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;¦ >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
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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¦
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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 ះ
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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
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