New Supplier Form

Supplier Type:

CIS Status

Company Name:

Requested by

VAT Number:

Company Registration No

Current Annual Turnover:

Company UTR

Company Contact Name:

Company Phone:

Address

Address Line 2

City

Postal / Zip Code

State/Region/Province

Who in your organisation is ultimately responsible for health and safety?

Name:

Phone

Who in your organization is responsible for the management of health and safety?

Name:

Phone

Who in your organization is responsible for the management of health and safety?

Name

Position

Phone

Qualifications

Attach a copy of your organisation's health and safety policy statement.

Attach an example of a method statement and associated risk assessment for work similar to those being carried out.

Are your Engineers DBS Checked?

Yes No

Supply details below of any relevant trade/professional associations that your organisation subscribes/belongs to (i.e. Gas Safe):

Locations Covered

Supply evidence of the following insurances.

Public Liability

Employers Liability

Bank Details

Account Name

Account Number

Account Sort Code

Completed by

Name

Position

Signed

This questionnaire is to be used in assessing the competence of a potential contractor. It should be completed in as much detail as possible and returned with all the requested support information. Please contact [email protected] if you have any queries. PLEASE NOTE THAT IF ANY OF YOUR DETAILS CHANGE IT IS YOUR RESPONSIBILITY TO INFORM US