CORE LABORATORIES’ANTI-CORRUPTION COMPLIANCEQUESTIONNAIRE TO PROSPECTIVE SALES REPRESENTATIVES, DISTRIBUTORS AND SUBCONTRACTORS
Thank you for your interest in providing services as either a sales representative, distributor or subcontractor (a “Service Provider”) to Core Laboratories, and its subsidiaries, divisions, affiliates and branch offices(“Core Lab”). As a public company subject to the laws of the United States and the various countries where Core Lab sells products and/or performs services, Core Lab has an affirmative obligation to know the background and qualifications of those persons who assist Core Lab in doing business and ensure those companies operate in an ethical and legal manner.
Core Lab requests you complete this Questionnaire. Please complete the Questionnaire as completely and accurately as possible. Incomplete answers may delay or prevent your approval as aService Provider. In the event Core Lab enters into an agreement with you, this Questionnaire may be incorporated as part of that agreement and your obligations to comply with all laws will be included in that definitive agreement before you render service to Core Lab.
In this Questionnaire, you and your company will be referred to as the Applicant. The term Applicant also refers to any affiliate of Applicant. References to “Anti-Corruption Laws” mean the laws of the United States,including the U.S. Foreign Corrupt Practices Act, the laws of the United Kingdom, including the Anti-Bribery Act of 2010 (the “2010 U.K. Act”)and other similar laws, as well as those of the country(ies) where Applicant will work with/for Core Lab, that prohibit the direct or indirect offer or payment of money or gifts to Public Officials in exchange for a business advantage.
The term “Applicant” means either an individual who will serve as the representative or a business entity if it will serve as the representative.
A “Public Official” includes any officer or employee or person acting in an official capacity for or on behalf of:
- any department, agency, or instrumentality of a government;
- a national company, such as a national oil company;
- a political party; or
- a public international organization (such as the World Bank Group);
Please answer in the space below or attach additional pages as necessary to answer each question completely.
1.Please provide the following information about Applicant:
(a)Full Legal Name:
(b)Other Assumed Names or Business Names:
(c)Business Address:
(d)Telephone:
(e)Fax:
(f)E-Mail:
2.What is Applicant’s primary type of business?
3.Please provide the following information about Applicant, if operating as a business rather than as an individual:
(a)Who are the owners, directors and officers?
(b)Who are the significant employees who will be involved in providing substantial services to Core Lab?
(c)Who are the shareholders and beneficial owners of Applicant (if different from above)?
4.Formation and registration of Applicant,if operating as a business rather than as an individual:
(a)Date of incorporation/formation:
(b)Commercial Registration Number/Business License or Registration:
(c)Jurisdictions where Applicant is authorized to conduct business:
5.(a)How long has Applicant been in business?
(b)What other lines of business is Applicant in?
(d)How much of Applicant's business is in the oilfield services industry and for how long?
Please provide a brief summary of the business experience that demonstrates Applicant is qualified to represent Core Lab and/or the experience of significant employees who will provide substantial services to Core Lab. You may provide a narrative of your experience or attach marketing materials, a resume or a curriculum vitae if you have one.
6.Are any of your officers, directors, shareholders, owners, or employees currently Public Officials, or do they currently have close family, business, or other ties with Public Officials? If ‘Yes’, please provide additional information on a separate sheet.
Yes ______No ______
7.Are any of your officers, directors, shareholders, owners, or employees formerPublic Officials, or have they previously had close family, business, or other ties with Public Officials? If ‘Yes’, please provide additional information on a separate sheet.
Yes ______No ______
8.Has Applicant or anyone on behalf of Applicant made a payment to any Public Official in connection with the promotion of goods or services of Applicant or any client of Applicant? If ‘Yes’, please provide additional information on a separate sheet.
Yes ______No ______
9.Has Applicant or anyone on behalf of Applicant paid the expenses (travel, meals, lodging, per diem, etc.) of any Public Officials or their relatives in connection with the promotion of goods or services of Applicant or any client of Applicant? If ‘Yes’, please provide additional information on a separate sheet.
Yes ______No ______
10.For purposes of compliance with the 2010 U.K. Act, has Applicant or anyone on behalf of Applicant made a payment to any non-Public person or entity in exchange for favorable treatment on any project or business opportunity? If ‘Yes’, please provide additional information on a separate sheet.
Yes ______No ______
11.For purposes of compliance with the 2010 U.K. Act, has Applicant or anyone on behalf of Applicant paid the expenses (travel, meals, lodging, per diem, etc.) of any non-Public person or entity in exchange for favorable treatment on any project or business opportunity? If ‘Yes’, please provide additional information on a separate sheet.
Yes ______No ______
12.For purposes of compliance with the 2010 U.K. Act, has Applicant or anyone on behalf of Applicant received a payment or other consideration from any potential customer in exchange for favorable treatment on any project or business opportunity? If ‘Yes’, please provide additional information on a separate sheet.
Yes ______No ______
13.Do you understand the prohibitions of Anti-Corruption Laws and do you agree to comply with those laws in representing Core Lab?
Yes ______No ______
14.Do you understand that if you are engaged to represent Core Lab, your obligation to not offer or make any payment to any Public Official or any non-Public person for purposes of obtaining or retaining business, and to comply with all Anti-CorruptionLaws is a continuing obligation?
Yes ______No ______
15.Has Applicant ever been you accused of violating Anti-Corruption Laws? If ‘Yes’, please provide additional information on a separate sheet.
Yes ______No ______
16.Does Applicant have any contracts, understandings or agreements with any government department or agency, including national oil companies, political parties, or public international organizations? If so, please describe who the contract is with and the nature of the contract on a separate sheet.
Yes ______No ______
17.Have you or do you intend to enter into any written or oral agreement with any agent, consultant or other representative to assist you in providing services to Core Lab?
Yes ______No ______
If ‘Yes’, please identify the agent, consultant or representative.
If “Yes”,is the agent, consultant or representative a present or former Public Official?
Yes ______No ______
18.Do you understand that the requirement that you comply with Anti-Corruption Laws applies to any agent, consultant or representative that you use and do you pledge to secure their compliance with Anti-Corruption Laws?
Yes ______No ______
Applicant hereby represents and warrants that the answers are complete, true, and accurate.
Applicant Name
By:______
(Signature)
Name: ______
Title:
Date:______
Thank you for your cooperation. We hope you understand the reason for these questions is not to be intrusive and that you understand our need for the information. Your answers will be reviewed and verified by a local representative of Core Lab and then forwarded to Core Lab senior management for review. If approved, an appropriate agreement will be prepared for your signature which will contain a certification that you will comply with Anti-Corruption Laws and that you will notify Core Lab of any change in your ownership, personnel or experience that would materially change your answers in this Questionnaire.
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