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CONTRACTOR AND SUPPLIER REGISTRATION FORM

Form Ref: RF/PCSD/D1/08 Issuance Date: 12th August 2008 Issues No. 2 Rev. 1

NUMBER/ NOMBOR

REGN DATE

NAME OF COMPANY

NAMA SYARIKAT

ROC REGISTRATION NUMBER

NO. PENDAFTARAN SYARIKAT

BUSINESS REGISTRATION NO.

NO. PENDAFTARAN PERNIAGAAN

BUSINESS ADDRESS

ALAMAT PERNIAGAAN

TELEPHONE NUMBER / NO. TELEFON FAX NUMBER / NO. FAKS CONTACT PERSON / UNTUK DIHUBUNGI REGISTERED ADDRESS

ALAMAT BERDAFTAR

Mobile No E-MAIL

HAVE YOU REGISTERED BEFORE / PERNAHKAH SYARIKAT ANDA MENDAFTAR DAHULU ?

YES / NO

YA / TIDAK

REGISTRATION CATEGORY / KATEGORI PENDAFTARAN

Please select Category by TICKING box below carefully. Indiscriminate selection of categories will results in form rejected for registration. Sila TANDAKAN di dalam kotak untuk Kategori yang dipilih. Pemilihan yang tidak bersesuaian akan mengakibatkan permohonan ini dibatalkan.

Example: Contoh : CATEGORY

KATEGORI

1

Then enter Code in space provided .(Refer to back of form for specialization code) Tandakan Kod di dalam kotak yang disediakan. (Rujuk di bahagian belakang borang bagi kod khusus) MINIMUM REQUIREMENT

SYARAT KELAYAKAN

BRIEF DESCRIPTION TYPE OF WORK

PENERANGAN RINGKAS JENIS KERJA

CAPITAL WORKS

KERJA-KERJA KAPITAL

(For CONTRACTORS)

PKK Head I Sub Head 3A or 3B or PKK Head III Sub Head 4 or 6 CIDB CE OR ME PKK Head I Sub Head 5 or PKK Head III Sub Head 5 CIDB CE OR ME PKK Head III or VII CIDB ME

Dams , Intake works, Pump Station and ancillaries, Reservoir and Water Retaining Structure, Water Treatment Plant, Pipeworks and Fittings, Sludge Treatment Facility

CAPITAL WORKS- WATER ENGINEERING

1 KERJA2 KAPITAL - KEJURUTERAAN AIR

CAPITAL WORKS- WASTEWATER ENGINEERING

2 KERJA2 KAPITAL - KEJURUTERAAN AIR KUMBAHAN

Sewage Treatment Plant, Pumping Station and ancillaries, Sewage Network, Sludge Treatment Facility, Tertiary Treatment, Biogas Facility, Disinfection

CAPITAL WORKS- M&E ENGINEERING

3 KERJA2 KAPITAL - KEJ. MEKANIKAL & ELEKTRIKAL

Mechanical Engineering - Air conditioning and ventilation system, Plumbing and Sanitary System, Pumping Installation (Water/Sewage), Sewage Treatment Installation, Water Treatment Installation, Fire Equipt, Protection System,Cranes and Hoist Equipment, Laboratory Equipment, Electrical Engineering - Electrical Building Services, Lightning Protection System, Power Plant, Main Switch Board (MSB)

CAPITAL WORKS- CONTROL & INSTRUMENTATION ENG.

4 KERJA2 KAPITAL - KEJURUTERAAN KAWALAN & PERALATAN

PKK Head I or III CIDB CE OR ME All PKK Head and Sub Head CIDB CE OR ME All PKK Head and Sub Head CIDB CE OR ME

SCADA and Telemetry, Main Control System

CAPITAL WORKS- OTHERS

5 KERJA2 KAPITAL - LAIN-LAIN

Building, Irrigation, Drainage and Flood Control Works, Tunnelling, Bridges , Jetties and Marine Structures, Roads and Pavement

CAPITAL WORKS- NRW SPECIALIST CONTRACTORS

6 KERJA-KERJA KAPITAL - KEROSAKAN DAN KEBOCORAN PAIP NOTE / Nota: Ensure you have the necessary PKK Head and Subhead for category selected Pastikan anda mempunyai Head dan Subhead PKK yang dipohon

(Please submit additional documentation to support this application)

For all Capital Works, SPAN permit is required before start of work. Bagi semua Kerja-Kerja Kapital, permit SPAN diperlukan sebelum memulakan kerja.

