2 Task Force 2010 - Corporate Company Questionnaire_KO_-- March 6 2012 - Privacy Act Reviewed.xlsx
XLSX spreadsheet 63 KB Posted
- Solicitation number
- W91B4N-12-R-5010
- Issued by
-
Department of the Army
About this file
Corporate Questionnaire
View the file
Other files
| File | Type | Posted |
|---|---|---|
| W91B4N-12-R-5010-0001.pdf | ||
| ConstructionCompany.pdf | ||
| W91B4N-12-R-5010 Solicitation.pdf | ||
| 1 HN_NHN_Vendor Registration Process_29 April 2012_.pptx | PPTX presentation | |
| W91B4N-12-R-5010_PP_Survey.docx | DOCX document | |
| EFT Form DFAS Rome.xls | XLS spreadsheet | |
| TFBSO_Vendor Registration Process_20 June 2012_.pptx | PPTX presentation | |
| 3 Vendor_Family_Detail_Form_30 March 2012.xls | XLS spreadsheet | |
| AISA_License_Small_Medium_Large Company.pdf | ||
| JCCS Vendor Registration.ppt | PPT presentation |
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Text version
General Information
| TASK FORCE - 2010 |
| CORPORATE COMPANY QUESTIONNAIRE |
| Please complete the questionnaire completely and in detail. |
| Many of the items are required in order to be registered to do business in Afghanistan |
| General Prime Vendor Information: |
| Official Business Name: |
| Doing Business As Name: |
| Date Business Commenced: |
| Complete Business Address: |
Complete Mailing Address:
Trading Locations (TLs): (other than the main business) - If you conduct business in more than one location, provide details below. If you need more space, include the information on the back of this sheet. State the total number of TLs _______.
Trading Name Address Own / Rent (Y or N)
Inventory Locations: List all inventory storage locations below. In you need more space, include the information on the back of this sheet. State the total number of inventory locations _______.
Inventory Location Name Address Own / Rent (Y or N)
Enterprise Information
| General Enterprise information: | Identify: | ||
| Enterprise Type: | Corporation | General Partnership | Multilateral Organization |
| Credit Partnership | Gov. Commercial Activity | Special Partnership | |
| Tax Exempt Org | Gov. Organization | State Owner Partnership | |
| Work Partnership | Limited Liability Co. |
| Incorporated Country: | Tax Start Date: |
| Registration Date: | Close Date: |
| Commercial Reg. No.: | Preferred Language: |
| Nature of Business: | Identify: | |
| Industry | Service | Construction |
| Transportation | Agro-Business | Other (specify) |
Describe the main activity from which your business income is derived: (Note: If you need more space, include the information on the back of this sheet.)
| Parent Company Information: | ||
| Parent Name | Address | Phone Number |
| Imports and Exports: |
| Do you import or export any goods or services? |
| If so, provide the following information: (Note: If you need more space, include the information on the back of this sheet.) |
List all Imports and Exports (One per Box) Import or Export ? Total Value (Specify Currency) Name of Company & its Country Location
Do you conduct business with companies who operate in any of the following countries or make purchases from those countries?
| Pakistan (YES or NO) | Iran (YES or NO) | Russia (YES or NO) | China (YES or NO) |
| Indonesia (YES or NO) | India (YES or NO) | Malaysia (YES or NO) | Canada (YES or NO) |
Contracts
| Contracts: |
| Provide the following information for all United States Government Contracts awarded to the Company or to its Owners, Investors, Shareholders, and Financial Contributors: (Note: If you need more space, include the information on the back of this sheet.) |
Contract Name List the Individual(s) to whom the Contract was Awarded Purpose of Contract (for example, fuel delivery, road construction, etc.) Contract #
Provide the following information for ALL other contracts (i.e contracts awarded by NATO, US State Department, USAID, and Other Countries) awarded to the Company or to the Owners, Investors, Shareholders, and Financial Contributors: (Note: If you need more space, include the information on the back of this sheet.)
Contract Name / Agency Issued By / Country Issued By List the Individual(s) to whom the Contract was Awarded Purpose of Contract (for example, fuel delivery, road construction, etc.) Contract #
Have you been a subcontractor for any other companies in the past 3 years? If so, provide the following: (Note: If you need more space, include the information on the back of this sheet.)
