Instructions on NHG e-Procurement Portal Supplier Account Authorisation & Activation
Required to be completed in this form:
Part 1: Authorisation Form for Account Activation
Part 2: Types of Services, Fees Payable and Payment Method
Part 3: Declaration and Undertaking
1. To enable us to expedite the processing, please provide all information requested.
2. Please confirm the point of contact from your organization and key in the contact details into the form below.
3. The form should be submitted with approved signatory of your company i.e. MD or equivalent.
4. Upon completion of this activation form, you are required to submit One (1) signed PDF file format (from page 1 to page 5) and email to .
5. Please save the PDF file name in the following format NHG-SE-[UEN]. UEN is your company’s unique entity no or ACRA Business Registration No e.g. NHG-SE-1999189M
6. We are pleased to inform you that SESAMi has based on NHG’s request to waive all Annual Subscription and Registration Fee.
7. Please note that SESAMi will accept payment via:
a. DBS, OCBC and/or Citibank Commercial and/or any of their Visa/MasterCard issued by the 3 banks;
b. Direct Credit (Information of our Account to enable Electronic Payment provided);
c. GIRO (Please refer below for the Application for Interbank GIRO Form); or
d. Cheque (Administrative fees and refundable security deposit applies).
8. Upon receiving the duly signed authorisation form, we will follow up with issuing of User ID and password to the approved point of contact.
9. Should you encounter difficulties in completing the form, or if you need further information, please contact us at
a. , or
b. contact Ms. Sharon at or (65) 6302 5327, or
c. call SESAMi hotline (65) 6333 1188
d. contact SESAMi at
SESAMi (Singapore) Pte Ltd
7B Keppel Road
#06-07/08 Tanjong Pagar Complex
Singapore 089055
Tel: (65) 6302 5300
Fax: (65) 6302 5301
E-mail:
- All information provided will be held in the strictest confidence
Agreement No.:______
(for SESAMi’s official use)
NHG e-Procurement Portal Supplier Account Authorisation & Activation
Part 1: Authorisation Form for Account ActivationApplicant Details
Registration No (UEN)*: /
Company Name :
Mail To Address : /
Bill To Email Address : /
POINT-OF-CONTACT DETAILS
Point-of-Contact Name
Department : /
Designation : /
E-mail Address : /
Mobile Number : /
Office Number :
Additional User Name1
Department : /
Designation : /
E-mail Address : /
Mobile Number : /
Office Number :
Additional User Name2
Department : /
Designation : /
E-mail Address : /
Mobile Number : /
Office Number :
* Please submit photocopies of certificates for verification. Note: All fields are mandatory
Part 2: Types of Services, Fees Payable and Payment Method
Credit Card
Name on Card / :
Credit Card No / :
Expiry Date (MMYY) / :
Type of Card / : / Visa / MasterCard / Issuing Bank / : / DBS / Citibank / OCBC
DIRECT CREDIT
Bank Name / : / Development Bank of Singapore / Bank Code : / 7171
Bank Branch / : / South Bridge DBS / Branch Code : / 010
Bank Address / : / 531 Upper Cross Road #01-51 Hong Lim Complex Singapore 050531
Bank Country / : / Singapore / Account Name : / SESAMi (S) Pte Ltd
Account Number / : / 010-900727-0
Swift Code / : / DBSSSGSG
GIRO
Please refer below for the Application for Interbank GIRO Form.
Cheque
An administrative fee of $7 is applicable for payment made by cheque. In addition, a mandatory refundable security deposit of $200 is required and to be made by cash or cheque within 7 working days after the authorisation form submission. All cheque payments must be clearly crossed and made payable to SESAMi (Singapore) Pte Ltd.
PAYMENT POLICY
Payment of transaction fees are to be made within thirty (30) days from Invoice date. Failure to comply with payment terms will result in the de-activation of supplier account. Thereafter, any re-activation of account will be chargeable at $100 per User ID.
