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    VERC Questionnaire - Rev8

    Uploaded by

    QHSSE Arakkonam
    This document is a vendor questionnaire that collects information about a company's ownership structure, management, and financials. It requests details on shareholders that own 25% or more of the company, the ultimate individual shareholders if shareholders are other companies, as well as financial data from the previous three years. A diagram illustrates iterating through shareholder information to map the full control chain up to individual persons. The legal representative must review and sign the completed questionnaire.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd

    VERC Questionnaire - Rev8

    Uploaded by

    QHSSE Arakkonam
    254 views3 pages
    This document is a vendor questionnaire that collects information about a company's ownership structure, management, and financials. It requests details on shareholders that own 25% or more of the company, the ultimate individual shareholders if shareholders are other companies, as well as financial data from the previous three years. A diagram illustrates iterating through shareholder information to map the full control chain up to individual persons. The legal representative must review and sign the completed questionnaire.

    Original Description:

    SAIPEM VENDOR VERC document

    Original Title

    VERC Questionnaire_rev8

    Copyright

    © © All Rights Reserved

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    This document is a vendor questionnaire that collects information about a company's ownership structure, management, and financials. It requests details on shareholders that own 25% or more of the company, the ultimate individual shareholders if shareholders are other companies, as well as financial data from the previous three years. A diagram illustrates iterating through shareholder information to map the full control chain up to individual persons. The legal representative must review and sign the completed questionnaire.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    254 views3 pages

    VERC Questionnaire - Rev8

    Uploaded by

    QHSSE Arakkonam
    This document is a vendor questionnaire that collects information about a company's ownership structure, management, and financials. It requests details on shareholders that own 25% or more of the company, the ultimate individual shareholders if shareholders are other companies, as well as financial data from the previous three years. A diagram illustrates iterating through shareholder information to map the full control chain up to individual persons. The legal representative must review and sign the completed questionnaire.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Download as xlsx, pdf, or txt
    of 3

    Doc. no.

    FORM-COR-PRO-057-E

    FORM
    Rev. 02 Date: 14/03/2016
    VERC QUESTIONNAIRE
    Page 1 of 1

    Ref. Doc. TI-COR-PRO-001-E

    Vendor Data

    Company Name:
    Legal Representatives:

    Top Management Members (please indicate Company Chairman, CEO,


    Managing Directors, etc):

    Public company with joint stocks? (Yes/No)

    Public company with governmental partecipation?


    (please specify the public partecipation percentage)

    Date of Incorporation

    Chamber of commerce registration (country):

    Chamber of commerce registration (date):

    Chamber of commerce registration (number):

    Number of direct employees:

    Presence of bearer shares? *

    Presence of trust companies?**

    Presence of Investment funds ?***

    * Please disclose the names of the shareholders and their percentage interests
    ** Please detail the ownership percentage and beneficiaries and settlor names. Add other rows in case of many trust companies.
    *** Please disclose name and ownership percentage of the “Investors” (natural or legal person)

    Vendor Ownership Structure

    Name Ownership %
    Shareholder:
    Shareholder:
    Shareholder:
    Shareholder:
    Shareholder:
    Shareholder:
    Shareholder:
    Shareholder:
    100%

    Shareholder Control Chain


    If the shareholders indicated in the Ownership Structure are companies with ownership ≥ 25% (or with relative majority), please provide further information on their Shareholders with ownership ≥ 25% (or with relative
    majority)
    Shareholder Name Ownership Structure (shareholders name) Ownership %

    Shareholder Name Ownership Structure (shareholders name) Ownership %

    Please add further rows in case of other Shareholders

    Presence of bearer shares? *


    Presence of trust companies?**

    Presence of Investment funds ?***


    * Please disclose the names of the shareholders and their percentage interests
    ** Please detail the ownership percentage and beneficiaries and settlor names. Add other rows in case of many trust companies.
    *** Please disclose name and ownership percentage of the “Investors” (natural or legal person)

    Vendor Financial Data (please provide last three years financial reports)

    Reference currency:

    Last Financial Year (e.g. 2019): Previous Year ( e.g. 2018) Second Previous Year (e.g. 2017)
    Company Capital:

    Net asset / Net worth / Equity:

    Turnover:

    I have reviewed this questionnaire, and I declare that the information provided is accurate and complete to the best of my knowledge and belief.
    I agree also that if subsequent developments cause the certifications and information reported herein to be no longer accurate or complete, I will immediately so advise Saipem.

    Legal Representative name Legal Representative signature Date dd/mm/yyyy

    This document is the property of Saipem SpA. All rights reserved.


    VENDOR CONTROL CHAIN

    Doc. no. FORM-COR-PRO-057-E

    FORM
    Rev.02 Date: 14/03/2016
    VERC QUESTIONNAIRE
    Page 1 of 1

    Ref. Doc. TI-COR-PRO-001-E

    Iterate the process


    untill shareholder (with
    ownership < 25%) or
    phisical person are found

    Iterate the process SHAREHOLDER 3.1.1 SHAREHOLDER


    3.1.2
    untill shareholder (with (ownership < 25%) (ownership ≥ 25%)
    ownership < 25%) or
    phisical person are found

    SHAREHOLDER SHAREHOLDER SHAREHOLDER SHAREHOLDER


    1.1 1.2 3.1 3.2 SHAREHOLDER 3.3
    (ownership ≥ 25%) (ownership < 25%) (ownership ≥ 25%) (ownership < 25%) (ownership < 25%)

    SHAREHOLDER 1 SHAREHOLDER 2 SHAREHOLDER 3


    (ownership ≥25%) (ownership < 25%) (ownership ≥ 25%)

    VENDOR
    VENDOR CONTROL CHAIN
    VENDOR

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