Appendix 02 - Candidate Questionnaire - Bilingual (1).docx

Appendix 2附錄2Candidate Questionnaire候選方問卷I. Candidate Information (Entities and Individuals) 候選方信息（實(shí)體和個(gè)人）1.Candidate Name and Address 候選方姓名和地址Candidates Legal Name 候選方的法定名稱：_Candidates Trade Name (if different from Legal Name) 候選方的商號(hào)（如果不同于法定名稱): _Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)): _Official ID Number (if applicable) 身份證明號(hào)碼（如適用）： _Business Address 企業(yè)地址： _ _Postal Code 郵政編碼: _Country 國家： _Website URL (if applicable) 網(wǎng)站鏈接（如適用）:_2.Contact Information 聯(lián)絡(luò)信息Name and Title of Contact Person(must be individual responsible for business relationship with Company; secretarial or administrative employeesmay not be listed as a Contact Person): 聯(lián)絡(luò)人的姓名和職銜（必須是負(fù)責(zé)與本公司業(yè)務(wù)關(guān)系的個(gè)人；不得將秘書或行政人員列為聯(lián)絡(luò)人）： _Contact Person Year of Birth 聯(lián)絡(luò)人出生年份： _Contact Person Country of Residence 聯(lián)絡(luò)人居住國：_Telephone Number 電話號(hào)碼：_E-Mail Address 電子郵件地址： _3.Which of the following best describes Candidate (check one)?以下哪一項(xiàng)最符合候選方的情況（選一項(xiàng)）？Individual 個(gè)人Sole Proprietor 個(gè)體經(jīng)營者Private Corporation 私營公司Partnership 合伙企業(yè) Limited Liability Partnership 有限責(zé)任合伙企業(yè)Publicly Traded Corporation 上市公司Other 其他：_4.Type(s) of Services to be Provided by Candidate(check all that apply):候選方提供服務(wù)的類型（勾選所有適用的選項(xiàng)）： Agribusiness Support Services 農(nóng)業(yè)支持服務(wù) General/Supervising Construction Contractos 總承包商/監(jiān)理施工承包商 Maintenance Contractors 維修保養(yǎng)承包商 Waste Management Services 廢品管理服務(wù) Environmental Consultants and Services 環(huán)境顧問和服務(wù) Transportation Services 運(yùn)輸服務(wù) Warehousing and Storage倉儲(chǔ) Freight Forwarders 貨運(yùn)代理 Customs Services 海關(guān)服務(wù) Government Relations/Lobbyists 政府關(guān)系/說客 Law Firms 律師事務(wù)所 Civil Law Notary 民法公證員 Tax Lawyers, Tax Advocates, Tax Accountants, and Tax Consultants 稅法律師、稅務(wù)支持、稅務(wù)會(huì)計(jì)和稅務(wù)顧問 Debt Collectors 債務(wù)催收 Real Estate Services 房地產(chǎn)服務(wù) Landlords/Property Owners 房東/業(yè)主 Public Relations 公共關(guān)系 Consultants (Other) 顧問（其他） Engineering & Architectural Services 工程與建筑設(shè)計(jì)服務(wù) Testing and Inspections 測(cè)試和檢查 Advertising, Marketing, and Promotional Services 廣告、市場(chǎng)營銷和推廣服務(wù) Utility Connection Services 公用事業(yè)服務(wù) Water, Sewer, Gas and Electrical Utilities and Metering/Utility Management Services 供水、排污、天然氣和電氣公用事業(yè)以及計(jì)量/公用事業(yè)管理服務(wù) Accounting, Financial, and Insurance Services 會(huì)計(jì)、金融和保險(xiǎn)服務(wù) Pharmaceutical Services 醫(yī)藥服務(wù) Healthcare Services 衛(wèi)生保健服務(wù) Food Safety Services 食品安全服務(wù) Travel and Visa Services 旅行和簽證服務(wù) Cafeterias and Catering 餐廳和餐飲Security and Safety Providers, Consultants, and Schools 安保和安全提供商、顧問及學(xué)校 Labor-Related Services 勞務(wù)相關(guān)服務(wù) Licenses and Permits 證照和許可 Other 其他:_5.If more than one type of service is selected in response to Question No. 4, please indicate the type of service that most accurately describes primary service to be provided by Candidate:如果回答第4題時(shí)選了一種以上服務(wù)，請(qǐng)指出與候選方提供的主要服務(wù)最相符的服務(wù)類型：6.Date thatCandidate was established (or