any application that you may receive nor to invite the short listed applicants to bid for the contract or contracts, which are the subject of this short listing, without incurring any liability to the Applicants;

g) We understand that qualification information will be subject to verification through a postqualification process prior to any award of contract. h) We hereby authorize you and your authorized representatives, to conduct any enquiries or investigations to verify the statements, document and information submitted in connection with this application and to seek clarification from our bankers and clients regarding any financial and technical aspects. This Application Submission Sheet will also serve as authorization to any individual or authorized representative of any institution referred to in the supporting information to provide such information deemed necessary and as requested by yourselves to verify statements and information provided in this application.

Signed: Name: In the Capacity of

. ..

Duly authorized to sign the application for and on behalf of: . Dated on ___________________day of _______________,___________(insert date of signing)

FORM A2:

APPLICANT INFORMATION SHEET

_____________________________________________________________ STRUCTURE AND ORGANIZATION _____________________________________________________________


1 Name of Company: (insert full legal name) Physical address: (insert street/number/town or city/country) Postal address: Telephone number: Telefax number: Email ____________________________________________________________________________ 2 Description of the Company s activities:

______________________________________________________________________________ 3 Number of years of experience in the provision of the works, services or supplies Under reference

___________________________________________________________________________

_____________________________________________________________________________________ 4 In case of a Joint Venture, the following documentation shall be required for each member of the

Joint venture: a. b. c. d. e. f. a copy of the Bidder s Trading license or equivalent; a copy of the Bidder s Certificate of Registration or equivalent; a copy of the Bidder s income tax clearance certificate or equivalent; a copy of the Bidder s VAT registration or equivalent; Power of Attorney of the signatory(ies)of the bid authorizing signature of the bid on behalf of the joint venture; a certified copy of the Joint Venture Agreement, which is legally binding on all partners, showing that all partners shall be jointly and severally liable and one of the partners will be nominated as being in charge, authorized to incur liabilities, and receive instructions for and on behalf of an and all partners of the joint venture.

The Applicant s authorized representative for information is: Name: (insert full legal name) Address:(insert street/number/town or city/country) Telephone/Fax numbers: (insert telephone/fax numbers, including country and city codes) E-mail address:(indicate e-mail address) _____________________________________________________________________________ 5 Describe your company s access from other sources (name the sources/companies) to Works, services or supplies it does not carry out or does not have in stock, and the delivery Schedule in these cases _____________________________________________________________________________________ 6 What is the time schedule of providing and completing the works, services or supplies Being applied for? _____________________________________________________________________________________ 7 Please indicate here or attach an organization chart showing the company structure Including key personnel 8 Please indicate the additional works, services or supplies that the company can provide

FORM A3: FINANCIAL STATEMENT


1. Share capital

Authorized share capital:

2.

Annual value of business under taken in the last two years

Year

Turn Over

3.

Approximate value of current work related to this type of works, services or supplies

4.

Name and address of Bankers from which references can be obtained and authority to seek References

FORM A4: RESOURCE: PERSONNEL


1. Number of staff

y y y

Management staff Technical staff Support staff

2.

Please list the present key personnel and management staff.

Name

Qualification

Years of relevant experience

FORM A5: RESOURCE: PROVIDERS EQUIPMENT AND FACILITIES

On the basis of the information provided in the short listing documents, please indicate Equipment and facilities considered by your firm to be necessary for undertaking the contract And whether this is already in the company s ownership or will be purchased.

The following facilities and infrastructure and available at the Applicants workshop: ___________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

___________________________________________________________________________________

FORM A6: EXPERIENCE: RELEVANT PROJECTS COMPLETED ___________________________________________________________________


Please fill in information about the relevant contracts completed over the past three years. Name Employer Description of Contracts Total Contract Price Date of Completion

The applicant MUST attach evidence of performance of the above contracts in the form of reference letters from the clients. This is applicable for both completed and current similar assignments.

_____________________________________________________________________________________

EXPERIENCE: CURRENT RELEVANT CONTRACTS ___________________________________________________________________


Please fill in information about the current relevant contracts being executed. Name Employer Description of Contract Contract Price Value completed and certified

FORM A7: LEGAL STATUS


1 Enclose a copy of the Memorandum and Articles of Association or its equivalent. A separate list of Directors/Partners/Proprietors should be attached. A joint venture agreement should be attached where applicable. Enclose a copy of the Certificate of Incorporation or its equivalent. Enclose a copy of the Power of Attorney to the signatory of the short listing document registered by the Registrar of Companies or written authorization to submit the application. Enclose an Income Tax Clearance Certificate addressed to OUL, for this particular purpose. y y 5 6 Enclose an Annual Tax Clearance certificate for the previous year. Attach a copy of VAT Registration Certificate for Ugandans.

2 3

Please enclose a copy of a Trading License for the previous year certified by an issuing authority. Please enclose a copy of your firm s insurance policy coverage (applicable to motor vehicle maintenance, repair of office equipment, etc) Please enclose a copy of your firm s ISO or other quality assurance certificate, if any.

APPLICATION FOR REGISTRATION

COMPANY NAME: ADDRESS: PHYSICAL ADDRESS: CONTACT PERSON: E-MAIL ADDRESS: GOODS/SERVICES/WORKS:

. .

..

. DATE: .

To: The Secretary General, Uganda Red Cross Society, Plot 28/30 Lumumba Avenue, P.O.BOX 494, Kampala.

Dear Sir/ Madam, Having been duly authorized to present and act on behalf of . The undersigned hereby express Interest as Supplier/Service provider for the following item.

Company

Item Applied For

Attach to this letter are copies of original Document defining: a. b. c. d. e. f. g. The Applicant legal status. The Principal place of Business. Certificate of incorporation. Names and Pass Port sized photos for Directors VAT registration Certificate Copy of company s latest audited financial statements Banking information (Current Bank statement)

Authorized representatives that may be contacted for further information General and Managerial Enquires Name Telephone: Fax: Email:

Technical Enquiries Name: Telephone: Fax: Email:

Financial Enquiries Name: Telephone: Fax: Email:

Declaration The undersigned declare that the statement made and information provided in the duly completed application are complete, true and correct to the best of my (our) knowledge. Signed: Name: For and behalf of (Name of applicant)

The Applicant are required to provide additional document as required below. I. II. III. A copy of trading license A copy of certificate of registration (under the business Names Registration Act) A copy of profile (a brief or published company profile)

Details of contracts of similar Nature and complexity 1 2 3 4 Name of contract Name of client Address of client Contract role Sole supplier-Subcontractor partner in a joint venture 5 6 7 8 Equivalent value in Uganda Date of award Date of Completion Duration of contract