Name of Prime Company Agency Issued By / Country Issued By Purpose of Contract (for example, fuel delivery, road construction, etc.) Contract #
List below all companies acquired and/or joint venture to include subsidiaries: (Note: If you need more space, include the information on the back of this sheet.)
Company Name Owners Telephone # Address
Owner
| Owner's Information: |
| FOR EVERY OWNER, PRIMARY INVESTOR, AND PRIMARY SHAREHOLDER TO INCLUDE FINANCIAL CONTRIBUTORS WITH LEGAL / FINANCIAL AGREEMENT -- ATTACH A COPY OF HIS/HER KARZAI-ERA TAZKERA, TAX IDENTIFICATION CERTIFICATE, & RECENT OFFICIAL BUSINESS PICTURE (Note: If you need more space, include the information on the back of this sheet.) |
Owner's First/Mid/Last Name Son of OR Daughter of Amount of Contributed Capital Ownership Start Date # of Shares
% of Shares (Total must = 100 %) Office Phone # Cell Phone # Other Phone # Email
Owner's First/Mid/Last Name Son of OR Daughter of Amount of Contributed Capital Ownership Start Date # of Shares
% of Shares (Total must = 100 %) Office Phone # Cell Phone # Other Phone # Email
Owner's First/Mid/Last Name Son of OR Daughter of Amount of Contributed Capital Ownership Start Date # of Shares
% of Shares (Total must = 100 %) Office Phone # Cell Phone # Other Phone # Email
Owner's First/Mid/Last Name Son of OR Daughter of Amount of Contributed Capital Ownership Start Date # of Shares
% of Shares (Total must = 100 %) Office Phone # Cell Phone # Other Phone # Email
AISA License
| Investment Licenses: ATTACH A COPY OF EACH LICENSE | |
| Investment License Type | Attached |
| AISA License | |
| Ministry of Commerce License | |
| Industry / Sector Licenses | |
| Joint Contingency Contracting System ID | |
| Other License | |
| Other License |
Employees
| Key Employees's Information: |
| FOR EACH KEY EMPLOYEE, ATTACH A COPY OF HIS/HER KAZERI - ERA TAZKERA, TAX IDENTIFICATION CERTIFICATE, & RECENT OFFICIAL BUSINESS PICTURE (Note: If you need more space, include the information on the back of this sheet.) |
| First/Mid/Last Name | Work Phone # | Cell Phone # | Other Phone # | |
| Contract Manager | ||||
| Project Manager | ||||
| Accountant | ||||
| Security Manager | ||||
| Other Key Manager |
| Employee Information: | ||||
| FOR EACH EMPLOYEE, ATTACH A COPY OF HIS/HER KAZERI - ERA TAZKERA | ||||
| First/Mid/Last Name | Role in Company | Work Phone # | Cell Phone # | Other Phone # |
ATTACH A COPY OF THE COMPANY'S MOST RECENT ORGANIZATIONAL CHART
Financial Information
| Financial Information: |
| *ATTACH AN ACCURATE BALANCE SHEET & PROFIT AND LOSS STATEMENT FOR THE PAST 2 YEARS |
| *PROVIDE COPIES OF BANK STATEMENTS TO INCLUDE HAWALA RECEIPTS AND INCOME TAX DOCUMENTS TO SHOW THE BUSINESS TRANSACTIONS FOR ALL ACCOUNTS FOR THE PAST YEAR. |
*PROVIDE COPIES OF ALL RENTALS AGREEMENTS INCLUDING OFFICE SPACE, LAND, AND EQUIPMENT AGREEMENTS
| Note: If you need more space, include the information on the back of this sheet. |
| Current Year (CY) Estimates: |
| CY Est. Annual Gross Sales: |
| CY Est. Annual Gross Expenses: |
| CY Est. Taxable Income: |
| Banking Information: Provide the following for ALL domestic and foreign bank accounts | |||
| Account # | Business or Personal Acct | Bank Phone Number | Address |
| Investments: Provide the following for all domestic and foreign company investments | ||||
| Investment in Land | Investment in Building & Machineries | Other Investments (including commercial, financial, govt, & personal) | Specify Currency | |
| Current Year | ||||
| Last Year | ||||
| Initial Capital |
| Rental Information |
| Do you rent office space, land, or equipment ? If so, provide the following information on the indivdual(s) from whom you rent: |
Type of Rental: Office Space, Land, or Equipment? Lessor First/Mid/Last Name Lessor's TIN Lessor's Phone Number Total Annual Rate (Specify Currency)
Muncipality Registered Address of Real Estate Office
Type of Rental: Office Space, Land, or Equipment? Lessor First/Mid/Last Name Lessor's TIN Lessor's Phone Number Total Annual Rate (Specify Currency)
Muncipality Registered Address of Real Estate Office
Subcontractors
| Subcontractors: |
| * ATTACH A COPY OF EACH SUBCONTRACTOR'S AISA LICENSE |
| * FOR EACH SUBCONTRACTOR, ATTACH COPIES OF KARZAI - ERA TAZKERAS FOR THE OWNERS, PRIMARY SHAREHOLDERS, PRIMARY FINANCIAL CONTRIBUTORS, PRESIDENT, VICE PRESIDENT, AND OPERATIONS MANAGER |
Note: If you need more space, include the information on the back of this sheet.