Part 3: Declaration and Undertaking
I, on behalf of the applicant entity named above (the “Applicant”), hereby:
(i) declare that the above named Point-of-Contact is authorised at all times to operate and utilise any of the services granted and provided to us through the online NHG e-Procurement Portal, and that such Point-of-Contact shall be deemed to be authorised at all times to act on behalf of the Applicant and to have the necessary capacity and authority to bind the Applicant to contracts of any amount;
(ii) declare that all the information provided herein is true and accurate as at the date of this application;
(iii) authorise SESAMi (S) Pte Ltd (“SESAMi”) to issue login details to the above named Point of Contact for National Healthcare Group Pte Ltd and all the participating clusters^ eProcurement online account;
(iv) undertake that, in the event that paragraph (i) above is untrue in any way, we shall promptly deactivate and revoke the National Healthcare Group Pte Ltd and all the participating clusters eProcurement online account for the Point-of-Contact by notice to SESAMi; and
(v) acknowledge and agree that each of SESAMi and National Healthcare Group Pte Ltd and all the participating clusters are entitled to rely on the correct use and/or entry of the prescribed login procedure by the Applicant as conclusive evidence of the authenticity of any communications received via the Point-of-Contact’s National Healthcare Group Pte Ltd and all the participating clusters online account.
Signature of Authorised Signatory ** / Date / Company Stamp
Name / : / Designation / :
NRIC/FIN / : / / Mobile/Office No / : /
^ The participating clusters refer to institutions under the following:
· National Healthcare Group Pte Ltd (NHG) cluster;
· National University Health System (NUHS) cluster;
· Jurong Health Services (JHS) cluster;
· Alexandra Health Pte Ltd (AHPL) cluster.
** To be signed by :
· For a sole proprietorship – the owner;
· For a partnership / limited liability partnership – a partner;
· For a club / society / association / management of a building – the chairman / president, secretary or treasurer of the committee or other governing body (or persons holding similar or equivalent positions); and
· for a company – a director
APPLICATION FOR INTERBANK GIRO
PART 1: PLEASE COMPLETE THIS FORM AND RETURN TO SESAMi (S) PTE LTD
Date: / Name of Billing Organization:
SESAMi (S) Pte Ltd
7B Keppel Road #06-07/08/09
Tanjong Pagar Complex
Singapore 089055
Name of Bank:
Business Registration Number / UEN:
Branch: / Paying for (if not applicant)
A) I/We hereby instruct you to process SESAMi (S) Pte Ltd’s Instructions to debit my/our account.
B) You are entitled to reject SESAMi (S) Pte Ltd’s debit instructions if my/our account does not have sufficient funds and charge me/us a fee for this. You may also at your discretion allow the debit even if this results in an overdraft on the account and impose charges accordingly.
C) This authorization will remain in force until terminated by your written notice sent to my/our address last known to you or upon receipt of my/our written revocation to SESAMi (S) Pte Ltd.
My/Our Name(s) as in Bank Account: / My/Our Contact Number(s): / NRIC Number:
My/Our Bank Account Number: / Signature/Thumbprint: (As in Bank’s record)
Please impress your thumbprint clearly if your bank account is operated by thumbprint.
PART 2: TO BE COMPLETED BY SESAMi (S) PTE LTD
Bank Branch SESAMi Account No.
7171 010 0109007270
Bank / Branch / Account No. to be debited
PART 3: TO BE COMPLETED BY BANK
To SESAMi (S) Pte Ltd
This Application is REJECTED (tick where applicable) for the following reason(s):
Signature/Thumbprint# differs from Financial Institution records. Wrong account number
Signature/Thumbprint# incomplete/unclear# Amendments not countersigned by customer
Account operated by Signature/Thumbprint# Others ______
Name of Approving Officer / Authorized Signature / Date
*For thumbprint, please go to the branch with your identification
#Delete where applicable
NHG e-Procurement Portal Supplier Authorisation Form v 1.0 / Page 1 of 3