Supplier / Sub-Contractor Registration Form

Who from Comiskey Mining Services requested you to register?*

Company Name*

ABN*

Are you self employeed or do you have employees working for you?

Self employeedI have employees

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email*

example@example.com

Contact Name*

First NameLast Name

Contact Name Phone Number*

Area CodePhone Number

Email*

example@example.com

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Area CodePhone Number

Name

First NameLast Name

Email

example@example.com

Phone Number

Area CodePhone Number

Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

BSB & Account No.

Bank

Insurance*

	Yes	No	N/A
Public Liability - min $10M
Professional Indemnity
WorkCover
Plant / Equipment / Vehicle
Marine Cargo (transport only)
Labour Hire Licence

Upload Insurance Certificates

Browse Files

Has your company ever been given an improvementnotice/fine/conviction from any government authority?*

Details*

Have the directors or the company ever been bankrupt?*

Details*

Has your company ever been in receivership or administration or has a suspension of trade placed against them? *

Details*

Have the directors ever been convicted of bribery,fraud or any other criminal offence?*

Details*

Our expectations of our subcontractors:

Comply with all applicable health and safety laws, regulations and statutory obligations.
Ensure Safety Standards and rules are consistently applied throughout the places where we work.
Personnel will not endanger or cause unacceptable risk to themselves or others through any act or omission.
Plant, equipment & tools are maintained, serviceable and fit for purpose and only being used in the manner for which it is intended.
Activities will be performed in accordance with our site processes, procedures, guidelines and agreed work practices in line with legislative requirements.
Be qualified, trained and competent to perform tasks that they are employed for.
Have the correct and appropriate personal protective equipment available to complete the task
Be fit for work
Be professional
Ensure your worker's conditions & entitlements are up to date and paid
Ensure you're aware of your obligations under Modern Slavery legislation.

Please download the subcontractor Management Checklist complete what is relevant and forward to info@comiskeymining.com.au (failure to provide the checklist will slow the application process down)

If you are going to Saraji South Mine download this Checklist and forward to your Comiskey Mining contact

Declaration -*

True and correct to the best of my knowledge

Name*

First NameLast Name

Position*

Date*

Date

Signature

Supplier / Sub-Contractor Registration Form

Directors

Accounts details

Insurance Details

Compliance

Disclaimer