HENGYUAN REFINING COMPANY BHD

Supplier Registration Form

Provision of Goods: Please tick relevant box
Civil IT Instrument Mechanical Marine Electrical Waste Inspection HSSE
Services

Provision of Services: Please tick relevant box

Civil IT Instrument Mechanical Marine Electrical Waste Inspection HSSE
Services

CONFIDENTIAL

PART A: COMPANY PROFILE

1. Name of Company: INFINITO E&P SDN BHD

2. Registered Address: NO 5-9P, THE BOULEVARD OFFICE, MID VALLEY CITY, LINGKARAN SYED PUTRA,
59200 KUALA LUMPUR

3. Business Address: NO 17, JALAN CH LIGHT 2A, COLLEGE HEIGHT INDUSTRIAL AREA, 71700 MANTIN
NEGERI SEMBILAN

4. Telephone No.: 06-758 1254 Fax No.: 06-758 1254

5. Company Status: PRIVATE / SUBSIDIARY

PUBLIC PARTNERSHIP

SOLE PROPRIETORSHIP

If the Company is a member of a Group, provide name & address of head office:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

6. Licensing/Registration No.: 1158606-P

(Please attach a copy of the licence/registration form)

7. Date Incorporated: 10th September 2015

8. SST Registration No.: ________________________________________________________________________
(Mandatory for company with annual taxable turnover exceeding RM 500,000.00)

PART B: FINANCIAL INFORMATION

2016 2017
(RM) (RM)

1. Turnover for most recent Financial years: ____________ ___________

(Please attach copies of relevant Audited Financial Statements, Balance Sheets and Profit & Loss statements)

2. Capital

For Partnership or Sole Proprietorship: Capital Set Aside

RM _______________

For Limited Company: Authorised Capital

: Paid-up Capital

RM 1,000 000.00

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3. Bank Name and Address: MAYBANK ISLAMIC BERHAD

NO 30 Jalan Teknologi, Seksyen 2, PJU 3, Kota Damansara,

47810 Petaling Jaya, Selangor

Bank Account No.: 569954062227

PART C: ORGANIZATION

1. Please submit your Company Organization Chart.

2. Particulars of Proprietor/Partners/Directors/Shareholders (please attach a copy of the Form 24 and Form

49).

Name Present Position Race % of Holding

a. NASRULLAH BIN NOOR BADARUDDIN DIRECTOR MALAY 100%
b. MUHAMMAD NAIMULLAH BIN
SALIM PAKHERI PROJECT DIRECTOR MALAY
c. SAMRIZAT SAZLI BIN SAMSUDIN COMMERCIAL DIRECTOR MALAY

3. Previous experience of Proprietor/Partners/Directors/Shareholders:

NAME OF NAME & ADDRESS OF POSITION TYPE OF

PROPRIETOR/ PREVIOUS OCCUPIED EXPERIENCE
PARTNER/DIRECTOR PLACE OF WORK &
DURATION
NASRULLAH BIN NOOR DERMAGA OIL & SALE MANAGER
BADARUDDIN GAS 5 YEARS

MUHAMMAD NAIMULLAH
BIN SALIM PAKHERI PBJV GROUP SDN BHD PROJECT ENGINEER 3 YEARS

SAMRIZAT SAZLI BIN

SAMSUDIN DAYA OCI SDN BHD COMMERCIAL 5 YEARS
DIRECTOR

4. List of Key Personnel in Company other than Proprietor/Partners/Directors/Shareholders:

NAME & NRIC NO. PO POSITION IN PREVIOUS EXPERIENCE

COMPANY (STATE OF NATURE)
MUHAMMAD KHAIRIL BUSINESS LEAD HOOK-UP &
BIN ZAINUDIN DEVELOPMENT
COMMISIONING ENGINEER
LEAD LEAD ENGINEER PROJECT ENGINEER
HERI HERIZAL BIN ZAHRIM

5. Principal Officer with whom HRC will make contact:

Name Position Telephone

1. Alessio Tonelli Proposal Manager +39 0444 968511

2.

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6. No. of Employee/Staff: 19

7. Registration with Government Authorities/Other Organizations (photocopies of certificates etc

are required).

NAME OF AUTHORITY/ VAL VALUE

CLAS CLASSIFICATION/TYPE DATE
ORGANIZATION L LIMIT OF WORK REGISTERED
Pl MINISTRY OF FINANCE AS ATTACHED
27 28/05/2019
COMMISSION ENERGY AS ATTACHED
10/08/2018
DOSH
KPD01 & KPD02 15/03/2019
CIDB G7: B,CE,ME 14/06/2019

SPAN C2 & C3 05/12/2017

01/03/2019

PART D: SUPPLIER’S PRODUCTS/GOODS/PROJECTS/SERVICES LIST

1. Goods Listing
Please refer to the attached goods listing and fill in the list of products that you are currently
marketing/supplying.

2. Letters of Appointments from Manufacturers/Principals

Please attach copies of Letter of Appointment for any Agency/Distribution/Dealership of any products that you
are currently supplying.