if Candidateis an Individual, year of birth):候選方的成立日期（如果候選方是個(gè)人，則說明出生年份）：_ mm-dd-yyyy or best information available 月月-日日-年年年年或現(xiàn)有最準(zhǔn)確的信息7.List every country in which Candidate will provide services for the Company (attach list on a separate page, as needed):列出候選方將會(huì)提供服務(wù)的每一個(gè)國家（如需要，請(qǐng)另紙列明）：8.Describe in detail the specific activities that Candidate will perform for or on behalf of the Company, including the nature and frequency of any interactions with any Government Entity or Official in connection with the activities(continue description on a separate page, as needed):詳細(xì)說明候選方將為本公司或代表本公司履行的特定活動(dòng)，包括在此類活動(dòng)上與政府實(shí)體或官員互動(dòng)的性質(zhì)和頻率。（如需要，請(qǐng)另紙書寫）：9.List all Government Entities and/or Officials that Candidate is expected to interact with in the coure of providing services for or on behalf of the Company. If you are unable to identify such Government Entities or Officials, please contact yourCompany liason before proceeding with this form.列出在為本公司或代表本公司提供服務(wù)的過程中預(yù)期會(huì)與候選方互動(dòng)的所有政府實(shí)體和/或官員。如果您無法確定此類政府實(shí)體或官員，請(qǐng)?jiān)诼?lián)絡(luò)貴方與本公司的聯(lián)絡(luò)人后再填寫本表。10.Is Candidate subject to any law requiring registration with any government agency or entity?候選方是否受制于有關(guān)在政府機(jī)構(gòu)或?qū)嶓w注冊(cè)的法律規(guī)定？YES 是NO 否If YES, provide the following information for eachsuch registration in every country in which Candidate has been or is currently registered(continue listona separate page, as needed):如果是，請(qǐng)?zhí)峁┖蜻x方過去或現(xiàn)在注冊(cè)的每個(gè)國家中的每一項(xiàng)此類注冊(cè)：Government Agency Name 政府機(jī)構(gòu)名稱：_Registration Number 注冊(cè)編號(hào)： _Registration Date (mm-dd-yyyy) 注冊(cè)日期（月月-日日-年年年年）：_Expiration Date (mm-dd-yyyy) 失效日期（月月-日日-年年年年）：_City, State/Province, Country 城市、州/省、國家：_11.Is Candidate registered with any other oganization (e.g., a Chamber of Commerce)?候選方是否在任何其他機(jī)構(gòu)注冊(cè)（比如商會(huì)）？YES 是NO 否If YES, provide the following information for each registration (continue liston a separate page, as needed):如果是，請(qǐng)?zhí)峁┟宽?xiàng)注冊(cè)的下列信息（如需要，請(qǐng)另紙書寫）：Organization Name 機(jī)構(gòu)名稱： _Registration Number 注冊(cè)編號(hào)： _Registration Date (mm-dd-yyyy) 注冊(cè)日期（月月-日日-年年年年）：_Expiration Date (mm-dd-yyyy) 失效日期（月月-日日-年年年年）：_City, State/Province, Country 城市、州/省、國家：_12.Will Candidate hire any subcontractors to provide services for or on behalf of the Company in any of the countries listed in response to No. 7 that may require the subcontractor to interact with any Government Entity or Official?候選方是否會(huì)雇用任何分包商，以便在第7題答案中所列的任何國家為本公司或代表本公司提供服務(wù)，而這可能需要分包商與政府實(shí)體或官員互動(dòng)？YES 是NO 否If YES, provide the following information for each such subcontractor(continue list on a separate page, as needed):如果是，請(qǐng)?zhí)峁┟恳晃淮祟惙职痰囊韵滦畔ⅲㄈ缧枰?，?qǐng)另紙書寫）：Subcontractor Name 分包商名稱：_Subcontractor Year of Birth (if Individual) 分包商出生年份（如果是個(gè)人）：_Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)）：_Official ID Number (if applicable) 身份證明號(hào)（如適用）：_Business Address 企業(yè)地址： _Postal Code 郵政編碼： _Country 國家： _Website URL (if applicable) 網(wǎng)站鏈接（如適用）：_Telephone Number 電話號(hào)碼： _Services to be Provided (briefly describe):待提供的服務(wù)（簡要描述）：Nature of Interaction with Government Entities / Officials (briefly describe):與政府實(shí)體/官員接觸的性質(zhì)（簡要描述）：13.Will Candidate use any subsidiaries and/or related parties(e.g., partnerships, sister companies, joint ventures) to provide services for or on behalf ofthe Company in any of the countries listed in response to No. 7 that will require interaction with aGovernment Entity or Official?候選方是否會(huì)使用任何子公司和/或相關(guān)方（即合伙企業(yè)、兄弟公司、合資企業(yè)）在第7題答案中所列的任何國家為本公司或代表本公司提供服務(wù)，而這需要與政府實(shí)體或官員互動(dòng)？YES 是NO 否If YES, provide the following information for each such subsidiary and/or related party(continue liston a separate page, as needed):如果是，請(qǐng)?zhí)峁┟恳患掖祟愖庸竞?或相關(guān)方的以下信息（如需要，請(qǐng)另紙書寫）：Subsidiary / Related Party Name 子公司/相關(guān)方名稱：_Subsidiary / Related Party Year of Birth (if Individual) 子公司 / 相關(guān)方的出生年份（如果是個(gè)人）： _Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)）： _ Official ID Number (if applicable) 身份證明號(hào)（如適用）：_Business Address 企業(yè)地址： _Postal Code 郵政編碼： _Country 國家： _Website URL (if applicable) 網(wǎng)站鏈接（如適用）：_Other Government Registration Numbers/ Registrations with other organizations 其他政府注冊(cè)編號(hào)/在其他機(jī)構(gòu)辦理的注冊(cè) _ (if different from responses to Nos. 10 and 11, above) （如果不同于上述第10和11題的答案）Candidates Ownership Percentage 候選方的所有權(quán)比例：_Other owners (and Percentage of Ownership) 其他所有者（及所有權(quán)比例）:_14.Will any third parties, intermediaries, or other persons or entities not identified in Sections I.12-13 of this Questionnaire be involved in any transactions and/or provide any services for the Company in connection with Candidates services that may require interaction with a Government Entity or Official?在可能需要與政府實(shí)體或官員互動(dòng)的候選方服務(wù)方面，本問卷第I.12-13部分未列出的任何第三方、中介或其他人或?qū)嶓w是否會(huì)參與任何交易和/或?yàn)楣咎峁┤魏畏?wù)？YES 是NO 否If YES, provide the following information for each third party, intermediary, person, or entity(continue liston a separate page, as needed):如果是，請(qǐng)?zhí)峁┟恳粋€(gè)第三方、中介、個(gè)人或?qū)嶓w的以下信息（如需要，請(qǐng)另紙書寫）：Name of Third Party / Intermediary 第三方/中介的名稱：_Year of Birth (if Individual) 出生年份（如果是個(gè)人）：_Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)）： _Country of Residence 居住國：_Nature and Extent of Involvement 參與的性質(zhì)和程度： _15.Identify the country/countries in which Candidates bank or financial institution will host Candidates receipt of payment fromthe Company for services provided to or on behalf of the Company:列出候選方的賬戶所在銀行或金融機(jī)構(gòu)將在哪個(gè)（些）國家接收候選方由于向本公司或代表本公司提供服務(wù)而從本公司收到的款項(xiàng)：16.Indicate the method(s) by which the candidate will receive payment (check one):說明候選方的收款方式（選一項(xiàng)）： Check 支票 Electronic Funds Transfer (EFT) 電子轉(zhuǎn)賬 Other 其他If Other, describe Candidates method(s) of payment:如果選其他，請(qǐng)具體說明候選方的付款方式：17.Identify any entities or individuals other than Candidate that will receive payment directly from the Company for services provided under Candidates contract with the Company (continue list on a separate page, as needed):列出除候選方外，將會(huì)因?yàn)楦鶕?jù)候選方與本公司的合同提供服務(wù)而從本公司直接收到款項(xiàng)的任何實(shí)體或個(gè)人（若需要，請(qǐng)另紙列明）：Name of Individual or Entity 個(gè)人的名字或?qū)嶓w的名稱：_ Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)）： _Title (if applicable) 職銜（如適用）：_Year of Birth (for Individual) 出生年份（如果是個(gè)人）：_Citizenship 國籍： _Country of Residence 居住國：_18.Does Candidate have specific policies and procedures in relation to facilitation payments? 