BUSINESS PARTNERS APPLICATION FORM (OFFSET)
COMPLETION INSTRUCTIONS:
Please complete this form and return to
This form is provided because your company is under consideration for a business relationship with BAE
SYSTEMS that may involve the generation of Offset Credits. Please respond to all of the questions in a
clear and candid manner. If your response to any of the questions requires more space than that which is
provided, please reference the section, the specific question and the response on a separate piece of
paper and attach it to this form.
Please note that submission of this form to BAE SYSTEMS is only one step in our corporate review
process, and such submission does not affirm the existence of a business relationship between BAE
SYSTEMS and your company. Completion of this form will not necessarily mean that a business
relationship with BAE Systems Inc. will ensue.
Please complete this form and return to
NN MM
Industrial Cooperation Manager
BAE Systems Hägglunds AB
SE-89182 Örnsköldsvik
nn. mmi@baesystems.se
+46-(0) 660 8xx xx
Background Information:
Name of Applicant ___________________________________
Name of Point of Contact at Applicant:
Applicant’s Postal Address:
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Registered Address (if different from mailing address)
…………………………………………………………………………………………………………………………
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...
Telephone:
Fax:
Email Address:
Website:
Type of Organization - Please (mark with an “x”) the applicable description:
Partnership
Private Corporation
Public Corporation
Sole Proprietorship
Other (describe)
Size of Organization – number of employees
0-100
100-500
500-1000
1000+
Date and Place of Incorporation/registration (if applicable):
If Applicant is a company, list Applicant’s branch offices, parent/subsidiary organizations, joint
ventures and related companies:
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
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If Applicant is a company, please provide copies of all corporate foundation and registration
documents translated into English if necessary.
If Applicant is a publicly traded company, please provide a copy of the company’s most recent
corporate reports, or web address from which corporate reports may be downloaded.
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All directors and officers of the Applicant’s organization:
Name
Position/Title
Nationality
Shareholder(s) of Applicant (if entity is not a public company) (continue on extra sheets if
necessary):
Name
Nationality
% Owned
Date Equity
Acquired
Beneficial or other owner(s) of Applicant (continue on extra sheets if necessary):
Name
Nationality
Relationship to Applicant
References: Please provide three recent business references
Name of
Point of Contact Mailing Address
Telephone and
Company
Name and email
address
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fax
Nature of
relationship
BUSINESS PARTNERS APPLICATION FORM (OFFSET)
Compliance Questions
1. Is any owner, officer, or employee of Applicant employed by, or the agent of, any customer of the
BAE SYSTEMS group?
Yes
No
If YES, please give full details.
2. Does any government or any department, agency or other organization of that government, or any
official1 or employee of that government own or have any other direct or indirect interest in Applicant,
including beneficial interests?
Yes
No
If YES, please give full details.
3. If Applicant is an individual, is Applicant an elected or appointed official of any government, or an
employee of any government department, agency or other organization of that government, including
military or paramilitary forces?
Yes
No
If YES, please give full details.
4. Is any owner, shareholder, officer or employee of Applicant, an elected or appointed official of any
government, member of any relevant royal family, or an employee of any government department,
agency or other organization of that government, including military or paramilitary forces?
Yes
No
If YES, please give full details.
5. Does any owner, officer or employee of Applicant, have a family relationship with any current official
or employee of any government or of any department, agency or of the organization of that
government?
Yes
No
If YES, please give full details.
1
Including members of any relevant royal family
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6. Does Applicant, or any of its shareholders or beneficial owners make any political donations?
Yes
No
If YES, please give full details.
7. Does any current or former government official, political party official or candidate for office have any
direct or indirect ownership interest in Applicant?
Yes
No
If YES, please provide full details, including their name, office, interest and role with respect to the
Applicant.
8. Is any officer or employee of Applicant, a political party official, candidate for political office or current
or former government official?
Yes
No
If YES, please provide full details, including their name, office, interest and role with respect to the
Applicant.
9. Has the Applicant, or any owner, officer or any employee of the Applicant, ever been debarred,
‘blacklisted’, or suspended from being allowed to work with any office of the local government on
procurement issues?
