调查表(中英文)

经典word整理文档，仅参考，双击此处可删除页眉页脚。本资料属于网络整理，如有侵权，请联系删除，谢谢！INTERMEDIARYQUESTIONNAIRE代理商问卷调查CategoryP1Thisquestionnaireisacriticalpartduediligenceprocessrelatedtowithanti‐briberylawsinandelsewhere.Pleaseanswerallapplicablequestionsandpromptlyreturnthisquestionnairetoitssender.CompletionofthisquestionnaireisrequiredforyourCompany’scontinuedorfuturerelationshipwithanyCLARCORcompany.Pleaseattachadditionalinformationifnecessarytofullycompletethisquestionnaire.此问卷调查为)尽职调查流程中很关键的一部分遵守某国及其他地区的反腐败法规请回答相关的问题并尽快回传如想和任何子公司继续或开展合作的请填写这份问卷调查,另外请附上问卷要求提供的相关附件.Thankyouforyourcooperation.谢谢您的合作.SECTIONA:BUSINESSINFORMATION部分:企业信息1.GeneralInformation:一般信息:RegisteredCompany注册公司名称:StreetAddress:_City:_____State/Province省份:_____Country国家:______PostalCode:___OfficeTelephone:__WebsiteAddress:__ContactPerson联系人:______Email:_____DateCompanywasEstablished:公司成立时间:__NumberofEmployees:员工人数:______2.Whichofthefollowingbestdescribesyourcompany?贵公司属于以下哪种公司?Individual/SoleProprietor个体所有者独资企业主PublicCompany上市公司PrivateCompany民营企业------Other:______3.Yourcompany’sprimaryindustry:贵公司主营业务:Construction建筑Filtration过滤Engineering工程Defense/Aerospace航空Oil/Gas/Energy/天然气/Manufacturing制造能源Transportation交通运输Other其他:____________________________________4.Yourcompany’scurrentorpendingrelationshipwithaCLARCOR贵公司现在或者将来与我公司的关系:Consultant咨询顾问Supplier供应商Distributor代理商salesAgent销售代表Other其他:____________________________________5.Willyourcompanyengageanyotherthirdparty(e.g.,consultant,salesagent,etc.)toassistinyourcompany’sbusinessrelationshipwiththeCLARCORcompany?贵公司会雇佣任何第三方机构(咨询顾问公司销售代理等)来帮助销售产品吗?No否Yes是Ifyes,describetheirinvolvement:如选是,请描述他们是怎么参与的:-----------------------------------------------------------------6.Identifythecountrieswhereyourcompanydoesbusiness:请指出贵公司在那些国家从事业务:_______国外没有业绩,目前仅限于国内____.7.Doesyourcompanyhaveanysubsidiaryorganizations?贵公司有子公司吗?No否Yes是(Ifyes,completethefollowingforeachsubsidiary)(如有,请完善以下子公司信息)Name:_______________________________________________________________________________Address地址:_____________________________________________________________________________City:_________________________________________________________________________________State/Province:________________________________________________________________________Country国家:_____________________________________________________________________________PostalCode:__________________________________________________________________________OfficeTelephone:______________________________________________________________________8.Isyourcompanypartofanyjointventures?贵公司有合资成分吗?No否Yes是(Ifyes,completethefollowing)(如是,请按如下填写)NameofJointVenture合资企业名称:__________________________________________________________________Address地址:_____________________________________________________________________________City:_________________________________________________________________________________State/Province:________________________________________________________________________Country国家:_____________________________________________________________________________PostalCode:__________________________________________________________________________OfficeTelephone:______________________________________________________________________PrimaryIndustryofJoint合资企业主营业务:_________________________________________________________9.Pleaseprovidebackgroundinformationonyourcompany’sexpertiseandbusinessactivities.Includeabrochureorrecentannualreport,if（填写业务范围即可）请提供公司专营业务活动的资质和背景资料,可以的话请提供样本资料或最近的年度报告._______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________SECTIONB:REFERENCEINFORMATION部分参考信息1.ProvidetwoexternalbusinessreferenceswithwhomCLARCORmayinquireifitchooses.