Full (registered) name of Participant : _______________________________________________________________
Trade name of Participant (if applicable) : __________________________________________________________
Name of most senior person in organisation : ________________________________________________________
Org. Registration Number : _____________________________________ Date Established : __________________
Physical Address : (Street) __________________________________________________(City)___________________
(Country) _______________________________________________ (Code) _________________
Shipping Address : (Street) _________________________________________________ (City)___________________
(Country) ____________________________________________ (Code) ___________________
Telephone No : (__________)(______)__________________ Fax No : (__________)(______)___________________
Country code City Code Number Country code City Code Number
E-mail address : _______________________________________ Website : __________________________________
Name of person responsible for payment of accounts : ______________________________________________