Buyer’s Application Form Please complete this application form in full. Should you have any queries regarding the questions below please contact us directly on + 98 21 84287209 or via sales@jppc.ir (Please indicate whether any of the information you have provided is confidential): Company’s name * Status of the company Manufacturer Importer Retailer Manufacturer/ Importer Wholesaler other note Postal address Telephone and Fax Email & Website CEO’s name Company representative ) Name of parent or holding company Detailed description of goods demanded from Iran Do you have any local contacts or representative in Iran or in a third country? If YES, please indicate the details: Name & address Type of Contacts Subsidiary Associate company Commission Agent How did you learn about our company? The quantity of product required (monthly or annual estimation): Target markets and areas covered (countries, cities, end user information): Facilities and equipment such as warehouse, tanks, sales and distribution offices in the importing Country What is the value of your annual imports from Iran? History of cooperation with any petrochemical company in Iran or in a third country Company′s registration details including official gazette, articles of association, signature authorization Full details of share holders and directors(over 5% of shares) and directors: Total Number of full time employees and year of count. your views on our products and services quality in your previous orders from our company (if any): )Any supporting documents indicating affordance to purchase (i.e. Bank statement for recent six months, confirmation letter from the bank reflecting the minimum credit level , Approved Financial balance sheet, etc.): (Optional) Generate New Image Generate New Image Remarks: .A. All provided documents will remain with us as confidential and will be used for official purposes .B. If the customer is not manufacturer (end user), providing complete information of the end users is essential C. By handing over the above mentioned documents the customer will be registered in our databas D. If the provided documents are insufficient and not in accordance with the required papers, the inquiry will be considered null and void.