New Supplier / Vendor Registration

Step 1 of 2 - Supplier Details

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Referral
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Submitted by Personnel
This supplier form serves as a vital tool for collecting essential information from you as a supplier. It enables Elemera (Safehouse, Inlex or Exio) to gather your contact details, payment information, QHSE management system specifics, as well as insurance and licenses details. This information also assists in assessing supplier compliance and mitigating potential risks. Please note, you may be required to provide additional information to our HSEQ Department contingent upon Scope of Supply.
If you have any questions about this form, please do not hesitate to contact us for clarifications.
Please be aware that you must submit this form to complete it. If you are utilising the Save and Continue later function, the information will only be accessible to you via the provided link for 30 days. After this period, the data will be automatically expire and deleted if the form is not submitted. Elemera administrators will not receive any information until it has been submitted.
Section 1 - Company Details
- Company Name*
- Company Address*
  Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Contact Name*
  First Last
- Company Contact Email*
- Company Contact Telephone*
- Scope of Supply*
- Supply Category
  - Freight Services
  - Training Provider
  - Stationery Supplier
  - Site Storage Provider
  - Electrical Services
  - Consulting Service
  - Security Management
  - IT Supplier
  - Printing Services
  - Software Vendor
  - Medical Supplier
  - Telecommunication Supplier
  - Environmental Supplier
  - Industrial Supplier
  - Marketing Agency
  - Furniture Supplier
- ABN / ACN
  Applicable to Australian businesses only
- GST Reg Number
  Applicable to Australian businesses only
Section 2 - Payment Information Section
- Payment Bank / Address Details
- Payment Account Name
- Payment BSB and Account Number
  For Australian bank accounts, BSB (Bank State Branch) is required along with the account number. However, for international bank accounts, only the account number is necessary.
- Payment Accounts Contact Name
- Payment Accounts Contact Email Address
- SWIFT Code
- IBAN No.
- Currency
Section 3 - Quality, Health & Safety and Environment
- 1. Do you have a Quality Management System?*
  - Yes
  - No
- 1a. Evidence / Comment
- 1b. Is your Quality Management System certified to ISO 9001?
  Drop files here or
  
  Max. file size: 50 MB, Max. files: 1.
- 2. Do you have a Health & Safety Management System?*
  - Yes
  - No
- 2a. Evidence / Comment
- 2b. Is your Health & Safety System certified to ISO 45001 or equivalent?
  Please enclose a copy of your certificate
  Drop files here or
  
  Max. file size: 50 MB, Max. files: 1.
- 3. Do you have an Environmental Management System?*
  If so, please provide example.
  - Yes
  - No
- 3a. Evidence / Comment
- 3b. Is your Environmental Management System certified to ISO 14001 or equivalent?
  Please enclose a copy of your certificate
  Drop files here or
  
  Max. file size: 50 MB, Max. files: 1.
- 4. Do you have a Modern Slavery & Exploitation Policy?*
  - Yes
  - No
- 4a. Please attach
  Please enclose a copy of your certificate
  Drop files here or
  
  Max. file size: 50 MB, Max. files: 1.
- 5. Are you an Aboriginal or Torres Strait Islander owned Company?*
  - Yes
  - No
- 6. Have you been prosecuted by an Australian Regulatory Authority in the past 5 years*
  - Yes
  - No
- 6a. If Yes, please provide details
- 7. Compliance: Is there a Conflict of Interest, perceived or otherwise arising through working with Safehouse, Inlex or Exio?*
  This includes any subcontractor or any of your personnel engaging in any activity or obtaining any interest that is likely to or may appear to impair, interfere with or restrict Safehouse/Inlex/Exio in providing the Services diligently, fairly and independently.
  - Yes
  - No
- 8. Compliance: The contractor confirms all staff engaged directly or subcontracted fulfill all legal requirements to work In Australia?*
  - Yes
  - No
- Compliance: Please provide details
Section 4: Please provide certificates of currency, relevant to Scope of Work.
Section 4 - Insurance(s)
- Product & Public Liability Expiry Date
  Please enter the earliest expiry date
  DD slash MM slash YYYY
- Product & Public Liability (All Vendors)
  Drop files here or
  
  Max. file size: 50 MB.
- Workers Compensation Expiry Date
  Please enter the earliest expiry date
  DD slash MM slash YYYY
- Workers Compensation (Contractors working on Company sites)
  Drop files here or
  
  Max. file size: 50 MB.
- Motor Vehicle Expiry Date
  Please enter the earliest expiry date
  DD slash MM slash YYYY
- Motor Vehicle (Contractors working on Company sites)
  Drop files here or
  
  Max. file size: 50 MB.
- Professional Indemnity Expiry Date
  Please enter the earliest expiry date
  DD slash MM slash YYYY
- Professional Indemnity (Consultants)
  Drop files here or
  
  Max. file size: 50 MB.
Section 5 - Licenses
- Does the service you provide require any High Risk / Statutory Licenses? i.e. Electrical License*
  i.e. Controlled Waste, Dangerous Goods, High Risk Licenses. If yes, please attach relevant copy(s)
  - Yes
  - No
- Statutory License Expiry Date
  Please enter the earliest expiry date
  DD slash MM slash YYYY
- Statutory Licenses copies
  Drop files here or
  
  Max. file size: 50 MB.
- Additional Files
  e.g.: JSEAs, HSEQ Manuals
  Drop files here or
  
  Max. file size: 50 MB.
The following declaration in relation to this form must be completed by a Director of the business or a nominated responsible person approved by a Director.
Section 6 - Authorised Supplier Representative
- I declare that the information provided in this Contractor Information Form is true and accurate and I will immediately notify in writing of any change in the details provided in this form.
- Hidden
  Supplier Questionnaire file upload
  Drop files here or
  
  Max. file size: 50 MB.
- Authorised Representative Name*
  First Last
- Position*
- Date*
  DD slash MM slash YYYY

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