| Provide the following for each subcontractor: | |||
| Name | Service Provided to Prime | Estimate the % of Business each Subcontractor will Receive | Joint Contingency Contracting System ID |
| 1 | |||
| 2 | |||
| 3 | |||
| 4 | |||
| 5 | |||
| 6 | |||
| 7 | |||
| 8 | |||
| 9 | |||
| 10 |
In detail, describe your process to select and monitor subcontractors:
Subsidiaries Subsidiaries:
| List all Worldwide Subsidiaries below | ||
| Note: If you need more space, include the information on the back of this sheet. | ||
| Name of Subsidiary | Company Speciality | Headquarters Location (City and Country) |
| 1 | ||
| 2 | ||
| 3 | ||
| 4 | ||
| 5 | ||
| 6 | ||
| 7 | ||
| 8 | ||
| 9 | ||
| 10 |
Affiliations Affiliations:
Government Affiliations: List all past or current government affiliations for key investors, shareholders, and financial contributors include individuals whose family members are in government positions
| Note: If you need more space, include the information on the back of this sheet. | |||
| Name of Individual | Government Agency of Individual / Family Member | Government Title of Individual / Family Member of Individual | Time Period |
| 1 | |||
| 2 | |||
| 3 |
Commercial Affiliations: List all past or current commercial affiliations for key investors, shareholders, and financial contributors
| Name of Individual | Company Affiliated With | Title | Time Period |
| 1 | |||
| 2 | |||
| 3 | |||
| Real Estate Affiliations: List all real estate affiliations for the Company |
| Name on Ownership Documentation | Address | Purpose of Real Estate |
| 1 | ||
| 2 | ||
| 3 |
Other
| Other Information: |
| ATTACH A COPY OF YOUR MOST RECENT ANNUAL SHAREHOLDERS MEETING NOTES |
Have you received grants from USAID or from any other organization or country including Afghanistan? If so, provide the following: (Note: if you need more space, include the information on the back of this sheet.)
Name of Grant Agency Issued By / Country Issued By Purpose of Grant Total Amount of Grant (Specify Currency)
Over the past year, have you sold any domestic or foreign assets in excess of $100K? If so, provide the following:
Type of Asset Sold Purchase Price (Specify Currency) Sales Price (Specify Currency) Reason for Sale
Does anyone in your company make business decisions for any other domestic or foreign companies? If so provide the following information:
Name of Company Owner(s) of Company Relationship to Company Role in Company
Certification
| Certification: |
| I certify that the information given above and in the attached appendices is true, accurate, and complete to the best of my knowledge. |
| Name: | |
| Phone Number: | |
| Position: | |
| Signature: | Date: |
| Name: | |
| Phone Number: | |
| Position: | |
| Signature: | Date: |
| CERTIFICATION OF THE INFORMATION PROVIDED IS REQUIRED FROM THE |
| PRESIDENT OR VICE PRESIDENT LEVEL OF AUTHORITY |
| Afghanistan Commercial Court Legal Representative to act on behalf of President, Vice President, and Shareholders |
| Name: | |
| Phone Number: | |
| Position: | |
| Signature: | Date: |
File details come from the government source that posted it. Updated .