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NipeX Joint Qualification System

NJQS Essential Services Supplier (ESS) Application Form

NJQS Essential Services Supplier (ESS) Application Form

This form should only be used by Essential (Community) Services Suppliers. To apply to join NipeX JQS as an Essential (Community) Services Supplier please fill in the registration form. The eligibility requirements for an Essential Services Supplier are: Be from the oil bearing / oil producing Community Execute contracts valued at N10,000,000.00 (Ten million Naira) or $50,000 (Fifty thousand US dollars), and below. Provide a formal identification by your Local Government Authority. Operate a wholly Nigerian owned business. If these statements apply to your company, please complete the form below, and forward it to the NipeX JQS team. See the Return Address and Contact Information section, below. Upon receipt of your completed form, we will send you information on how to access the NipeX JQS website, including your login details, and guidance on how to complete the questionnaire.

NipeX Joint Qualification System Application Form

1. Contact Person

(Please write or type your details clearly, using capital letters)

Title: _____________________________________________________________________________ First Name & Initials: _______________________________________________________________ Surname: _________________________________________________________________________ Job Title: __________________________________________________________________________ Department (if available): ___________________________________________________________ Email: ____________________________________________________________________________

2. Your Company Information

Company name: ____________________________________________________________________ Address: __________________________________________________________________________ Postcode: _________________________________________________________________________ Telephone: ________________________________________________________________________ Fax: ______________________________________________________________________________ Email: _____________________________________________________________________________ Website (if available): _______________________________________________________________

3. Return Address and Contact information:

NJQS Team, 30 Lady Oyinkan Abayomi Drive (Formerly Queen's Drive, Ikoyi, Lagos, Nigeria

Tel: +234 1 271 7593, +234 1 463 0525-6, + 234 1 448 4360 +234 1 764 4294, +234 1 764 4296 , +234 1 279 9352 Website: www.nipexng.com or www.nipex.com.ng Email: [email protected] or [email protected]

Version 4. 03/13

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