Page 1 of 6

CONTRACTOR AND SUPPLIER REGISTRATION FORM

Form Ref: RF/PCSD/D1/08 Issuance Date: 12th August 2008 Issues No. 2 Rev. 1

CATEGORY

KATEGORI

MINIMUM REQUIREMENT

SYARAT KELAYAKAN

BRIEF DESCRIPTION TYPE OF WORK

PENERANGAN RINGKAS JENIS KERJA

SUPPLIERS AND SERVICE PROVIDERS

PEMBEKAL

PUMPS

7 8 9

PAM

MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF PKK Head 4 SHead 7(b) MoF MoF MoF IKRAM/MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF MoF/KDN MoF MoF MoF

All pumps for water and sewerage All blowers / mixers for water and sewerage All valves and actuators All piping materials and fittings Suppliers of automation, control component products Supply of instrumentation equipment, probe etc and analysers

BLOWER / MIXER

PENGHEMBUS UDARA / MIXER

VALVES AND ACTUATOR

INJAP DAN PENGGERAK

PIPES AND FITTINGS

10 PAIP DAN PERALATAN PENYAMBUNGAN

CONTROL, AUTOMATION AND ELECT. SYSTEMS

11 KAWALAN, AUTOMASI DAN SISTEM ELEKTRIKAL

INSTRUMENTATION AND ANALYSERS

12 INSTRUMENTASI DAN PENGANALISA

DOSING SYSTEMS

13

Dosing system for chemicals, polymers Motor and variable speed drives Other water treatment equipment besides the above Other wastewater treatment equipment besides the above Sludge dewatering equipment

MOTOR AND VSD

14 MOTOR DAN "VARIABLE SPEED DRIVE"

WATER TREATMENT EQUIPMENT AND PRODUCT

15 PERALATAN DAN PRODUK RAWATAN AIR

WASTEWATER TREATMENT EQUIPT. / PRODUCT

16 PERALATAN DAN PRODUK RAWATAN AIR KUMBAHAN

DEWATERING AND SLUDGE HANDLING

17 PENGERING DAN PENGENDALIAN ENAPNYAH

ENVIRONMENTAL AND GEOTECHNICAL PRODUCT

18 PRODUK ALAM PERSEKITAR DAN GEOTEKNIKAL

SURVEY - ENGINEERING AND LAND

19 KERJA-KERJA UKUR TANAH

Engineering and land surveyors Engineering and land surveyors Engineering and land surveyors IT systems, software, development Servers, PCs, misc IT hardware IT system dedicated for process control, GIS, SCADA Compliance to construction material approved by IKRAM. Misc construction materials Chemicals used for water and wastewater treatment, lab analysis Independent laboratories for analysis and monitoring Personal protective equipment, safety equipment Office stationeries, IT consumables

SURVEY - UTILITY DETECTION / MAPPING

20 KERJA-KERJA UKUR TANAH - UTILITY DETECTION AND MAPPING

SOIL INVESTIGATION

21 KAJIAN TANAH

IT SOFTWARE

22 PERISIAN

IT HARDWARE

23 PERKAKASAN

IT PROCESS CONTROL, SCADA AND GIS

24 KAWALAN PROSES,SCADA DAN GIS

CONSTRUCTION MATERIAL

25 BAHAN BINAAN

CHEMICAL - WATER TREATMENT

26 BAHAN KIMIA UNTUK RAWATAN AIR

LABORATORY AND MONITORING

27 BAHAN MAKMAL DAN PENGAWASAN

SAFETY EQUIPMENT AND PPE

28 PERALATAN KESELAMATAN

STATIONARY & IT CONSUMABLES

29 PERALATAN PEJABAT & ALATGANTI IT

GROCERIES

30 BARANGAN DAPUR

OFFICE SUPPLIES AND EQUIPMENT

31 PERALATAN PEJABAT

Misc office supplies Misc office electrcal products Office furniture Uniform for staff General printing corporate materials, brochure, annual report Office cleaning

