Government Procurement Contract Declaration

Government Procurement Contract Declaration
Please complete this form to declare your company's compliance and eligibility for participation in a government procurement contract.
Company Name
Company Registration Number
Registered Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Contact Person Full Name
First NameLast Name
Contact Email Address
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Procurement Project/Contract Title
Brief Description of Goods/Services Provided
Contract Value (in USD)
Declaration of Eligibility
Upload Supporting Documents (e.g., company registration, compliance certificates, etc.)
Cancelof
Authorized Representative Signature
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Date of Declaration
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: