Vendor Application Form - LAFON

TOTAL KENYA LTD
VENDOR VETTING FORM - QLTY 031-1

(CONFIDENTIAL)
1
1.1
GENERAL INFORMATION
Identification:
Company:
LAFON TECHNOLOGIES
P.O. Box:
Location:
Post Code:
33530
City: BASSENS
Telephone:
+33 5 57 80 80 80
Fax:
Web Site:
www.lafon.fr
Legal Status:
SAS
1.2
Share Capital :
10 000 000
Turnover:
40 000 000
1.3
Petroleum Equipments Manufacturer
Contact Persons:
Function
Surname Name First Name
Sales Manager
Area Bussiness
Manager
Mobile:
Email: contact@lafon.fr
Date Established:
Scope of Business:
Country: FRANCE
+33 5 56 31 61 21
VALADE
JeanFranois
DUMERY
Neil
Phone
Number
+33 6 80 32
98 32
+33 6 23 32
23 32
Email
jeanfrancois.valade@lafon.fr
neil.dumery@lafon.fr
Shareholders/Group:
Yes
YES
YES
YES
Does your Company belong to a group?

Do you have participation in other companies?
Do you have agreements with other companies?
1.4
No
Principal shareholders of the Company (or group)

Madic Group
% of participation
100 %
Structure and Business Agreements:

Main affiliates or participations in other companies
% of participation
You are welcome to send the presentation brochure and organization chart of your Company and/ group
1.5
Insurance:
Does an insurance company cover the liability risk for your activities?
What is the limit of your liability risk insurance cover
1.6
Human Resource:
Staff:
Total number of wage-earning workers employed
May 2007
Current Year
Yes
YES
1000000
No
Last Year
QLTY 031-1
Page 1 of 9
Vendor:
(For contractors, also fill 3.7)
This form must be accompanied with copies of: 1) VAT
Registration, 2) PIN
Certificate, 3) Certificate of Incorporation, 4) Bank Statement, 5) VAT Compliant Report, 6) ETR/ESD Compliance
2
FINANCIAL
INFORMATION
2.1
Business Performance (In Kes 000s):
Year N-2
Year N-1
Year N
(Expected
Results)
Turnover
39 954 430
38 750 300
39 000 000
Personnel Cost
5 560 422
5 503 000
5 622 620
Other Operational Costs

Depreciation Costs
Financial cost
Net Profit
Investments
Training Expenses
Operational Result
Exceptional Result
Net Debts
2.2
Bank Details:
Account
Name : BNP PARIBAS PAYS DE LOIRE
Bank Name : BNP PARIBAS
Branch :
Account
00010742575
Number :
Swift CODE : BNPAFRPPVLE
Bank Key :
IBAN :
May 2007
4
FR76 3000 4024 0800 0107 4257 558
QLTY 031-1
Page 2 of 9
Vendor:
3 ACTIVITIES: GENERAL
3.1
Geographical Presence:
Please list your main site (Head Office, Representation, Industrial site etc.)
SITE
Country
3.2
FRANCE
BASSENS
ESPAGNE
LEON
ALGERIE
ANABA
Who are your main customers?

Customer
Address
TOTAL AMO
TOTAL New
Caledonia
Exxon Mobil
Do you export -?
3.3
3.4
SCOPE (ACTIVITY)
City
Yes
Telephone
LARCHEVEQUE
Noumea
BILLET
Thailande
CHUNG
No
Who are your customers outside Kenya?

Customer
Address
Who are your main suppliers?

Supplier
Sales (Kes)
May 2007
Contact
Paris
Telephone
Telephone
Contact
Contact
Annual Purchases
QLTY 031-1
Page 3 of 9
Vendor:
3.5
Are you a manufacturer, Distributor or Trader? (Please classify product)

As a Company you are?
Product
Manufacturer
Distributor
Trader
1.
2.
3.
CONTRACTOR ONLY
3.6
Are you: a contractor/sub-contractor?
Yes
No
If yes, list main activities:1.

2.
3.
3.7
Years of work experience:

Key Personnel/Staff
3.8
Qualifications
Experience
You are registered under what class:

Registration/Certificate obtained - List:1.
2.
3.
Equipment: List main equipment owned:1.
2.
May 2007
QLTY 031-1
Page 4 of 9
Vendor:
3.
3.9
Key projects completed:

Project
Value
Contact
Contact Address
4 QUALITY: ENVIRONMENT
4.1
4.2
Commitment:
Is there a written commitment (policy statement) issued by the top management of your
Company regarding:Yes
No
Sustainable development
X
Health and Safety
Environment
Quality
Quality Management:
Yes
For the activity concerned with this questionnaire, does your Company
have a national or international certification?
Do you have own specifications concerning work practices, procedures
or designs?
X
X
Do you have set procedures for conducting the various types or works?
Can a quality or safety inspector inspect your premises?
Do you carry out internal audits? If yes, specify which types
Do you have a training plan for your staff?
Does your technical staff have the necessary certification in relation to

their duties? (e.g. electrician, welder...)
Certification or referential
Certification or Referential
ISO 9001
ISO 14000
May 2007
Activity
Sites
ALL
ALL
No
Validity Date
2018
2018
QLTY 031-1
Page 5 of 9
Vendor:
4.3
Environmental Management:
Environmental Certification
Does your Company have a national or international certification?
Do you manage the waste from the sites through a regulatory process?
Is your staff aware and trained on waste management?
Certification and Referential
Activity
Sites
ISO 9001
Industrial
all
Process
ISO 14000
Environmental
all
process
Yes
No
Formatted: Centered
X
X
X
Formatted: Centered
Formatted: Centered
Validity Date
2018
2018
5 SAFEFTY AND HEALTH

5.1
Safety and Health Management:

Yes
No
For the activity concerned by this questionnaire, does you Company

have a national or international certification?
5.2
For companies already regarding Safety & Health Management:

Your Safety and Health Manager
: _______________________________________
Certification or Referential of Safety & Heath

Activity
5.3
Sites
Validity Date
Safety & Health Questionnaire:

Yes
Do you have the necessary personal protective equipment to carry out works?
If yes, please give details of equipment: Helmet, Glove, Glass.
Do you have Safety & Heath rules and regulations which all staff and
contracted employees must adhere to?
Is your staff trained on specialized works such as hot works, entry into
confined spaces, electrical works, degreasing etc?
Do you frequently review all your equipment for safe working conditions? If
yes, please give details of the frequency of checks:
Do you have a Safety & Health Committee that meets on a regular basis? If
yes, give details of frequency of meetings:
Do you treat waste generated though your activity or works? If yes, give an
example of waste management conducted by your Company:
Do you conduct annual occupational medical examination of your
own/contracted staff?
Has your staff been trained on fire fighting with hazardous products?
Do you have necessary fire fighting equipment? If yes, please give details of
the equipment.
May 2007
No
X
Formatted: Centered
Formatted: Centered
Formatted: Centered
Formatted: Centered
Formatted: Centered
Formatted: Centered
Formatted: Centered
Formatted: Centered
Formatted: Centered
QLTY 031-1
Page 6 of 9
Vendor:
Details
5.4
Accident statistics over the past 2 years for your permanent and contracted staff:
Year N-1
Year N-2
Number of accidents that resulted in injuries and lost working days.
Number of accidents that resulted in slight injuries and no lost working
days.
5.5
Reporting of accidents and incidents:

Year N-1
Do you report all accidents that result in major or slight injury?
Do you investigate all serious and fatal injuries?
5.6
Control of critical equipments:

Year N-1
Do you have a list of risks related to your activities?
Year N-2
YES
In the face of these risks, do you have operating procedures and PPE?
Do you carry out periodic inspections of critical equipments used in
your activities, with records available?
6.0
Year N-2
YES
YES
Conflict of Interest
Yes
No
Do you have any filial or business relationship whatsoever with any

staff member of Total Kenya Ltd?
If yes, provide the name of the staff and the nature of the relationship.
Name
Nature of Relationship
1.
2.
Declaration:
I/We certify that the information given is correct and any intentional provision of incorrect/false
information will automatically lead to disqualification.
Form filled by:
May 2007
Name _____________________
Sign: _____________________
QLTY 031-1
Page 7 of 9
Vendor:
Date
_____________________
Company Stamp/Seal
FOR OFFICIAL USE ONLY

YES
NO
1. Have you seen the Vendors recent bank details?

Comment :
2. Comment on Vendors organization :
3. Vendor is recommended:
Not recommended
Reasons:
Reviewed by:
Procurement Committee
(1)
(2)
(3)
(4)
(5)
Approved by: _________________________

Managing Director
May 2007
Date: ___________________
QLTY 031-1
Page 8 of 9
Vendor:
SAP-TL INFORMATION
Vendor Account Number:
Purchase Organisation:
1816
9816
Vendor created in SAP-TL by:

Name : ________________________
Sign: ______________________
Date : _________________________
May 2007
QLTY 031-1
Page 9 of 9

Vendor Application Form - LAFON

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Vendor Application Form - LAFON

Uploaded by

Copyright:

Available Formats

TOTAL KENYA LTD

VENDOR VETTING FORM - QLTY 031-1

Petroleum Equipments Manufacturer

Does your Company belong to a group?

Principal shareholders of the Company (or group)

Structure and Business Agreements:

Business Performance (In Kes 000s):

Other Operational Costs

Who are your main customers?

Who are your customers outside Kenya?

Who are your main suppliers?

Are you a manufacturer, Distributor or Trader? (Please classify product)

Are you: a contractor/sub-contractor?

If yes, list main activities:1.

Years of work experience:

You are registered under what class:

Key projects completed:

Can a quality or safety inspector inspect your premises?

Do you carry out internal audits? If yes, specify which types

Do you have a training plan for your staff?

Does your technical staff have the necessary certification in relation to

5 SAFEFTY AND HEALTH

Safety and Health Management:

For the activity concerned by this questionnaire, does you Company

For companies already regarding Safety & Health Management:

Certification or Referential of Safety & Heath

Safety & Health Questionnaire:

Reporting of accidents and incidents:

Control of critical equipments:

Do you have any filial or business relationship whatsoever with any

FOR OFFICIAL USE ONLY

1. Have you seen the Vendors recent bank details?

2. Comment on Vendors organization :

Approved by: _________________________

Vendor created in SAP-TL by:

You might also like