Page 1 of 4 United Nations Children’s Fund

UNICEF IRAQ, Iraq Support Centre in Amman (ISCA)

P.O. Box 1551, Amman11821Jordan

Telephone: (962) 6 551 5921/ (962) 6 551 4253

Facsimile: (962) 6 551 3745

Training & Consultation Companies / Institutes / Bureaus Profile Form (For UNICEF Iraq)

UNICEF fully subscribes to the Convention on the Right of the Child and draws the attention of potential training companies / institutes/ bureaus to Article 32 of the Convention which inter alia requires that a child shall be protected performing any work that is likely to be hazardous or to interfere with the Child’s education or to be harmful to the Child’s health or physical, mental, spiritual, moral or social development.
UNICEF reserves the right to terminate any contract unconditionally and without liability in the event that the training companies / institutes / bureaus is discovered to be in non-compliance with the national labour laws and regulations with respect to child employment.
The training companies / institutes / bureaus guarantees that neither any of their affiliates, nor any subsidiaries controlled by the companies / institutes / bureaus is engaged in the sale or manufacture of anti-personnel mines or of components utilized in the manufacture of anti-personnel mines. The training companies / institutes / bureausrecognize that a breach of this provision will entitle UNICEF to terminate contract with the company / institute / bureau.

I representing the training company acknowledge and ensure the company’s compliance with the above statement. By signing this form, I also confirm that any offer of compensation to any UNICEF staff person, no matter how small or in what form, may result in temporary or permanent exclusion from doing future business with UNICEF.

Company Name: ______Date:______

Name ______Signature: ______

Title: ______Company Stamp

For UNICEF Official use only:

Date Visited: ______By: ______

No. Assigned (ProMS):______

  • The following part should be completed by the training company / institute / bureau and submitted to UNICEF in duplicate.
  • Any information is for UNICEF official use only and will be treated as confidential.
  • Attach additional document(s), if space is not enough, but information must be provided in the following sequence for all columns.

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1. Present Company’s Name: ______

1-1. Previous Name of Company (if applicable): ______

(Please attach relevant document)

1-2. Parent Company’s Name (if applicable): ______

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2. Address (Street): ______

(Town):______(Governorate): ______

Postal Address (P.O. Box): ______

2-1. Please attach a sketch shown the location of your office

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3. TelephoneNumber: ______Cell: ______

4. Fax Number: ______

5. E-mail: ______

6. Website: ______

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7. Contract Person (minimum 2 persons)

7-1. Name: ______Title (official capacity): ______

Signature: ______

7-2. Name: ______Title (official capacity): ______

Signature: ______

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7-3. Name of Person authorized to collect cheque from UNICEF for payment:

Name: ______Title (official capacity): ______

Specimen Signature: ______Specimen Signature: ______

8. Type of Organization (only one is allowed to select and mark X)

State Enterprise: ______Private Company: ______Other (Please specify): ______

9. Please indicate the main services / products, you are interested in providing to UNICEF (briefly)

10. Please specify previous contracts in attached Annex A

11. Does your company hold Membership of National / International Professional Associations? Yes No (If yes, please attach proof of membership)

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12. Supporting Documentation for registration / establishment (Only if applicable, also please attach a copy of documents)

12-1. Ref No. ______Date of Issue:______Issued from:______

12-2. Date of Expiry of Lease Contract for Office Premise(s)

(Please attach a copy of the contract endorsed by Notary Public)

12-3. Date of Establishment: ______

(Please attach documents, e.g. Minutes of the First Meeting of Board of Director)

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13. Resources

13-1. Number of full time employees: _____ (Please complete Annex B)

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14. Maximum ceiling of a contract value, which company can work: USD $______

15.Gross Annual Turnover: Current year estimate: USD $______

Last year:USD $______

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16. Bank Name: ______

16-1. Bank Address (City & Country)______

16-2. Bank Account No. ______

16-3. Account Holder: ______

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17. Approved Standard (ISO, FDA, GMP etc. please specify:______

18-1. Does your company have a statement on quality policy?

YesNo(If yes, please attach a copy.)

18-2.Which of the flowing doe your company implement?

Raw Material Control:____Sub-Component Control:____

Process Control:____Final/Pre-delivery Control:____

18-3. Authorized Contact Person regarding Quality Control:

Name: ______Title: ______

Telephone: ______E-Mail: ______

19. Is your company covered by any third party liability insurance? YesNo

(If yes, please provide copy of relevant document,)

20. Does your company have a documented environmental policy?YesNo

(If yes, please provide copy of relevant document,)

I hereby certify that the information provide above and in all the Annexes are correct and that no person in any connection with this establishment as a principal or employee, so far as know, it employed by UNCIEF, or barred by UNICEF, as a training company / institute / bureau for providing training and consultation services.

Name ______Signature: ______Date: ______

Title: ______Company Stamp