Staatsolie - Suriname's National Energy, Oil & Gas Company

1. Registered legal name of business: *

2. Trading name (if different from question above): *

3. Address: *

4. Postal address: *

5. Telephone: *

6. Website:

7a. Contact person (general): *

7b. Position: *

7c. Telephone/Mobile : *

7d. Email address: *

8a. Contact person (accounts representatives): *

8b. Position: *

8c. Telephone/Mobile : *

8d. Email address: *

9a. Name of persons authorized to sign for contract purposes: *

9b. Position: *

10. Date and place of business registration: *

Attachment 1: Organization chart of your company (incl. names of key personnel) *

Attachment 2: Certificate of Incorporation or Extract from the Chamber of Commerce *

11. Name of owner(s)/partners/directors: *

12. Type of company: *

13. Total number of employeeson pay-roll: *

14. Approximate number of years’ experience as a company: *

1. Bank name *

2. Bank address *

3. Sales turnover last financial year *

4. Sales turnover average over the last 3 years *

Submit the latest annual report of your company (preferably not the Group Consolidated Report)

1. Have you or has your business been the subject of legal proceedings for insolvency, bankruptcy, receivership, or your business activities suspended for related reasons? *

No
Yes

2. Are you or your staff subject of legal proceedings for corrupt or unethical business practice or offering any inducement to any procurement entity in order to be considered for tender award?

No
Yes

3. Do you have any immediate family members who are currently conducting business with Staatsolie or is an employee of Staatsolie? *

No
Yes

4. Is your company in any way associated with any other firm that is currently conducting business with or has applied to be considered for pre-qualification or any other tender in Staatsolie? *

No
Yes

1. Do you have an ISO (or other) certification for this type of work? * *

Yes
No

2. Name of the certifying institute:

Attach relevant documentation if available

4. State if your company has any quality or environmental standard certification

Yes
No

1. Does your company have a Health, Safety and Environment program in place? *

Yes
No

2. Does your company have a Alcohol and Drug Policy? *

Yes
No

3. Does your company have an HSE incident reporting system? *

Yes
No

Number of fatalities: *

Number of lost medical Treatment and/or First Aid Cases: *

Please list up to 5 major contracts still current or completed in the last three years, under the following headings (substitute your own schedules if you wish and give as much detail as is relevant to undertaking the pipeline project)

Please provide any other information you would like to include

I hereby confirm that the information given in this form and the attachments are true and correct and acknowledge the right of Staatsolie Maatschappij Suriname N.V. to verify the information. I agree that Staatsolie Maatschappij Suriname N.V., at its sole discretion, may disqualify the company from registration and further participation in case any information given in this form seems to be false or incorrect. *

Confidence in our own abilities

See an error? Let us know. Thank you!