attach a. supplier registration form

8/2/2019 Attach a. Supplier Registration Form

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SUPPLIER REGISTRATION FORM

Document No: FCN/PCM/SRF/01

Issue Date: 01.04.2010

Revision No: 01

Revision Date: 21/03/2012

Page 1

ATTACHMENT A

AAPPPPLLIICCAATTIIOONN FFOORR SSUUPPPPLLIIEERR RREEGGIISSTTRRAATTIIOONN

1. INSTRUCTION

1.1 This Supplier Registration Form (SRF) is strictly for Fibrecomm Network (M) Sdn Bhd(Fibrecomm)s supplierregistration only.

1.2 The Supplier is required to fill in the Application for Supplier Registration Form and bind together

with supporting documents stated in Part III to Fibrecomms Procurement and ContractManagement Department in the following format:

PART DOCUMENTS

Part I Cover Letter

Part II Supplier Registration Form

Part III Supporting Documents:

APPENDIX A - Business Registration Form (Form D / Form 9)

APPENDIX B - Memorandum and Articles of Association

APPENDIX C - Form 24

APPENDIX D - Form 49

APPENDIX E - Latest Company Profile and Organization Chart

APPENDIX F - Latest Three (3) Years Audited Financial Reports

APPENDIX G - License / Certification With Authorities

(e.g. MCMC, CIDB, PKK, MOF etc.)

APPENDIX H - Works CategoryAPPENDIX I - Major Customers

APPENDIX J - Brochures and Catalogues

Please ensure that all documents have been certified true copy by your

director/company secretary accordingly)

2. TERMS AND CONDITIONS

2.1 Acceptance and Rejection

Fibrecomm reserves the right to accept or reject any SRF submitted by supplier. Registration with

Fibrecomm does not indicate any award of project/job.

2.2 Cancellation of Registration

Fibrecomm reserves the right to cancel the suppliers registration without assigning any reason tothe supplier.

2.3 Changes

Supplier is required to promptly inform Fibrecomm if there are any changes to the SRF, certificate

and/or supporting documents submitted.


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14. Organizational Information(Please attach the latest organization

chart inAPPENDIX E)

Total number of employees:

Management: ___6_______

Technical: ___34______

Admin: ___5_______Others: ____8_______

Total: 53

15. Financial Information

Authorised Capital Paid Up Capital Financial Accounts

(Please attach the latest 3 years

Audited Accounts inAPPENDIX F)

RM_5,000,000.00_______

RM_1,001,000.00_______

16. Sales/Turnover(Please attach figures for the latest

three( 3) years)

1. RM 20416126____2. RM 18690325____

3. RM 22464350_____

SECTION 2: REGISTRATION AND CERTIFICATION WITH AUTHORITIES

17. Registration and Type ApprovalHave you been registered or certified by

a third party organization such as

MCMC, CIDB, MOF etc.

(Please attach a valid copy of the

certificates in APPENDIX G)

Authority Name Registration

Number

Expiry Date

SECTION 3: PRODUCT AND SERVICES INFORMATION

18. Works CategoryProvide a brief summary of products and/or services offered by your company. You must have the valid

authorization, legal rights and licenses to provide such products and services to Fibrecomm

(Please mark the appropriate field andAPPENDIX H)

19. Major Customers(Please provide details of project

undertaken with your major customersinAPPENDIX I)

Name of Customer Contact

Person

Telephone No.

20. Local Technical Support(Please provide your brochures and

catalogues inAPPENDIX J)

Facilities/manpower availability: ________________________

After sale services/technical support

Storage Available ________________________(If available, state location)

Not Available


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SECTION 4: DECLARATION

I/We (name) _HJ HELAN BIN AWANG______________as (designation) _EXECUTIVE DIRECTOR_

of(Company name) ____KOMASI ENTERPRISE SDN BHD__________________________________

1. Certify that all information provided in this SRF and all supporting documents is true and correct to thebest of our knowledge.

2. Certify there are no Fibrecomms employee working or holding any position in the company:3. We acknowledge that there are:

4. Please confirm and tick one of the following boxes:

We acknowledge that we are not a related party to Fibrecomm as defined in the Listing

Requirement ofKuala Lumpur Stock Exchange (KLSE).

We are to be considered as a related party of Fibrecomm for the following reason (please specify);

______________________________________________________________________________________________________________________________________________________

5. We confirm that in providing the information herein, we are not in breach of any obligation or secrecy or

confidentiality or otherwise.

Signature:

I/C No: 710115-01-6325

Date: 17-04-2012. Company Stamp ....

ex-Fibrecomm staff working or holding any position with our company. (If yes, please

submit list of names, position held and date of joint).

relative working or holding any position with our company. (If yes, please submit list of names,

relationship, position held and date of joint).