ELECTRICAL PRODUCTS

32 BARANGAN ELEKTRIK

OFFICE FURNITURE

33 PERABOT PEJABAT

UNIFORM

34 PAKAIAN SERAGAM

PRINTING

35 PERCETAKAN

OFFICE CLEANING

36 PEMBERSIHAN PEJABAT

COURIER / POSTAGE / MAILING SERVICES

37 PERKHIDMATAN POS LAJU DAN PENGHANTARAN SURAT

RENOVATION

38 UBAHSUAI PEJABAT

PEST CONTROL

39 KAWALAN SERANGGA PEROSAK

SECURITY

40 KAWALAN KESELAMATAN

ACCOMMODATION AND TRAVEL AGENCY

41 PENGINAPAN DAN AGENSI KEMBARA

Hotels, travel agents Telephone systems, mobile. Talkie talkie systems Specify category of work Nyatakan kategori kerja ____________________________________________________

TELECOMMUNICATION

42 TELEKOMUNIKASI

OTHERS

43 LAIN - LAIN

eg: Management Consultants, Auditors, Training

Perunding pengurusan, juruodit, latihan

Pendaftaran PKK bagi kontraktor adalah wajib (Registration with PKK is compulsory for contractors)

Pendaftaran Kementerian Kewangan bagi perunding , bekalan dan perkhidmatan adalah di wajibkan (Registration with Ministry of Finance is compulsory for consultant, suppliers)

Page 2 of 6

CONTRACTOR AND SUPPLIER REGISTRATION FORM

Form Ref: RF/PCSD/D1/08 Issuance Date: 12th August 2008 Issues No. 2 Rev. 1

COMPANY ANNUAL TURNOVER

DAGANGAN TAHUNAN SYARIKAT

PAID UP CAPITAL MODAL BERBAYAR NAME/NAMA % Shareholding/Pegangan IC No.

NAME OF SHAREHOLDERS

NAMA-NAMA PEMILIK SAHAM

NAME OF DIRECTORS

SENARAI NAMA PENGARAH

NAME/NAMA

IC No.

NAME OF KEY OFFICERS

SENARAI KAKITANGAN UTAMA

NAME/NAMA

POSITION/JAWATAN

IC No.

BUMIPUTRA STATUS

TARAF BUMIPUTERA

YES / NO PERCENTAGE BUMIPUTRA OWNERSHIP PERATUSAN MILIK BUMIPUTERA

BANKERS / BANK

MAIN BANKER BANK UTAMA ACCOUNT NUMBER/NO. AKAUN CREDIT FACILITIES KEMUDAHAN KREDIT ATTACH LAST 3 MONTH OF ACCOUNT STATEMENT Hantarkan penyata bank untuk 3 bulan terkini

MAJOR CUSTOMERS / PELANGGAN-PELANGGAN UTAMA

NAME/NAMA PROJECTS / ITEM SUPPLIED/PROJEK/BARANG-BARANG YANG DIBEKAL

Page 3 of 6

CONTRACTOR AND SUPPLIER REGISTRATION FORM

Form Ref: RF/PCSD/D1/08 Issuance Date: 12th August 2008 Issues No. 2 Rev. 1

MAJOR PROJECT (LAST 5 YEARS) / PROJEK-PROJEK UTAMA (5 TAHUN KEBELAKANG)

DESCRIPTION OF PROJECT JENIS PROJEK TYPE OF CONSTRUCTION/ JENIS KERJA CLIENT / PEMAJU VALUE(RM)/ NILAI Commencement Mula Completion Siap

Type of Construction / Jenis kerja : Dams , Intake works, Pump Station and ancillaries, Reservoir and Water Retaining Structure, Water Treatment Plant, Pipeworks and Fittings,Sludge Treatment Facility Sewage Treatment Plant, Pumping Station and ancillaries, Sewage Network, Sludge Treatment Facility, Tertiary Treatment, Biogas Facility, Disinfection Mechanical Engineering - Air conditioning and ventilation system, Plumbing and Sanitary System, Pumping Installation (Water/Sewage), ewage Treatment Installation, Water Treatment Installation, Fire Equipt, Protection System,Cranes and Hoist Equipment, Laboratory Equipment, Electrical Engineering - Electrical Building Services, Lightning Protection System, Power Plant, Main Switch Board (MSB)

(Attach separate sheet using same format if insufficient space ) (Sila lampirkan salinan yang lain jika ruang yang diberi tidak mencukupi)

INFORMATION BELOW IS FOR CONTRACTORS /

CERT NO / NO SIJIL CERT VALID TILL / SAH TEMPOH HINGGA

MAKLUMAT DI BAWAH ADALAH UNTUK KONTRAKTOR HEAD / KEPALA SUBHEAD / SUB KEPALA

PKK

CLASS / KELAS PKK BUMI STATUS / TARAF BUMIPUTERA YES / NO YA / TIDAK

Certificate is compulsory for capital works. Please attach to this application Sijil adalah diwajibkan untuk kerja kapital. Sila sertakan dengan permohonan.

