World Islamic Economic Forum (WIEF) 2015 UK Islamic Finance delegation and pavilion Overseas Market Introduction Service (OMIS) Request Form All questions are mandatory questions. This form is purely to register your interest in receiving a quote from our Overseas Teams. At this stage you are not obliged to proceed. If you have any questions regarding this form or the service itself, please contact your International Trade Adviser (ITA) or the Central Support Team on 0207 234 3000. If you are using this form to register and pay for your attendance at an event run by our overseas UKTI teams, please complete the mandatory questions in all sections except Requirements and Experience, completing the Event Booking section instead. Please pay particular attention to Q7 and Q8. All completed forms should be submitted as a WORD document (NOT PDF) to your International Trade Adviser or to omis@uktilondon.org.uk. REGISTRATION 1a: Company Name b: Address including Postcode c: Position in Company 2a: Title b: Name c: Email d: Phone Number e: Alternative Phone Number COMPANY DETAILS 3a: Year Established b: Employees Please select c: Turnover Please select d: Export Turnover % Please select e: Website f: Short Profile of Company PRIMARY MARKET & SECTOR 4: Which is the Primary Country/Region you are commissioning this service for? Malaysia 5: Is this OMIS request related to a High Value Opportunity (HVO)? If yes, please state which one. No 6: Which sector will you be initially targeting? 1 2 TYPE OF SERVICE REQUIRED Market/Sector Report Contacts – Validated Visit Programme Contacts – Warmed Retainer Event – Group Subscription Event - Solo NATURE OF BUSINESS 7: Please describe your product/service including any unique selling points. The more information you can provide for our Overseas Team, the better. Who buys/uses your product/service? How is your product/service sold/marketed in the UK and Overseas? OBJECTIVES 8: Please state your specific requirements in commissioning this service. Please provide as much information as possible to guide our overseas team in your requirements. What would you like the overseas team to deliver for you and what are you ultimate goals in this market? ADDED VALUE 9: If the product/service is not manufactured/provided in the UK, please advise how you add value in the UK. ADDITIONAL INFORMATION 10: Please advise if you have any major deadlines. Please also feel free to forward any literature you may have. 3 11: Are you an adviser/consultant working on behalf of a client? If so please provide written confirmation from them authorising you to act on their behalf. 12: Are are currently represented in the country you are initiating this work in? 13: Do you have any contacts that UKTI should not approach during the research? 14: Are you happy for UKTI to disclose company information to potential contacts? If you would prefer to remain anonymous, please advise why. EVENT BOOKING Please only complete this section if you are using the OMIS service to pay for your attendance at an event run by our Overseas Teams. 15: Name and City of Event World Islamic Economic Forum (WIEF 2015) Kuala Lumpur 16: Date of Event 3-5 November 2015 17: Participation Fee £300 PERMISSIONS AND PAYMENT OPTIONS Please select your preferred method of payment. Credit/Debit Card Bank Transfer Cheque Billing Address if different from the one provided in the Registration Section. PLEASE READ You will need your log in details, supplied automatically on registration, in order to access and handle your OMIS directly. You will be supported by your UK Trade & Investment International Trade Adviser and a UK based system administrator who will be able to assist you with the process. You will be informed when action is required from you. You will be able to access your order, read and respond to key documents directly and electronically process the order. 4 DATA PROTECTION ACT 1998 Information regarding the collection, use, disclosure and processing of personal data is to be found in the Privacy Statement on the UK Trade & Investment website (www.ukti.gov.uk/uktihome/privacypolicy.html). We would like to send you UKTI news and event information, please tick here if you prefer not to receive this information by email Occasionally we work with carefully selected third parties, please tick here if you prefer not to receive information by email from carefully selected UK based Trade Association/Chamber of Commerce/Business partners Please tick here if you would prefer not to receive information by email from our overseas offices For further information on UKTI services please visit our website www.gov.uk/ukti EQUALITY & DIVERSITY MONITORING Please only provide this information if you have not done so before. We are monitoring the companies that use our services, to have a better understanding of the profile of our client base; your co-operation will help us to do this. We collect this data to make sure that we are reaching all of London’s exporting businesses. The specific information received will not be shared outside of UK Trade & Investment. It will not be used to decide if you are eligible for our services. We would like to know about the ownership of your company. If there is more than one owner, please tell us about the majority. Ethnicity o Is your business White British owned? o Is your business Black, Asian or Minority Ethnic (BAME) owned? Yes No Unable to say* Male Female No Majority Ownership is defined as: at least 51% owned or the majority composition of senior management comprises of individuals from a minority ethnic background. Minority ethnic – includes people of mixed ethnic backgrounds and any other white non-British group e.g. White Irish. *state reason why (expand this box as required): Gender o Is your business majority male or female owned? Ownership is defined as: at least 51% owned or the majority composition of senior management comprises of either men or women. 5 Disability o Yes No Is your business disabled owned? Ownership is defined as: at least 51% owned or the majority composition of senior management comprises of disabled people. Under the 1995 Disability Discrimination Act, this could be a physical or mental impairment which has a substantial and long-term adverse effect on the ability to carry out day to day activities (e.g. dyslexia, hearing / visual impairments, mental health issues, epilepsy or cancer). 6