Step 1 of 30%If this is an update to an already existing application, please send the updated information directly through email to: *protected email*Company InformationCompany Name:(Required)Address of Company:(Required) Street Address City Province / Territory / State ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone:(Required)Website: Email:(Required) Key Contact:Name:(Required) First Last Phone:(Required)Email:(Required) Is your mailing address for purchase orders and billing different from above?(Required) Yes NoPlease indicate the correct address for mailing (if different from above) for purchase orders and billing.Address:(Required) Street Address City Province / Territory / State ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone:(Required)Billing Contact:Name:(Required) First Last Phone:(Required)Email:(Required) GST #:(Required)How many years has your organization been in business under your present firm name:(Required)How many years has your organization been operating under current management:(Required)Contact for Insurance Information:Name: First Last Phone:Email: Are you insured?(Required) Yes NoPlease describe your insurance coverage(Required)Are there any judgments, claims or suits pending or outstanding against your company?(Required)If Yes, please provide details. Yes NoDetails:(Required)Are you now (or have you ever been) involved in any bankruptcy or reorganization proceedings?(Required)If Yes, please provide details. Yes NoDetails:(Required)Business Classification & Ownership(Required) Inuit Indigenous-Other Qualified as Northern Vendor Corporation (Publicly held) Corporation (Privately held) Sole Proprietor Partnership Government Agency/Public Institution Not-for-profit OtherOther:(Required)If Inuit, please state land claim area and include Aboriginal/Inuit certificate/ownership:Land claim area:(Required)Aboriginal/Inuit certificate/ownership:(Required)Max. file size: 50 MB.Please select the applicable Security Clearance of your organization:Please select all that apply:(Required) Top Secret Secret Reliability Pending No ClearanceIs your Company registered with the Controlled Goods Program (CGP) to handle Controlled Goods? (Canada: Controlled Goods Program)Is your Company registered with the Controlled Goods Program (CGP) to handle Controlled Goods? (Canada: Controlled Goods Program)If yes, please provide registration number and expiry date. Yes NoRegistration Number:(Required)Expiry Date:(Required) MM slash DD slash YYYY Number of full-time employees:(Required)Numbers of part-time employees:(Required)Which provinces/territories are you licensed to do business in? (select all that apply)(Required) British Columbia New Brunswick Alberta Prince Edward Island Saskatchewan Labrador Manitoba Nunavut Ontario Northwest Territories Quebec Yukon Territory Newfoundland Nova ScotiaHealth, Safety, Environment and QualityDoes your company have an employee safety program?(Required) Yes NoPlease specify:(Required)Does your company have an HSE policy document?(Required) Yes NoDo you track HSE (Health, Safety and Environment) performance statistics?(Required) Yes NoDoes your company have an Environmental Program?(Required) Yes NoPlease specify:(Required)Are you registered to a quality system? (If yes, please provide registration date/ valid until & certificate number).(Required) Yes NoRegistration date:(Required) MM slash DD slash YYYY Certificate number:(Required)Has your company ever conducted business with Nasittuq?(Required)(If yes, please provide details below) Yes NoDetails:(Required)COMPANY WORK HISTORY AND REFERENCESList your company’s major jobs in progress Customer Type of Work Size (in $ M) Customer Contact Phone LocationActions EditDelete There are no Jobs in progress. Add Job in progress Maximum number of jobs in progress reached. List your company’s major jobs completed in the past 3 years Customer Type of Work Size (in $ M) Customer Contact Phone LocationActions EditDelete There are no Jobs in the past 3 years. Add Job in the past 3 years Maximum number of jobs in the past 3 years reached. Please select primary category of business:Category:Category Manufacturing Distributor Consulting Contracting Other (please specify)Other (please specify)Consultant Information Technology Management Training Facilitation Software Projects/Business Engineering / Design / Architect Other (please specify)Other (please specify)Contractor Building/General HVAC Plumbing/Electrical/Mechanical Transportation Other (please specify) WarehousingOther (please specify):Please describe any other information regarding the services and/or materials that your company can provide to Nasittuq that would be beneficial in Nasittuq’s consideration of your organization:The information submitted in this form is protected, as per our Privacy Policy.