3. List of Projects
Please fill in projects/contracts executed by the Company during the last 3 years (if insufficient space, please
attach additional sheets):

N NAME OF CLIENT & ADDRESS TITLE OF CONTRACT DATE OF

PROJECT/CONTRACT VALUE COMPLETION
Please refer the attachment

PART E: MAIN CUSTOMERS

1. Name your major customers and the period over which you have supplied them:

Name of Customers Main Products Period

a. Gas Malaysia Berhad Regulator ________

b. Petronas Gas Berhad Natural Gas Pressure Regulator ________
c. Petronas Carigali Sdn Bhd Multiphase Flow Meter 2years

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2. Please list down your MAIN products only:

GOODS LISTING

ITEM MATERIAL MANUFACTURER/ SUPPLIERS MESC GROUP

NO. DESCRIPTION PRODUCT BRAND TATUS **
Please refer the
attachment

** LEGEND :

A = AGENT D = DEALER S = STOCKIST M = MANUFACTURER

PART F: HSSE/QUALITY ASSURANCE/CONTROL

Do you have an HSSE-MS programme for your business? If yes, please Yes
attach. Yes/No:
Do you have a Quality Assurance/Quality Control (QA/QC) programme for Yes
your business? If yes, please attach. Yes/No:
Is your QA system accredited to ISO 9000? If yes, please attach a Yes
copy of the certificate. Yes/No:

PART G: WAREHOUSE FACILITY

(where applicable for Goods)
1. Factory/Warehouse address: NO 17, JALAN CH LIGHT 2A, COLLEGE HEIGHT INDUSTRIAL AREA,
71700 MANTIN NEGERI SEMBILAN

2. Do you currently hold stock for the products that you are supplying?
If yes, please provide details.

Materials Stock Volume Location

a. _______________ ________________ __________

b. _______________ ________________ __________
c. _______________ ________________ __________
d. _______________ ________________ __________
e. _______________ ________________ __________

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PART H: DECLARATION

“I/We declare that the particulars given are correct and I/we fully understand that no consideration will be given to
our company if any of the particulars are found incorrect. I/We will be liable for de-registration without notice if:

a. Any particulars found incorrect subsequent to our registration as your Approved Supplier.

b. We are in breach of or in conflict with your company’s Life Saving Rules, HRC Code of Conduct (including
HRC General Business Principles) and HSSE Policy (statements of which are attached to this questionnaire,
and which we have read thoroughly and understood).

c. We are in breach of your “General Terms & Conditions of Purchase Order” and/or of the specific terms in
the individual purchase orders (copy provided upon request).

d. We fail to immediately notify your company of any change in the Shareholding and/or any major changes
in our services to you.”

Supplier’s Stamp and Signature: ______________________ Date: ________________________

CHECKLIST

Company Registration Form /

Form 24 /

Form 49 /

Audited Financial Statement (past 2 years) /

Balance Sheet (past 2 years) /

Profit & Loss Statement (past 2 years) /

Bank Statement /

Organization Chart /

Agency Letter(s) (if any) /

ISO 9000 Certificate (if any) /

Goods Listing (main ones only) /

Custom’s SST Registration Confirmation Form

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FOR HRC INTERNAL USE ONLY

JOINT SUPPLIER EVALUATION REPORT

Technical Approval:
(a) Supplier meets basic criteria? The basic criteria are:
(i) The supplier has not been blacklisted by HRC.
(ii) There is a demand for the category of goods or services provided by the supplier.
(b) Undertake the technical evaluation of the supplier’s capability, track record, HSSE record, etc.
(c) Support the recommendation for the registration of supplier.

…………………………………………………………………………………….….…………………………………………………………

……………………………………………………………………………………………………………………………….…………………..

Commercial & Financial Standing:

………………………………………………………….…………………………………………………………………………………………

………………………………………………………………………………………………………………………………….…………………

HSSE (if applicable):

………………………………………………………….…………………………………………………………………………………………

………………………………………………………………………………………………………………………………….…………………

 Rejected/Approved* by Line Recommendation:

……………….………… ……………….………… ……………….………… ……………….…………

Line Section Head Finance Manager, Contract & Procurement HSSE (If applicable)
Date: Date: Date: Date:

 Rejected/Approved* by Business Assurance Advisor Manufacturing

 Related Party Transaction (RPT) Vendor ? * Yes / No

……………………..…………
Finance
Date:

* please circle where appropriate

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Hengyuan’s 12 Life-Saving Rules

1. Work with a valid Work 2. Conduct gas tests when

Permit when required required

3. Verify isolation before work 4. Obtain authorisation

begins and use the specified before entering a
life protecting equipment confined space

5. Obtain authorisation before 6. Protect yourself against

overriding or disabling a fall when working at
safety critical equipment height

7. Do not walk under a 8. Do not smoke outside

suspended load designated smoking
areas

9. No alcohol or drugs while 10. While driving, do not

working or driving use your phone and do
not exceed speed limits

11. Wear your seat belt 12. Follow prescribed

Journey Management
Plan

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HSSE POLICY

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CODE OF CONDUCT/GENERAL BUSINESS PRINCIPLES

Contractor acknowledges the following:-

(i) Received a copy of the HRC Code of Conduct (copy attached below);

Contractor agrees that it and its Related Parties will adhere to the principles contained in the Business Principles (or
where Contractor has adopted equivalent principles, to those equivalent principles) in all its dealings with, for or on
behalf of Company in connection with the Purchase Contract and the business resulting there from. In the event that
Contractor or any of its Related Parties supply staff that work on behalf of Company or represent Company, Contractor
commits that such staff will behave in a manner that is consistent with the HRC Code of Conduct. Contractor will
notify Company immediately if it becomes aware of any behaviour by Company staff, Contractor or its Related Parties
which is, or may be, inconsistent with the Business Principles, the HRC Code of Conduct or, where the Contractor
has adopted equivalent principles, their equivalent.

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