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APPENDIX H

List of Works Category

Main Category Sub-Category Description

TickHere (/)

A. SUPPLIES

A1 STATIONERY

A1.1 Office Stationery

A1.2 Computer Media

A1.3 Envelope

A1.4 Paper

A1.5 File

A1.6 Diary

A2 KITCHEN/GROCERIES/REFRESHMENTS/PANTRY/CATERING

A3 PRINTING

A3.1 Preprinted - File, Envelope, Booklet, Magazine

A3.2 Pamphlet, Memo Pad, Letterhead, Form

A3.3 Continuous Stationery and Computer Forms

A3.4 Label Sticker, Iron On (Plastic and Paper)

A3.5 Business Card and Greeting Card

A3.6 Poster, Banner, Bunting

A3.7 Hardcover Binding

A3.8 Softcover Binding

A3.9 Colour Separater

A3.10 Type Setting

A4 RECORDING EQUIPMENT AND MEDIA AUDIO VIDEOA5 MOTOR VEHICLE

A5.1 Motor Vehicles

A5.2 Accessories

A6 SOUVENIR AND PROMOTIONAL ITEM

A7 CUSTOMER PREMISE EQUIPMENT AND SUPPORT SYSTEM

A7.1 PABX Equipment and Accessories

A7.2 Voice Over Internet Protocol (VOIP)

A7.3 Code Division Multiple Access (CDMA)

A7.4 Modilator-Demodulator (MODEM)

A7.5 Mobile Phone

A7.6 Caller IDA7.7 PA System

A7.8 Digital Cordles Communication System

A7.9 Radio Communication System

A7.10 Data Communication System

A7.11 Lightning Arrestor

A7.12 Key Telephone System (KTS)

A7.13 Enhanced Private Branch Exchange (PABX) Equipment and Accessories

A7.14 Video Conferencing Equipment

A7.15 Analog Phone

A7.16 Digital Phone

A7.17 Network Terminal

A8 UNIFORMED MATERIAL

A8.1 Corporate Uniform

A8.2 Raincoat


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A8.3 Tie

A8.4 Scarf

A8.5 T-shirt

A8.6 Helmet

A8.7 Songkok

A8.8 Shoes

A8.9 Textile

A9CIVIL, MECHANICAL AND ELECTRICAL ENGINEERING EQUIPMENT

AND INFRASTRUCTURE

A9.1 Generating Set

A9.2 Generating Cable Accessories

A9.3 Primemover

A9.4 Centrifugal Pump

A9.5 Lightning and Earthing Protection System

A9.6 Battery and Rectifier System (For DC Power)A9.7 Air-conditioned System

A9.8 Tower, Guyed Mast, Monopole, Mini Structure

A9.9 Cabin / Shelter

A9.10 Mechanical and Electrical Appliances

A9.11 Un-interrupted Power Supply (UPS)

A9.12 Diesel and Lubricant Oil

A9.13 Test Gear

A9.14 Transformer

A9.15 AC Transmission Systems

A9.16 AC Distribution Systems

A9.17 CongenerationA9.18 Main Switch Board

A9.19 CGPA

A9.20 GPA

A9.21 Compressor Dryer

A9.22 Water Pumps

A10 TELECOMM/NETWORK EQUIPMENT AND ACCESSORIES

A10.1 Telecommunication Equipment and Accessories

A10.1.1 Switching Equipment International Gateway

A10.1.2 Tandem, Local, ATM, Mobile, Softswitch

A10.1.3 Transmission Equipment: SDH Equipment for Fibre

A10.1.4 Microwave, PDH, Multiplexer, CompressorA10.1.5 TV/Radio Transmission Equipment

A10.1.6 Data Communication Equipmt (IDNX, X_25)

A10.1.7 Satellite and Broadcast Communication Equipment

A10.1.8 Access Network Equipment : Wired

A10.1.9 Access Network Equipment : Wireless

A10.2 Cable and Accessories

A10.2.1 Fibre Optic Cable

A10.2.2 Fibre Optic Cable Accessories

A10.2.3 Copper Cable

A10.2.4 Copper Cable Accessories

A10.2.5 RF/Coaxial Cable and AccessoriesA10.2.6 Connector, Surge Arrestor, Attemator

A10.2.7 Outside Plant Materials

A10.2.8 Poles (Iron, Concrete, Wood)


