Page 1

smaKmnaMecjGgárkm<úCa Cambodian Rice Exports Association www.riceassociation.com  

APPLICATION FORM  Section 1: Company Details and General Information 

1.

Name of Company/Institution (full legal name): 

eQμaHRkumh‘un b¤sßab½nrdæ 2.

Address:

Gasydæan Postal Code:                                                                      City/Province:                                   Country: 

elxkUd

TIRkug¼extþ

RbeTs

3.

Tel. (include country and area codes):                                                            Fax (include country and area codes): 

elxTUrs½BÞ

elxTUrsar

Email:                                                                                                                    Website (URL): 

GIuEm:l

eKhTMB½r

Contact Name and Title (More than one): 

4.

eQμaHGñkEdlGacTak;Tg nigtYnaTI ¬elIsBImYy¦ 5.

Nature of Business (please tick in below box): 

RbePTénGaCIvkmμ ¬sUmKUskñúgRbGb;EdlGñkeRCIserIs¦

-Non Rice Exporter:                     

-Rice Exporter:                   

eRkABIGñknaMecjGgár

GñknaMecjGgár

Rice Mill Factory:

Rice Mill Factory:

m©as;m:asIunkinRsUv

m©as;m:asIunkinRsUv

Processor:                        

Bank:                                            

Rkumh‘unEkéqñGgár Trader:

FnaKar

Logistic Company:                     

GñkCMnYj

Rkumh‘undwkCBa¢Ún

Broker:                            

Freight Forwarder:                    

QμÜjkNþal

Wholesaler/Retailer:

Gñklk;dMu¼ray

Rkumh‘un Forwarder

Other (Please Specify):...................................... 

epSgeTót ¬sUmbBa¢ak;¦ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

1  


smaKmnaMecjGgárkm<úCa Cambodian Rice Exports Association www.riceassociation.com  

6.

 Type of Business 

RbePTénGaCIvkmμ  Corporate/Limited:            Partnership:           Sole ownership:       Gov. Agency:         Other (specify): ……………………….. 

Rkumh‘unsaCIvkmμmankMNt;

Rkumh‘unshkmμsiTi§

ÉkkmμsiTi§

Pñak;garrdæaPi)al

epSg² ¬bBa¢ak;¦ ………………………..

Year Established (under the name shown in 1): 

7.

qñaMEdlbegáItGaCIvkmμ Employee number: 

cMnYnbuKÁlikbeRmIkargar Certificate of Incorporation Number:                                                                                        VAT/Tax ID Number: 

8.

elxviBaØabnb½RtbBa¢ak;karcuHeQμaHkñúgbBa¢IBaNiC¢kmμ

Bn§b¤elxBn§

Section 2: Technical Capability and Information on Goods / Services Offered    9.  International Offices/Representation (countries where the company has local offices/representation): 

kariyal½y nigtMNagCaGnþrCati ¬RbeTsEdlRkumh‘unmankariyal½ytaMgenA nigtMNag¦   10.  List below  your  Products or Service Names and its annual sales  turnover in terms of quantity (Unit) 

rayeQμaHRbePTGgár plitpl b¤esvarbs;GñkEdl)anlk;CamFümRbcaMqñaM Note: For Rice Mill Factory, Processor, Trader, Broker, and Wholesaler/Retailer only. 

sMKal; sMrab;m©as;eragm:asuInRsUvRkumh‘unEkécñGgárGñkCMnYjQμÜjkNþal nigGñklk;dMunigrayb:ueNÑaH Product

Average Annual Turnover in Quantity (Unit) 

RbePTGgár plitpl b¤¤esva

brimaNRbcaMqñaMCamFüm KitCabrimaN ¬Ékta¦

                                     

2  


smaKmnaMecjGgárkm<úCa Cambodian Rice Exports Association www.riceassociation.com  

11. Milling and Warehouse Capacity: List the mills and warehouses owned/rented by your company with indication of capacity (MT) for  milling and warehouses capacity (MT/H/Mill) for rice mills. Provide addresses of their location.  

smtßPaBm:asIunkinRsUv nigXøaMgpÞúkGgár sUmpþl;CabBa¢IeQμμaH eragm:asIunkinRsUUv nigXøaMgpÞúkGgár EdlCam©as;/CYledayRkumhu‘nrbs;Gñk edaybgðaj BIsmtßPaBpÞkú Caetan enAkñgú XøaMg nigi smtßPaBplitRbcaMéf¶rbs;ma: sInu kinRsUvsRmab;GgárKitCaem:ag. sUmpþln; vU Gasydæan TItaMgXøaMg nigeragcRk TaMgGs;enaH. Note: For Rice Mill Factory, Processor, Trader, Broker, and Wholesaler/Retailer only. 

sMKal; sMrab;m©as;eragm:asuInRsUvRkumh‘unEkécñGgárGñkCMnYjQμÜjkNþal nigGñklk;dMunigrayb:ueNÑaH Facility (Mills) 

rayeQμμaH ¬eragm:asIun nig saxa¦

Capacity in Mtn/Hrs 

smtßPaBCaetanGgár¼1em:ag

Address

Gasydæan

                     Facility (Warehouse) 

Capacity in Mtn 

Address

rayeQμμaH ¬XøaMg¦

smtßPaBpÞúkCaetan

Gasydæan

                  12. Please list the name of warehouses and location.  

sUmpþl;CabBa¢IeQμaHXøaMg nigTItaMgXøaMg EdlRkumh‘uneRbIR)as; Note: For Logistic Company and Freight Forwarder only 

sMKal; sMrab;Rkumh‘undwkCBa¢ÚnnigRkumh‘un Forwarder Etប៉ុេ

្ណ ះ

  3   


smaKmnaMecjGgárkm<úCa Cambodian Rice Exports Association www.riceassociation.com  

Warehouse

Address

rayeQμμaH ¬XøaMg¦

Gasydæan

  Section 3: Others 

Certification:  I, the undersigned, warrant that the information provided in this form is correct, and in the event of changes details will be provided as soon as  possible. 

´sUmFanafaB½t’manEdl)anpþl;[cMeBaHEbbbTenHKWBitCaRtwmRtUv nigRbsinebImankrNIpøas;bþÚrnwgpþl;CUnqab;²EdlGaceFVIeTA)an.             Name                                                                                                          Title 

eQμaH

tYnaTI

                            Stamp and Signature                                                                                 Date 

Rta nig htßelxa

kalbriecäT

Please Fill up both Khmer and English Word, return completed form to:  contact@riceassociation.com/info@riceassociation.com. 

sUmbMeBjCaPasarExμr nig Gg;eKøs ehIybBa¢ÚnEbbbTEdlbMeBjehIyRtlb;mkvij o

Please return your document as below: 

sUmP¢ab;mkCamYynUv³ o

Certificate of Incorporation 

viBaØabnbRt bBa¢ak;karcuHeQμaHkñúgbBa¢IBaNiC¢kmμ o

Patent

b½NÑ)a:tg; o

VAT

viBaØabnb½RtcuHbBa¢IGakrelItémøbEnßm Remark: each certificate sign and seal with the company stamp 

viBaØabnb½RtnImYy² RtUvman htßelxa nigRtarbs;Rkumh‘un

-----------------------------------------------------------

4  

CREA application form  

please complet the application form and send me back with below address: Mr. Lim Kim Khung Tel: 078 990 999 contact@riceassociation.com inf...

Read more
Read more
Similar to
Popular now
Just for you