Yes
No
If YES, please give full details, include a description of the incident and how it was concluded,
and whether the suspension or debarment is still active.
10. Has the Applicant, any former or associated organization of the Applicant, any present or former
owner, officer or employee of the Applicant been charged with any criminal act, or been the subject of
any allegation or investigation of fraud, bribery or other corrupt activity?
Yes
No
If YES, please give full details.
11. Has the Applicant ever been the defendant in a civil suit where the plaintiff alleged that the defendant
had committed fraud (of any type or form) or breach of contract? If so, when did this occur, what
were the circumstances and how/when was it resolved?
Yes
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No
BUSINESS PARTNERS APPLICATION FORM (OFFSET)
If YES, please give full details.
12. Does the Applicant have any business or financial arrangements where equity is pledged as collateral
or whereby there may result in a change in any portion of ownership from the configuration described
above in this Application?
Yes
No
If YES, please give full details.
13. Does your company currently employ individuals who hold passports from Afghanistan, Burma,
Belarus, China, Cote d’Ivoire, Cyprus, Democratic Republic of Congo, Sierra Leone, Cuba, Eritrea,
Haiti, Iran, Iraq, Lebanon, Liberia, Libya, North Korea, Somalia, Sri Lanka, Sudan, Syria, Vietnam,
Venezuela, Yemen or Zimbabwe?
Yes
No
If YES, please give full details.
14. Does the Applicant have a written policy concerning the following:
(a) Code of Conduct
Yes
No
If YES, please provide
(b) Bribery and anti-corruption
Yes
No
If YES, please provide
(c) the giving of gifts or gratuities to government officials or government employees:
Yes
No
If YES, please provide
(d) the provision of hospitalities, such as travel expenses or entertainment, to government
officials or employees:
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Yes
No
If YES, please provide
(e) the hiring of current or former government officials or government employees:
Yes
If YES, please provide
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No
BUSINESS PARTNERS APPLICATION FORM (OFFSET)
15. Please list any individuals or organizations that may be sub-contracted by your entity in the
course of discharging the proposed project:
Name
Position/Title
Nationality
Experience
Certification of Compliance with Anticorruption Laws
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I hereby make the following declarations, statements, representations and promises:
a)
I make this declaration as either the owner, or duly authorized director, officer or employee of the
Applicant named below. I certify that I am authorized to so act on behalf of the Applicant.
b)
The information I have provided is true to the best of my knowledge. I understand that you will rely
on this information in deciding whether to enter into any contractual agreement with the Applicant
named below. I hereby consent to your making such enquiries as you may consider necessary to
verify this information and to process, store, and transfer such information in the manner you
consider appropriate, including by electronic means including within BAE Systems Inc., the BAE
Systems Group, and/or to BAE Systems plc. in the UK .
c)
I have received, read and understand BAE Systems’ Code of Conduct and the attached briefing
note on BAE’s anticorruption policies and will fully comply with these policies (the “Policies”) and
with all applicable laws.
d)
Neither I nor any officer, director, shareholder or employee of the Applicant named below will give,
promise, or offer or attempt to give, promise or offer anything of value for the purpose of obtaining
or retaining business or to obtain any improper advantage from a government official, political party
official, or candidate for public office. Applicant will not ask anyone to give or attempt to give
anything of value on Applicant’s behalf for the purpose of obtaining or retaining business or to
obtain any improper advantage from a government official, political party official, or candidate for
public office in relation to BAE SYSTEMS, US business.
e)
No-one at the Applicant will give, offer or promise anything of value to a commercial business
partner or to any BAE Systems employee for any improper purpose or to secure an improper
advantage.
f)
In the event that BAE Systems enters into a business relationship with the Applicant, I will report
promptly any breach, or possible breach, of which I may become aware of the provisions of the
Policies or of any law, whether enacted pursuant to the OECD Convention or the US Foreign
Corrupt Practices Act, to my primary point of contact at BAE Systems who shall be named in any
forthcoming agreement should Applicant’s appointment be approved.
Signed
……………………………………………………………………
Name (please print in capitals)…………………………………………………………………
TITLE (in capitals): …………………………………………………………………
Name of Applicant: …………………………………………………………………
Date:
……………………………………
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