Supplier Registration

Name of Registered Business/Company *

Address*

Postal code*

State*

City*

Country*

Tax Registration Number in the Country*

Business Registration Number*

Year of Establishment *

Name of Representative*

Mobile /Phone Number*

Email address*

How many employees does your business have in South Sudan?*

Please indicate what is the category of your business*

Type of Business*

National

International

Annual Turnover (USD)*

Please list your main clients*

Company name	Type of contract (spot, monthly, 12-month, etc)	Aprox. contract value (USD)	Contact name	Contact phone	Contact email

Which category is your business willing to supply*

Local customs and clearance agent

Domestic freight - Air

Domestic freight - Road

Domestic freight - River

Fuel

Food and beverages

Supplies, stationery and other consumables

Hygiene and cleaning products

Construction and rehabilitation material

Energy equipment (including spare parts)

Non-food items (NFI)

IT, office equipment (including spare parts)

International travel

Insurances

Furniture

Name of Bank*

Bank Address*

Title of Bank Account*

Bank Account Number*

Swift Code*

Can you accept bank transfers?*

Yes

No

Do you own a bank account?*

Yes

No

Please select in which locations your company is able to deliver*

Do you have previous experience working with MSF (If 'Yes' select the sections you worked for)*

Yes

No

Please select the sections your company have worked with*

MSF Spain (OCBA)

MSF France (OCP)

MSF Belgium (OCB)

MSF Holland (OCP)

MSF Switzerland (OCG)

For how long have you been working with MSF? (in years)*

Do you Have Previous Working experience with INGO/NGO*

Yes

No

if Yes Please mention the Name*

Aircraft type	Capacity	Home base	Registration no	State of registration	Aircraft owner

Storage Capacity
Storage Capacity	Depot Location	Diesel (liters)	Petrol (liters)	Jet A-1 (Liters)

Suppliers Registration Form

Domestic freight - Air

Domestic freight - River

Requested Routes

Fuel Category