ISRAEL ELECTRIC CORP. LTD.
ORGANIZATION, LOGISTICS & SECURITY
SUPPLY & STORES DIVISION
SUPPLIER CERTIFICATION UNIT
MANUFACTURER QUALIFICATION QUESTIONNAIRE
Page 1 of 4
1.
Company Details
Name
Previous names
Private Company
Public Company
Other
Address
Telephone No.
Fax No.
E-mail
Address for Correspondence
Country and Registration Date:
Registration No.
(Attach a Copy of the Registration Certificate)
Factory details:
Address for Correspondence :
Name
Office Name
Address
Address
Telephone No.
Telephone No.
Fax No.
Fax No.
E-mail
E-mail
External auditor:
Office Name
Address
Telephone No.
Fax No.
E-mail
Page 2 of 4
Local Agent*
Name
Address
Telephone No.
Fax No.
E-mail
* Attach letter of authorization including the full details of the Local agent
2. Company Profile
General Description of the Company
Company Owners
Names of Senior Company Officers:
Chief Executive Officer (CEO)
Chief Financial Officer (CFO)
President
Chairman of the Board
Directors
Vice-President of Finance
Vice-President of Marketing
Other Senior Management Officers
Names of Major Shareholders
Name & Address of Parent Company and Subsidiaries (including percentage of
holdings)
Has the company been declared a company in liquidation temporarily/permanently* in the last three years?
Yes
no
Has any law court appointed a receiver or trustee or administrator during the last three years?
Yes
no
Major Creditors:
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*Delete the Unnecessary
Has any substantial claim* been filed against the company or is any claim pending?
If yes, specify:
No
Yes
Has the company acquired all the necessary licenses required by law in to manage its business and to
supply products/services**? Yes
No
If no, specify:
3. Manufacturing Ability
Description of main products*
Description of main manufacturing facilities:
Description of annual production capacity:
4. Quality
Do you have a certified Quality Management System?****
Yes
No
Are you certified/accredited to other standards**?
Yes
No
If yes, please specify:
* "Substantial claim" is a claim which could have a material effect on the
Company's capital, profit or operation.
** Please delete the unnecessary.
* ** Attach a list of clients and equipment installations during the last three years.
**** Attach Quality Management System certifications and a quality manual.
Do you work according to other standards?
If yes, specify:
Yes
No
Page 4 of 4
5. Financial information
Bank
Branch
International Bank Account No.
Country
Specify total turnover for each of the last five years
The company must attach to this questionnaire hard copies of annual reports in English (including
notes) duly signed and certified by it's independent Auditors and it's authorized officers for the last
three years including: balance sheet, income statement and cash flow statement, (attached annexure).
The qualified supplier must provide IEC with annual audited Financial Statements in English as mentioned
above once every three years, during the period of qualification
IEC reserves the right not to qualify the supplier nor renew his qualification in the event of supplier's
failure to submit the requested reports, as requested above.
Please Note:
It is the duty of the supplier to inform the IEC immediately of any change in the
information provided in this questionnaire.
Please send all information to: ISRAEL ELECTRIC CORPORATION LTD.
ORGANIZATION, LOGISTICS & SECURITY
Supply & Stores Division
Supplier Certification Unit
P.O.Box 10
Haifa 31000,
Israel
Tel: 972-4-8182506/7
fax: 972-4-8182508
Signature
Position
Name
Date
Company
Country
Private or Public Company
Currency
Year
Year
Year 3
Balance Sheet
Assets
Total Current Assets
Cash & Equivalents
Marketable Securities
Trade Receivables
Other Receivables
Inventory
Non- Current Investments
Net Fixed Assets
Other Assets
Total Assets
Total Current Liabilities
Long Term Liabilities
Other Liabilities
Provisions
Minority Interest
Share Capital & Reserves
Retained Earnings
Miscellaneous
Total Liabilities
Year
Year
Year 3
Profit And Loss Acct.
Sales
Cost Of Sales
Selling & Administrative Exp.
Research & Development Exp.
Other Expenses (Income)
Share of Subsidiaries Results
Financing Expenses (Income)
Income Tax
Expenses (Income) After Tax
Year
Year
Year 3
Profit And Loss Acct.
Minority Interest
Earnings per Share
Net Profit
Year
Year
Year 3
Cash Flow
Cash From Operating
Cash From Investments
Purchases of Plant, Equipment Machinery
Cash From Financing
Exchange Differentials
Increase (Decrease) In Cash
Number of Employees
External Auditor's Signature:
Company's Authorized Representative
Signature: