Vendor Disclosure Form

Name of Company:

Company's Registered Office Address:

Nature/Type of Business:

Contact Person:

Contact Phone Number/Email:

Kindly indicate below any related party interest with any staff and/or any Director of First Bank of Nigeria Limited.

SN:

Staff Name:

Designation/Role:

Nature and Extent of Recorded Interest:

SN:

Staff Name:

Designation/Role:

Nature and Extent of Recorded Interest:

SN:

Staff Name:

Designation/Role:

Nature and Extent of Recorded Interest:

I hereby confirm that my responses to the above questions are complete and correct to the best of my knowledge and belief.

I agree that if I become aware of any information that might indicate that this disclosure is inaccurate, I will notify Procurement Department immediately.

Name:

Designation:

Date: