Authorized Supplier Representative completing this questionnaire:
Information Provided By: Important
Signature ** ________________________________
Name** This is required for ;
Title** Manager of ___________________________ 1) signature and approval by
Date** Management (MD , GM , Comapany
email address * owner) with the signature.
2) company's stamp also required
Approval: 3) fully information in each field
Signature ** ________________________________ "4) reasons if any field could not
prvide or fill in on sheet."
Name**
Title** _________________________
Date**
email address *
Additional Internal comments: