Page 1 of 1
Ireland General Supplier PQQ
Company Information
Q1.Company Name
*
Q2.Trading Name (If different)
*
Q3.Registered Address
*
Q4.Company Registration Number
*
A
Yes
B
No
Q5.VAT Registration Number
*
A
Yes
B
No
Q6.Company Website
*
Q7.Primary Person Contact Name
*
Q8. Contact Email Address
*
Q9. Contact Telephone Number
*
Business Details
Q10. Type of Business Entity
*
A
Limited Company
B
Sole Trader
C
Partnership
D
Other
Q11.Date of Incorporation
*
Q12. Where is your Business Registered
*
Q13. Do you hold relevant Public Liability Insurance
*
A
Yes
B
No
Q14. Do you hold relevant Product Liability Insurance
*
A
Yes
B
No
Q15. Do you hold relevant Employers Liability Insurance
*
A
Yes
B
No
Q16. Do you hold relevant Public Indemnity Insurance Liability Insurance
*
A
Yes
B
No
Legal and Regulatory Compliance
Q17. Do you have clear rules on accepting or offering gifts, hospitality or other benefits?
*
A
Yes
B
No
*
Please Upload anti-bribery/ corruption policy if relevant
Click to choose a file or drag here
Q18. Does your organisation comply with the EU GDPR and Ireland's Data Protection Act 2018?
*
A
Yes
B
No
Q19. Are you compliant with Health and Safety Legislation?
*
A
Yes
B
No
Please provide any relevant documents
Click to choose a file or drag here
Environmental and Sustainability
Q20. Do you have an Environmental Policy?
*
A
Yes
B
No
Q21. Are you registered under any environmental schemes (e.g ISO4001) ?
*
A
Yes
B
No
Financial and Tax Compliance
Q22. Do you have any pending legal disputes or insolvency proceedings?
*
A
Yes
B
No
Q23. Are you fully compliant with your local tax obligations? (e.g. VAT, Corporation Tax)
*
A
Yes
B
No
Supply Chain and Subcontracting
Q24. Do you use subcontractors or Third Parties to deliver goods/services?
*
A
Yes
B
No
Q25. Do your suppliers comply with Modern Slavery and Environmental regulations?
*
A
Yes
B
No
C
Unsure
Payment Terms
Payment terms 30 days end of month (Example: invoice received 2nd May payment will process 30 days from the end of that month)
Q26. Please confirm that you agree to the above payment terms
*
A
Yes
B
No
Q27. Please provide bank details on letter headed document
*
Click to choose a file or drag here
Declaration
I confirm that the information provided is accurate and complete to the best of my knowledge. I understand that providing false or misleading information may lead to disqualification or termination of our business relationship.
*
Confirm
Name
*
Position
*
Date
*
Signature
*
Signature
