company/contractor registration for the facilities and services division

COMPANY/CONTRACTOR REGISTRATIONFOR THE FACILITIES AND SERVICES DIVISIONAll sections of this form must be completed. The appropriate details and all documentary evidence should beattached when the forms are submitted to avoid delays in registration.Business DetailsBusiness Name:ABN:Business address:Postal address (if different):Business telephone number: ( ) ____________________ Fax number: ( ) ________________________Primary Business Category (eg. HVAC)Sub Category (eg. Controls)Primary Contact DetailsPrimary Contact Name & Title:Primary Contact Telephone number:Primary Contact Email address:Company Insurance DetailsPlease attach documents using the checklist below when faxing this form for registration.(Photocopies are aceptable).WorkcoverCertificate of CurrencyIf not registered, please give reasons:___________________________________________________________________Public liability Insurance: The certificate of Currency indicating policy number, expiry date andlimit. The University requires coverage of not less than $10MBusiness name: Certificate of registration of business name under the provisions of the Business NameActCompanies: Certificate of incorporation of a proprietary company stating the current name, orcertificate of registration of a foreign company in VictoriaBuilding practitioner’s number and type: (include copy of registration)Note: The transfer and/or printing of this document will render it an uncontrolled copy.Document Title:FSD - Contractor RegistrationDate & Version: 5 January 2012 V.04Authorised by:C MolloyAuthorK ThongPage: 1 of 2

Company CertificationsPlease attach documents using the checklist below when faxing this form for registration.(Photocopies are aceptable).OHS Management SystemIf not registered, please give reasons:___________________________________________________________________Quality MangementIf not registered, please give reasons:___________________________________________________________________Preferred Project Size $0-$20,000 $20,000.-$200,000 $200,000-$500,000 $500,000+Monash University prefers to pay its vendors by EFT. If you would like to be paid in this way, please provideyour company’s banking details:BSB: ______________Bank Account Number: _________________ Bank Country ____________University Payment Terms: The standard terms of settlement are net 30 days after the month of invoice. Thepreferred option is by Electronic Funds Transfer (EFT).DeclarationI declare that the particulars shown herein are true and correct in every detail.Signature: ____________________________________Name: ________________________________________ Position:____________________________________Date: ____________Information is to be returned, via one of these channels:By Post:Contractor AdministratorFacilities & Services – Building 40,Monash UniversityClayton VIC 3800By Fax:(03) 9905 1199By Email:Kim.thong@monash.eduPrivacy Collection StatementThe information on this form is collected for the primary purpose of registering you as a Facilities and Services Contractor.Other purposes of collection may include to: create a record in the Building and Engineering Information Management Systems(BEIMS) database, for inclusion in the BEIMS contactor lookup web site, to communicate with you and de-identified statisticalanalysis. If you choose not to provide all the information requested on this form it may not be possible for you to be a contractorfor Monash University. You have a right to access personal information that Monash University holds about you, subject to anyexceptions in relevant legislation. If you wish to seek access to your personal information or inquire about the handling of yourpersonal information, please contact the University Privacy Officer privacyofficer@monash.edu.auNote: The transfer and/or printing of this document will render it an uncontrolled copy.Document Title:FSD - Contractor RegistrationDate & Version: 5 January 2012 V.04Authorised by:C MolloyAuthorK ThongPage: 2 of 2