Supplier Evaluation Questionnaire Page 2
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FRM-QAL-0010
Revision No: 6
Date: 18/02/2012
SUPPLIER EVALUATION QUESTIONNAIRE
Section 1.
Company / Individual Details –
TO BE COMPLETED BY ALL SUPPLIER TYPES.
Company Name
ABN
Goods / Services to
be provided to FGL
Postal Address
Purchase Orders
Street name & no
Email address
Post Code
Contact name
City / Suburb
Phone
State
Country
Fax
EFT Details
Remittance Information
(tick preferred method)
Bank Name
Email address
BSB No
Fax number
Account No
Printed / Posted
Business Entity Details
Please tick one box only below based on what the contractor’s business is carried through.
Company
Partnership
Trust
Sole Trader
(We require copies of the following to facilitate payment)
Section 2.
Insurance, Registration and License Details –
EXCLUDES PRODUCT SUPPLIERS ONLY.
Policy No:
Exp.Date:
Ins. Provider:
a) Certificate of Currency for Workers’
Compensation
Policy No:
Exp.Date:
Ins. Provider:
b) Certificate of Currency for Public Liability
Policy No:
Exp.Date:
Ins. Provider:
c)
Certificate of Currency for Motor Vehicle
(if applicable)
Policy No:
Exp.Date:
Ins. Provider:
d) Certificate of Currency for Professional
Indemnity (if applicable).
Registrations / Licenses
Provide details of all Statutory Registrations & Licenses held by your organisation for example; Painters, Electrical, Plumbing, Gas, Builders,
Architects, Dangerous Goods, etc. (Please supply copies of each with this questionnaire)
Copy Supplied with
Category
Type
Number
Expiry Date
Questionnaire.
e.g. Electrical
License
EW165999
01-01-2014
Yes
Process Owner: D. Gordon
Intranet version is current, copies are uncontrolled documents
Process Author: N.DiCarlantonio
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