Vendor Registration

Name of your contact at NYUADC: *

NYUADC contact email: *

Do you have a member of the same family, household* or friends who are employed by NYUADC?: *
*A Member of the same family or household is defined as a spouse, dependent children, and any other family members or persons residing in the same household as a University employee.

Yes No

Select the estimated Procurement value (product/service): * Less than USD 10,000 Between USD 10,000 and 50,000 Above USD 50,000

Is the NYUADC end user requesting this service and/or providing payment a member of your family or household? *

Yes No

Company/Organization Name: *

Address: *

P.O. Box: *

City: *

Country: * Choose one United Arab Emirates Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong, China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger NigeriaNiue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of the Congo Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan, China Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

Zip Code: *

Company Main Number: *

Website:

Number of years of UAE trading history: * Less than 1 year 1-2 years 3-5 years Over 5 years None

Area of Expertise *

Other services provided *

UAE Commercial License Number: *
If you are a government entity, enter UAE government

Chamber of Commerce Membership Number:

Do you have license to import: *

Yes No

Are you registered for VAT in the UAE: *

Yes No

Tax Registration Number: *

Willing to share financial statements up to (Please upload the documents in Upload Documents section) * 1 Year 2 Year 3 Year None

Willing to provide a performance bond * None NA TBD 10% Less than 10%

Contact Name: *

Title: *

Office Phone: *

Mobile Phone: *

Email Address: *

Contact Name: *

Title: *

Office Phone: *

Mobile Phone: *

Email Address: *

Purchase Order Auto Dispatch Email Address: *

Logistics Contact Name:

Logistics Contact Email Address:

6 (six) digit Vendor Code: *

Please follow the instruction below to help you find your Supplier Categorization 6 digit Code

1. Go to the North American Industry Classification System Find your 6 (six) digit code
2. Type in keyword related to your primary business offering — eg. Laboratory
3. Then review the general list and find your specific category — eg. Laboratory equipment, dental and medical merchange wholesalers.
4. Find the code corresponding to your category and enter in the box above

Is your company based in UAE and VAT registered:* (If yes submission of VAT certificate is mandatory)

Yes No

Does your company comply with all applicable UAE labor laws? *

Yes No Not applicable

Are you personally or any of your affiliate companies incorporated or registered in Sudan or Iran? *

Yes No

Do you use contractors or consultants who reside or are incorporated or registered in Sudan or Iran? *

Yes No

Number of references you would be willing to provide * 1 Reference 2 Reference 3 Reference More than 3 Reference

Company: *

Contact Name: *

Email Address: *

Phone: *

Address: *

Type of Insurance: * General Third Party Liability Worker's Compensation Professional Liability (Errors and Omissions) Auto Liability Contractor All Risk N/A

Insurance coverage (e.g. PI, TPL, etc.) amount: * None Not Applicable Up to $1m Between $1-2m Over $2m

Check here to indicate you have read and agreed to the terms and condition laid out in the above document. *
In case of a definitive agreement signed between the parties for the sale or supply of goods or services, such Agreement shall be deemed to incorporate the NYUADC Terms & Conditions appended herewith. To the extent there is any conflict or inconsistency between the two, the Agreement shall take priority.

Are you providing a service that involves “on campus” work by your company’s employees and/or sub-contractor(s) if any? *

Yes No

Please review the Supplier Code of Conduct (PDF)

Check here to indicate you have read and agreed to the terms and condition laid out in the above document. *
In case of a definitive agreement signed between the parties for the sale or supply of goods or services. Such Agreement shall be deemed to incorporate the NYUADC Terms & Conditions appended herewith. To the extent there is any conflict or inconsistency between the two, the Agreement shall take priority.

I certify that the above information is accurate and complete to the best of my knowledge. I understand that as a vendor registered at NYUADC, I am liable for notifying the NYUADC Procurement department of any changes to this information, and failure to do so might cause a delay in payment. I have attached copies of my company's valid UAE Commercial License, Chamber of Commerce membership, Certificate of Insurance and License to Import (if applicable) to this form and will provide updated copies of these documents annually to NYUADC Procurement. *