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A10.2.9 Pipes

A10.2.10 Poles Accessories

A10.3 Telecommunication Test Equipment and Accessories

A11 EXHIBITION BOOTH

A12 QUEUE MANAGEMENT EQUIPMENT AND SYSTEMS

A13 OFFICE FURNITURE, FITTING AND FIXTURE

A14 OFFICE EQUIPMENT AND AIDS

A14.1 Scanner

A14.2 Laminating

A14.3 Counting Machine

A14.4 Photostat

A14.5 TV

A14.6 Calculator

A14.7 Printer

A14.8 ShredderA14.9 LCD

A14.10 Fax

A14.11 Toner Cartridge

A14.12 Data Tape

A15 SECURITY AND LOSS CONTROL

A15.1 CCTV and Duress Alarm

A15.2 Monitoring & Protection System (MAPS)

A15.3 Fire Fighting Equipment and System

A15.4 Fire Extinguisher

A15.5 Security Card

A15.6 Security EquipmentA16 SAFETY AND HEALTH

A16.1 Personal Protective Equipment

A16.1.1 Safety Shoes

A16.1.2 First Aid Kit

A16.1.3 Helmet and Torchlight

A16.1.4 Safety Belt

A17 SIGNAGE

A17.1 Outdoor Signage

A17.2 Indoor Signage

A18 CARD

A18.1 Smart CardA19 PRODUCT PACKAGING

A20 INFORMATION TECHNOLOGY (IT) HARDWARE AND SOFTWARE

A20.1 PC, Notebook, Workstations and Related Peripheral

A20.2 Small to Large Multi-user Systems

A20.3 Software Product

A20.4 Other Computer Related Item

A20.5 Networking Products

A20.6 IT Security Equipment

A20.7 Uninterruptible Power Supply (UPS)

A20.8 Router

A20.9 Magnetic TapeA20.10 Cartridge

A20.11 Storage

A21 INTERNET SERVICE PROVIDER HARDWARE AND SOFTWARE


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A21.1 ISP Equipment and Related Peripheral

A21.2 ISP Software Product and Services

A21.3 ISP Networking Product and Services

A21.4 ISP Satellite Communication Equipment

A22 INTERNET PROTOCOL THONY H/WARE & S/WARE

A22.1 IPT Equipment and Related Peripheral

A22.2 IPT Software Product and Services

A22.3 IPT Networking Product & Services

A22.4 IPT Satellite Communication Equipment

A23 TOOLS EQUIPMENT

A24 ADVERTISING EQUIPMENT

A25 SPORTS EQUIPMENT

A26 OUTDOOR ADVERTISING

A27 BOOK / MAGAZINE / NEWSPAPER

B. PROFESSIONAL SERVICES

B1 ARCHITECTURAL

B2CIVIL STRUCTURE, MECHANICAL & ELECTRICAL

CONSULTANT

B3 SURVEYOR

B5 TRANSLATOR

B6 QUALITY CONSULTANT

B7EVENT MANAGEMENT AND PUBLIC RELATION

CONSULTANT

B8 IT SPECIALIST / CONSULTANT

B9 TRAINING CONSULTANT

B10 FINANCIAL CONSULTANT / AUDIT CONSULTANTB11 RESEARCH AGENCY

B12 PROPERTY DEVELOPMENT / CONSULTANT

B13 INTERIOR DESIGN CONSULTANT

B14 ONE STOP AGENCY-TELECOMMUNICATION

B15 DATA ENTRY AGENCY

B16 SOIL INVESTIGATION

B17 RISK MANAGEMENT

B18 REGULATORY CONSULTANT

B19 OTHER PROFESSIONAL SERVICES

B20 PROFESSIONAL PHOTOGHARPHER

B22 LOSS ADJUSTERC. SERVICES

C1 ADVERTISING

C1.1 Agency

C1.2 Multimedia Services

C1.3 Recording Services

C2 TAILORING SERVICES

C3 LAUNDRY SERVICES

C4 SECURITY SERVICES

C5 MEDICAL SERVICES

C6 BILLING MAILING HOUSE

C7 SCRAP DEALERC8 BUILDING MAINTENANCE SERVICES

C8.1 Office Premises Maintenance

C8.2 Parking


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C8.3 Lift Installation and Maintenance

C8.4 Electrical and Mechanical Maintenance

C8.5 Plumbing

C8.6 Hygiene Service

C8.7 Pest Control Services

C8.8 Landscaping

C8.9 Lawn

C8.10 Internal Wiring Telephone Installation/ Maintenance

C8.11 LAN and WAN Cabling Installation and Maintenance

C9 TRANSPORTATION AGENCY AND WAREHOUSE SERVICE

C9.1 Packer and Mover (Admin)

C9.2 Sea, Air and Land Travel

C9.3 Freight Forwarder and Custom Clearing Agent

C9.4 Packer and Mover (Logistic)