请提供两个贵公司业务上往来的公司,日后查询（填写不重复的供应商信息）JobTitle:Address:城市:Country国家:Telephone:EmailAddress:State/Province省:PostalCode邮政编码:Facsimile传真:公司#2Name:Contact:JobTitle:Address:城市:Country国家:Telephone:EmailAddress:State/Province省:PostalCode邮政编码:Facsimile传真:2.Willyourcompanyprovidearecentauditedfinancialstatement?贵公司愿意提供最近的经审计的财务报表吗?No否Yes是如果没有请提供一份可供公司以后查询贵公司财务状况稳定性的财务参考资料,例如银行供应商信息等.（请提供除了部分问题1中第三个供应商的资料）公司JobTitle:Address:城市:Country国家:Telephone:EmailAddress:State/Province省:PostalCode邮政编码:Facsimile传真:SECTIONC:INFORMATIONABOUT“KEYPEOPLE”部分:主要负责人信息1.Listallowners,partnersorshareholdersofyourcompany(percentageshouldtotal100%).Includeanygovernmentownership.Youmayskipthisquestionifyourcompanyispubliclyheld.However,ifyourcompanyispubliclyheldandyouknowthatsomeofitssharesareownedorcontrolledbyagovernmentorgovernmententity,pleaseidentifythegovernmentorgovernmententity.请列出贵公司的所有人,合伙人或者股东(按总为100%).包括任何国有成分如果您公司是上市公司可以跳过这个问题.,如果您知道公司有部分股份是国有的或者是政府单位所有的,请指出（只需填写持股人信息）NAME姓名TITLE职务CITIZENSHIP国籍OWNERSHIP所有权%2.Listtheindividualsonyourcompany’sBoardofDirectors.请列出公司董事会的成员.NAME姓名TITLE职务CITIZENSHIP国籍3.Listallcompanymanagerswhowillinteractwiththecompanyorassistinthesaleofitsproducts:NAME姓名TITLE职务CITIZENSHIP国籍Pleaseprovidearesumeorshortbiographicalbackgroundforallofthe“KeyPeople”listedaboveinthisSectionC(i.e.,allnon‐entityowners,partnersorshareholders,membersoftheofDirectorsandallcompanyemployeeswhowillinteractwiththecompanyorassistinthesaleofitsproducts).请提供C”主要负责人”的一份简短简历(例如:所有企业主合伙人或者股东,董事会成员和所有负责销售Clarcor产品的公司员工)4.HaveanyoftheKeyPeoplelistedaboveheldajobinthelast5yearswiththegovernment,anygovernmentagency(includingthemilitary)oranygovernmentownedorgovernmentcontrolledentity?在过去的五年里上面列出的主要负责人”有否在政府,政府机关包括军队或者任何国有企业或国有控股企业工作过吗?No否Yes是(Ifyes,pleasecompletetheinformationbelow)(如果有请填写下面的信息)GOVERNMENTNAMEJOB/RANKCOUNTRYENDDATE姓名国家5.DoanyoftheKeyPeopleprovideanyservicestoorhaveorseekanybusinesswithagovernment,anygovernmentagency(includingthemilitary)oranygovernmentownedorgovernmentcontrolledentity?这些主要负责人”是否曾经或正在从事与任何政府,政府机关(包括军队国有企业或者国有控股企业的商务往来?No否Yes(Completechart是(请填写下面表格)NAME姓名TYPEOFBUSINESSPERFORMEDORBUSINESSSOLICITED业务类别描述IDENTITYOFGOVERNMENTORGOVERNMENTOWNEDORGOVERNMENTCONTROLLEDENTITY政府或者国有企业名称6.DoanyoftheKeyPeoplecurrentlyholdanypositionwithorhaveanysubstantialdutiesforanypoliticalpartyorpoliticalcampaign?“主要负责人”有否在任何政党里任职或担任重要职位?No否Yes(Completechart是(请完成下面表格)POSITION职务NAME姓名POSITION/DUTIES职务职责7.AreanyoftheKeyPeopleacandidateforanypoliticaloffice?“主要负责人”里面有是政党候选人吗?No否NAME姓名Yes(Completechart是(请完成下面表格)OFFICESEEKING寻求职位8.AreanycloserelativesofanyoftheKeyPeople:“主要负责人”的亲属里面有没有:a)Employedorotherwiseengagedinanycapacitybyagovernment,anygovernmentagency(includingthemilitary)oranygovernmentownedorgovernmentcontrolledentity?在任何政府,政府机关包括军队或者国有企业和国有控股企业里面任职或从事工作?No否Yes是b)Holdanypositionwithorhavesubstantialdutiesforanypoliticalpartyorpoliticalcampaign?在任何政党里任职或担任重要职位?No否Yes是c)Acandidateforanypoliticaloffice?是政党候选人?No否Yes是(If“yes”tooneormoreofthesequestions,pleasecompletetheinformationbelow)(如果对一个或者多个问题的回答是肯定的话,请填写下面信息)NAME姓名RELATIVE&RELATIONSHIPPOSITIONDUTIES9.Willyourcompanyorassistinthesaleofthecompany’sproductstoagovernment,anygovernmentagency(includingthemilitary)oranygovernmentownedorgovernmentcontrolledentity?您公司会帮助销售公司的产品给政府,任何政府机关(包括军队),或者国有企业和国有控股企业吗?No否Yes是(Ifyes,identifyeachpotentialpurchaser)(如果回答””,请把潜在的购买方详细指出)_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________SECTIOND:COMPLIANCEINFORMATION部分合规信息1.Doesyourcompanycurrentlyhaveawrittenpolicy