Company Name  *
Address Details
Address 1  *    Address 2    Address 3
City  *    State  *    Country  *
E-Mail  *    Phone      URL
Other Details
Bank Name *    Bank Account No  *    Currency
Company Licensed Yes/No    License No.    License Date
Nature of Business    Language    Remarks
No. of Employees  *      No. of Pharmacist *      No. of Bio-Medial   Engineers  *  
No. of Medicines   Registered  *      No. of Registered   Manufacturer  *      Average turnover   per year(SDG)  *  
Participated in CMS Tender    Last Tender (Year)
   Total amount won    (EUR)  
Have you apologized for supplying requested items by CMS    If Yes, Explain

Note: * Mandatory Fields