C9.5 Warehouse

C9.6 Towing Services

C9.7 Crane / Low Loader Services

C10 DOCUMENT STORAGE SERVICES

C11 RENTAL

C11.1 Motor Vehicles

C11.1.1 Forklift

C11.1.2 Crane

C11.2 Office Equipment

C11.3 PA System

C11.4 Office Furniture and Fitting

C11.5 Civil, Mechanical and Electrical Engineering EquipmentC11.6 Generator Set

C11.7 Satelite and Broadcast Communication Equipment

C12 OFFICE EQUIPMENT REPAIR AND MAINTENANCE SERVICES

C12.1 Office Equipment Repair and Maintenance

C12.2 Office Air-condition Repair and Maintenance

C12.3 Refurbishment of Office Furniture

C12.4 Refurbishment of Fitting and Fixture

C13 WORKSHOP

C13.1 Vehicle Repair and Services

C13.11 Accident Repair

C13.1.2 General Services

C13.1.3 Air-Condition Servicing

C13.1.4 Tyre

C14 TRAVEL AGENCY

C15 MAILING SERVICES

C15.1 Corporate Mailing Services

C15.2 Courier Service

C16 CONTACT CENTRE SERVICES

C17 ENTERTAINMENT

C18 DEBT COLLECTION AGENCY

C23 HOTEL/RESORT/REST HOUSE

C24 EMPLOYMENT AGENCYC25 DIGITAL MEDIA AND INTERACTIVE SERVICES

D. WORKS

D2 CIVIL STRUCTURE ENGINEERING


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D2.1 Road & Bridge Construction and Repair

D2.2 Slope/Landslide/Erosion Protection

D2.3 Slope/Landslide/Erosion Construction and Repair

D2.4 Structure / Cabin / Shelter Repair

D2.5 Room Renovation

D3 BUILDING CONSTRUCTION, REPAIR AND RENOVATION

D3.1 Building Construction

D3.2 Interior Renovation Services

D3.3 General Building Repair and Services

D4 MECHANICAL AND ELECTRICAL ENGINEERING

D4.1 Air Conditioning and Ventilation System

D4.2 Fire Prevention and Protection System

D4.3 Generator

D4.4 AC Mechanical and Electrical Appliances

D4.5 DC Power (Rectifier & Battery), UPS

D4.6 Sub-Station

D4.7 Towers, Guyed Mast, Monopole and Mini Structure

D4.8 Cabin / Shelter

D4.9 Lightning and Earthing Protection System

D4.10 Building Wiring

D5 TELECOMMUNICATION WORK

D5.1 Outside Plant

D5.1.1 Trenching Work Services

D5.1.2 Fiber Cable Network Services

D5.1.3 Copper Cable Network Services

D5.1.4 Outside Plant MaterialsD5.2 Inside Plant

D5.2.1 Access Network Equipment Installation and Maintenance Service

D5.2.2 Transmission Equipment Installation and Maintenance Service

D5.2.3 Switching Equipment Installation and Maintenance Service

D5.3 Microwave Network

D5.3.1 Microwave Equipment Installation and Commissioning Service

D5.3.2Microwave Transmission Equipment Installation and Commissioning

Service

D5.3.3Satellite Transmission Equipment Installation, Commissioning and

Decommissioning Service

D5.4 Mobile Access Network ServicesD5.4.1 Mobile Access Equipment Installation and Commissioning Service

D5.4.2 Mobile Access Infrastructure and Cabling

D5.5 Telecommunication Equipment Part Repair

D6 IT HARDWARE AND SOFTWARE

D6.1 PC, Notebook and Related Peripheral and Service

D6.2 Small to Large Multi-user Systems and Service

D6.3 Software Product and Services

D6.4 Other Computer Related Services

D6.5 Networking Products and Services

D6.6 IT Security Equipment and Services

D6.7 Uninterruptible Power Supply (UPS)

D6.8 Router


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CHECK LIST OF ENCLOSURES REQUIRED:

Please ensure that all relevant documents/certificate/license listed below are attached together with SRF before

submitting it. SRF with missing attachment will be rejected. The checklist is for your guidance only.

APPENDIX A - Business Registration Form (Form D / Form 9)

APPENDIX B - Memorandum and Articles of Association

APPENDIX C - Form 24

APPENDIX D - Form 49

APPENDIX E - Latest Company Profile and Organization Chart

APPENDIX F - Latest Three (3) Years Audited Financial Reports

APPENDIX G - License / Certification With Authorities (e.g. MCMC, CIDB, PKK,

MOF etc.)

APPENDIX H - Works Category

APPENDIX I - Major Customers

APPENDIX J - Brochures and Catalogues