FINANCIAL GRADE / GRED KEWANGAN REGN NUMBER / NOMBOR PENDAFTARAN

CERT VALID TILL / TARIKH HABIS TEMPOH PERAKUAN

CIDB

CATEGORY/KATEGORI

SPECIALIZATION/PENGKHUSUSAN Enter category and specialisation codes Isikan kategori dan kod pengkhususan

SPAN

REGISTERED ?

BERDAFTAR ?

YES / NO

YA / TIDAK

PERMIT NUMBER NOMBOR PERMIT

VALID TILL SAH HINGGA

CLASS KELAS

STATE NEGERI

SPAN PERMIT REQUIRED BEFORE START OF WORK PERMIT SPAN DIPERLUKAN SEBELUM MEMULAKAN KERJA

Page 4 of 6

CONTRACTOR AND SUPPLIER REGISTRATION FORM

Form Ref: RF/PCSD/D1/08 Issuance Date: 12th August 2008 Issues No. 2 Rev. 1

INFORMATION BELOW IS FOR SUPPLIERS/SERVICE PROVIDERS /

MOF REGISTRATION PENDAFTARAN KEMENTERIAN KEWANGAN

CERT NO / NO. SIJIL CODE/KOD

MAKLUMAT DI BAWAH ADALAH UNTUK KPEMBEKAL DAN PERKHIDMATAN EXPIRY DATE/TARIKH LUPUT

FIELD / BIDANG

CODE/KOD

FIELD / BIDANG

BUMIPUTERA STATUS / TARAF BUMIPUTERA

Attach certificate/Sertakan sijil

YES / NO

YA / TIDAK

PLEDGE / PENGAKUAN

DO YOU HAVE ANY PENGURUSAN ASET AIR BERHAD EMPLOYEE WHO HAS SHARE(S) IN YOUR BUSINESS ?

ADAKAH PEKERJA PENGURUSAN ASET AIR BERHAD MEMPUNYAI SYER DI DALAM PERNIAGAAN ANDA ?

(Please Tick / Sila tandakan)

YES YA

NO TIDAK

IF YES, PLEASE STATE NAME(S):

JIKA YA, SILA CATIT NAMA

DO YOU HAVE ANY CLOSE FAMILY MEMBER(S) CURRENTLY EMPLOYED BY PENGURUSAN ASET AIR BERHAD ?

ADAKAH ANDA MEMPUNYAI AHLI KELUARGA YANG BERKHIDMAT DENGAN PENGURUSAN ASET AIR BERHAD ?

(Please tick /Sila tandakan)

YES YA

NO TIDAK

IF YES , PLEASE STATE NAME(S)

JIKA YA, SILA CATIT NAMA

BY BIDDING FOR OR/AND ACCEPTING BUSINESS FROM PENGURUSAN ASET AIR BERHAD , I AND MY COMPANY PLEDGE TO UPHOLD THE HIGHEST ETHICAL STANDARDS. I AGREE THAT I AND MY COMPANY WILL NOT ENGAGE IN ANY FORM OF PAYMENT ACTIVITIES, OFFERING GIFTS, ENTERTAINMENT,LOANS AND OTHER CONSIDERATIONS NO MATTER HOW MINOR, TO PENGURUSAN ASET AIR BERHAD EMPLOYEES, OR SPOUSES OR DEPENDENT CHILDREN FOR INFLUENCING INDIVIDUALS TO ACT CONTRARY TO PENGURUSAN ASET AIR BERHAD INTEREST. I AGREE TO REPORT IN WRITING TO THE PROCUREMENT HEAD OR THE CHIEF EXECUTIVE OFFICER ON ANY ACTIVITIES BY PENGURUSAN ASET AIR BERHAD EMPLOYEES WHICH MAY NOW OR IN THE FUTURE BE CONTRARY TO PENGURUSAN ASET AIR BERHAD INTEREST. I UNDERSTAND THAT PENGURUSAN ASET AIR BERHAD WILL TERMINATE OUR BUSINESS RELATIONSHIP IF THE ABOVE IS NOT FOLLOWED OR INFORMATION PROVIDED ABOVE ARE FOUND BE FALSE.

DENGAN MEMBUAT TAWARAN UNTUK ATAUPUN MENERIMA PERNIAGAAN DARI PENGURUSAN ASET AIR BERHAD, SAYA DAN SYARIKAT SAYA, TIDAK AKAN MELAKUKAN PERBUATAN RASUAH, PEMBERIAN HADIAH, HIBURAN, MEMBERI PINJAMAN WALAUPUN DALAM KEADAAN NOMINAL KEPADA PEKERJA PENGURUSAN ASET AIR BERHAD, KELUARGA MEREKA ATAU ANAK-ANAK TANGGUNGAN BAGI TUJUAN UNTUK MEMPENGARUHI SESEORANG INDIVIDU DI MANA DIANGGAP SEBAGAI KELAKUAN YANG BERTENTANGAN DENGAN KEPENTINGAN PAAB. SAYA BERSETUJU UNTUK MEMBUAT LAPORAN BERTULIS KEPADA KETUA JABATAN PEROLEHAN ATAU KETUA EKSEKUTIF MENGENAI SEBARANG AKTIVITI PEKERJA PENGURUSAN ASET AIR BERHAD YANG DIANGGAP BERTENTANGAN DENGAN KEPENTINGAN PAAB.

SAYA MEMAHAMI DAN BERSETUJU JIKA PENGURUSAN ASET AIR BERHAD MENAMATKAN URUSAN PERNIAGAAN JIKA SAYA TIDAK MEMATUHI PERKARA-PERKARA DI ATAS ATAUPUN MAKLUMAT YANG DIBERI ADALAH TIDAK BENAR.

YOURS FAITHFULLY/ YANG BENAR ,

NAME/NAMA POSITION/JAWATAN DATE/TARIKH COMPANY STAMP/COP SYARIKAT

Page 5 of 6

CONTRACTOR AND SUPPLIER REGISTRATION FORM

Form Ref: RF/PCSD/D1/08 Issuance Date: 12th August 2008 Issues No. 2 Rev. 1

SUBMIT COMPLETED FORMS AND FOLLOWING ATTACHMENTS / HANTAR BORANG LENGKAP BERSERTA DENGAN DOKUMEN DIBAWAH

1. FORM/BORANG 24,49 AND ANNUAL RETURNS (FOR COMPANIES)/

PENYATA TAHUNAN SYARIKAT

7. BANK STATEMENT LAST 3 MONTHS PENYATA BANK UNTUK SELAMA 3 BULAN

2. FORM A & B /

BORANG A & B ( FOR BUSINESSES/PERNIAGAAN )

EPF STATEMENT/

PENYATA KWSP

(Last 3 months )

3. DIRECTOR RESOLUTION FOR CHEQUE SIGNING - IF ANY

RESOLUSI PENGARAH BAGI PENANDATANGAN CEK SYARIKAT

4. COMPANY PROFILE / PROFAIL SYARIKAT 5. MoF / PKK CERTIFICATES - IF ANY

SIJIL MOF/PKK - JIKA ADA

6. CIDB / SPAN /PROFESSIONAL CERTIFICATE

SIJIL CIDB/JPP/ PROFESSIONAL

RETURN FORM AND ATTACHMENT TO : HANTARKAN BORANG & LAMPIRAN KE : PROCUREMENT & CORPORATE SERVICES DEPARTMENT, PENGURUSAN ASET AIR BERHAD

24TH FLOOR, MENARA MULTI PURPOSE, CAPITAL SQUARE, NO. 8, JALAN MUNSHI ABDULLAH, 50100 KUALA LUMPUR TEL NO : 03-2614 5555 FAX NO 03-2614 5588 E-mail address : [email protected]

FOR PAAB USE / UNTUK KEGUNAAN PENGURUSAN ASET AIR BERHAD

RECEIVED BY

DATE RECEIVED

DATE SENT TO PMD FOR REVIEW (Capital Works only)

Capital Works Application reviewed by PMD - Enter details below

REVIEWED BY RECOMMENDED DATE Category of Work allowed (Enter category code) Comments:

CHECKED BY

DISEMAK OLEH

DATE/TARIKH

NO. ASSIGNED/

NO. DIBERI

System Update by

Di kemaskini oleh

Date Approved

Tarikh kelulusan

NOTES / NOTA-NOTA

Department/Jabatan

Page 6 of 6

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