Form: Business Partner Screening Questionnaire
(Annex 9 to the Letter of Tender)
This questionnaire is part of the TSCNET integrity check and must be completed by (potential) Business Partners who are to provide services for TSCNET as part of a self-disclosure process.
| 1. Key data of the Business Partner | |
| Name: | Organization of the company / legal form: |
| Registered address and country: | Website: |
| 1. General company information on the Business Partner | |||
| a. | Provide all current or former company names other than the name used for registration under which the company is known to operate or has operated within the past 5 years. | ||
| [ ] | Other company name(s): | ||
| [ ] | There are no other company names. | ||
| b. | Provide the date of incorporation or commencement of business of the company and the country where the company is (currently) registered or incorporated. | ||
| Date: | Country: | ||
| c. | Does the Business Partner have an anti-bribery and anti-corruption program including policies, procedures, and controls to prevent improper business conduct? Yes [ ] No [ ] If so, please provide as much detail as possible about the program: |
| 3. | Future business relationship | |
| a. | Describe the company's business model and (planned) activity / services for TSCNET: | |
| b. | Describe the company's qualifications and previous experience in the business area of the proposed activity for TSCNET: | |
| c. | ||
| If so, please provide as much detail as possible about the third parties or subcontractors and about the services they provide: | ||
| d. | What due diligence does the Business Partner perform on third parties and subcontractors it may use? | |
| e. | Are parts of the services / products for TSCNET produced in the U.S. and/or does the final product contain 10% or more in value of U.S.-origin commodities or technical data? Yes [ ] No [ ] |
4. Key persons of the company ("Key Persons")
| a. | The names of all shareholders / stockholders holding a significant proportion of shares (more than 10%) must be disclosed indicating their shareholding as a percentage. If the company is wholly or partially owned by a legal entity, provide the names of the natural persons who are the ultimate beneficial owners. | |||
| Name of the shareholder / stockholder | Nationality | Shareholdings in % | ||
| b. | Provide the names of all the people * who, by virtue of their position, have a significant influence on the company's business activities, in particular the managing directors and senior executives, * and / or those expected to be involved in providing services to TSCNET. | |||
| Name of person | Position | |||
5. Connections to TSCNET employees / management
| a. | Are there any personal, family, contractual or similar close relationships between any of the Business Partners Key Persons (as listed in section 4 above) and TSCNET employees / management? | |
| Yes [ ] | No [ ] | |
| If so, please provide as much detail as possible about the background: |
| 6. Connections to public officials / PEPs | |||
| a. | Are there any personal, family, contractual or similar close relationships between any of the Business Partner’s Key Persons (as listed in section 4 above) and public officials[1]? | ||
| Yes [ ] | No [ ] | ||
| If so, please provide as much detail as possible about the background: | |||
| b. | Are any of the direct or indirect shareholders of the Business Partner (as listed in section 4 above) a public official? | ||
| Yes [ ] | No [ ] | ||
| If so, please provide as much detail as possible about the background: | |||
| c. | Are any of the Business Partner’s Key Persons (as listed in section 4 above) a politically exposed person (PEP)? Yes [ ] No [ ] |
7. Bank account details
| a. | Specify the name of the bank where the company's account is held to which payments are to be made. | ||
| Bank: | Branch (city and country): | ||
| b. | Is the name of the account holder the same as the name of the company? | ||
| Yes [ ] | No [ ] | ||
| If not, please explain: | |||
| c. | Is the bank account located in the country where the Business Partner has its principal place of business or where the services are provided to TSCNET? | ||
| Yes [ ] | No [ ] | ||
| If not, please explain: |
8. Legal proceedings / investigations
| Has the Business Partner or any of its Key Persons been involved in any significant legal proceedings, official investigations, convictions or regulatory sanctions (esp. related to corruption or fraud) in the last 5 years or are any proceedings or official investigations currently pending? | ||||
| Yes [ ] | No [ ] | |||
| If so, provide at least the year in question, the type of litigation/investigation, and the outcome of the litigation. | ||||
| Year | Type of proceedings/investigation | Outcome | ||
| Please attach the following document: | |
| * Copy of a current extract from the commercial register (not older than 12 months) | |
| I hereby confirm that all information or documents contained in or attached to this questionnaire are true and complete and given in good faith. I understand that incorrect and / or incomplete information or documentation entitle TSCNET to terminate the proposed contract or to claim damages under applicable laws. |
| Place, Date | Signature, position of the representative |
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Public officials are public servants and other public administrators. For purposes hereof, public officials in the sense of criminal jurisprudence include but are not limited to:
- judges, prosecutors and notaries;
- individuals otherwise serving in or appointed to an official function under public law, who are entrusted with tasks related to public administration for an authority or elsewhere;
- employees of enterprises operating under private law (e.g., GmbHs, AGs), provided that they perform tasks related to public administration – for instance, as employees of
- local utilities forming part of the service administration and functioning as a public service (energy – especially gas, electricity, district heat, water, traffic, waste, etc.); or
- inspection or certification bodies (e.g., TÜV);
- employees of European institutions (such as the European Commission) or public or other servants working for the European Union (EU) or an entity created on the basis of EU law;
- individuals tasked with executing functions of the EU or an entity created on the basis of EU law;
- individuals appointed and/or elected to offices related to legislation, administration or justice in a foreign country; or
- individuals performing public functions for a foreign state (including its authorities) or public enterprise or working for an international organization.