侯選方是否有制定任何與(小額)疏通費(fèi)用相關(guān)的政策及流程?YES 是NO 否II. Candidate Personnel Information (“Key Persons”) 候選方個(gè)人信息（“核心人物”）1.For Candidates that are NOT publicly traded companies, list all owners, partners, or shareholders of the Candidate. If any of the shareholders is a company (as opposed to an individual), you must list all owners, partners, or shareholders of such company below (percentage should total 100%). For Candidates that ARE publicly traded companies, list the owners, partners, or shareholders that have five (5) percent or more of the voting rights or outstanding shares of any class of stock in Candidate. To the extent any of the owners is an entity (as opposed to an individual), provide the ownership information for those entities on a separate page (continue list on a separate page, as needed).如果候選方不是上市公司，請(qǐng)列出候選方的全體所有者、合伙人或股東。如果其中任何一名股東是公司（而非個(gè)人），則必須在下方列出該公司的全體所有者、合伙人或股東（各項(xiàng)比例相加應(yīng)為100%）。如果候選方是上市公司，請(qǐng)列出在候選方任何等級(jí)股票中至少占百分之五(5%)投票權(quán)或已發(fā)行股份的所有者、合伙人或股東。如果任何股東是實(shí)體（而非個(gè)人），則另紙?zhí)峁┻@些實(shí)體的所有權(quán)信息（必要時(shí)請(qǐng)另紙列明）。Name of Individual or Entity 個(gè)人的名字或?qū)嶓w的名稱：_ Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)）： _Title (if applicable) 職銜（如適用）：_Year of Birth (for Individual) 出生年份（如果是個(gè)人）：_Citizenship 國籍： _Country of Residence 居住國： _Ownership Percentage (%) 所有權(quán)比例(%)： _Name of Individual or Entity 個(gè)人的名字或?qū)嶓w的名稱：_Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)）： _Title (if applicable) 職銜（如適用）：_Year of Birth (for Individual) 出生年份（如果是個(gè)人）：_Citizenship 國籍： _Country of Residence 居住國： _Ownership Percentage (%) 所有權(quán)比例(%)：_Name of Individual or Entity 個(gè)人的名字或?qū)嶓w的名稱：_ Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)）：_Title (if applicable) 職銜（如適用）：_Year of Birth (for Individual) 出生年份（如果是個(gè)人）：_Citizenship 國籍：_Country of Residence 居住國：_Ownership Percentage (%) 所有權(quán)比例(%)：_2.Does Candidate have a Board of Directors?候選方是否有董事會(huì)？YES 是NO 否If YES, provide the following information for each member of the Board of Directors(continue liston a separate page, as needed):如果選是，則提供每一位董事會(huì)成員的以下信息（如需要，請(qǐng)另紙列明）：Name 姓名：_Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)）：_Title 職銜： _Year of Birth 出生年份： _Citizenship 國籍： _Country of Residence 居住國：_Name 姓名： _Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)）：_Title 職銜： _Year of Birth 出生年份： _Citizenship 國籍： _Country of Residence 居住國： _Name 姓名： _Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)）: _Title 職銜：_Year of Birth 出生年份：_Citizenship 國籍： _Country of Residence 居住國： _Name 姓名：_Tax ID Number (or country equivalent) 稅務(wù)登記證號(hào)（或所在國同等編號(hào)）： _Title 職銜： _Year of Birth 出生年份： _Citizenship 國籍：_Country of Residence 居住國： _3.Who are Candidates “key” people (e.g., partners, officers, senior managers, significant employees) who will have a significant role in providing services for or on behalf of the Compan