Republic of Liberia MINISTRY OF GENDER & DEVELOPMENT 110 UN Drive & Gurley Street P.O. Box Monrovia 10, Liberia, West Africa

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1 PROCUREMENT DIVISION Ref.: Request for Registration on the Supplier Database of the Procurement Division. The Ministry of Gender and Development ) intends to develop a database of Suppliers and Service Providers in accordance with section 29 (j) of the Public Procurement and Concessions Act of This registration is open to Suppliers and Service Providers in the under-listed business categories: Supply of goods Provision of non-consulting services Minor construction works and maintenance of facilities 4. Provision of consulting services Interested suppliers, contractors and consultants are encouraged to register. Registration is not a requirement for participating in bidding opportunities at the Ministry. Nevertheless, the Ministry will refer to the Database when and where needed in case of Quotation Request, Restricted Bidding and Single/Sole Source Procurement. Interested Suppliers and Service Providers should apply using the attached official registration form. Prospective suppliers, contractors and consultants are required to read the registration form carefully, complete all sections, sign, and date the form. The completed registration form must be accompanied with valid copies of the following where applicable: i) Business Registration Certificate; ii) Valid Tax Clearance Certificate; and iii) Accreditation Certificate. The completed application for registration should be submitted by to (or (lmwaritay@yahoo.com or pdawolo@yahoo.com) or to the address below, latest by May 23, For further clarification on how to fill-in the forms, please call the following numbers: ( or ). Many thanks in advance for your kind cooperation. Best regards, The Procurement Director Ground Floor Ministry of Gender and Development Corner of UN Drive and Gurley Street Monrovia, Liberia

2 FORM 1: SUPPLY OF GOODS, WORKS, AND PROVISION OF NON-CONSULTANCY SERVICES Required Documentation Checklist Please ensure that all listed documentation below is attached (where applicable) to the registration form. Document Name Attached Original Valid Tax Clearance Yes No Business Registration Yes No Copy of Accreditation Certificate Yes No For Office Use Only Status of registration form: Approved Decline Awaiting Approval 1

3 Form 2: Supplier Details Company/Supplier Name Tax Identification Number (TIN) Web Address Address Telephone Number Company s /Supplier s Physical Address Postal Address (if Available) Insert supplier grouping details Type of Firm (Please tick the relevant box) Public Company Private Company Corporation Joint Venture Sole Proprietor Foreign Company Partnership Other (Please specify) Main contact person in your business Name Company Position Cell Phone Number Address 2

4 Goods, Works and Non-consulting Services Please list a maximum of six (6) Goods, Works or Non-consulting services for which your company/business wishes to be registered with the Ministry of Gender and Development. Please indicate only your core business activities

5 FORM No. 3: Consultancy Services No. Consulting Firm Areas of Expertise Country Current Address 4. Phone Number 5. Address 6. Name of Firm 7. Address of Firm 8. Main Contact Person 9. Tax Identification Number (TIN) 10. Assignments undertaken (in the last 3 years) 4

6 FORM No. 4: Consultancy Services Individual Consultant No. Areas of Expertise Family Name Middle Name Gender 4. Nationality- Country 5. Dependents 6. Current Address 7. Phone Language(s) 10. Educational Status /Degree 1 Are you a member of any Professional Association? If yes, please state. 1 Plesae state assignments undertaken in the last three (3) years 5