PROSPECTIVE VENDOR INFORMATION SHEET

Vendor No.: ___________________

(IOM Internal Use)

Company Details
Registered Vendor Name*: Proshika Manobik Unnayan Kendra
Tax Organization Type*: Corporation
Supplier Type*: National or Local CSO
Company Web Site: www.proshikabd.com
Tax Country*: Bangladesh
Taxpayer ID/Tax Registration No*:
Products and/or Services Education and Training Services
Additional Information
UNGM No.: UNGM#862661 Commitment to Antiracism: Yes
UNPP No.: Does your entity agrees with UN Yes
Supplier Code of Conduct:
Is your Entity Women Owned?: No Is the Bank Account Certificate added Yes
as attachment?:
Is your Entity Disability Inclusive?: Yes

Address*
Street Name and House No. PROSHIKA Bhavan, I/1-GA, Section -2, Mirpur
ZIP/Postal Code* Dhaka - 1216
City* Dhaka
Region* Dhaka
Country* Bangladesh
Contact Information for communications
First Name*: Md. Sarwar IMPORTANT
Last Name*: Hossain All fields marked with * are mandatory.
Job Title Technical Adviser The form will be returned if mandatory field/s is/are empty
Email*: sarwar.bracss@gmail.co The Vendor Name should match ID or registration documents
m

Other Contacts
First Name*: Serajul
Last Name*: Islam Will this person have a role in Wave? Yes
Job Title: Chief Executive If yes, what will be that role? Manages
agreements and
deliverables
Email*: Serajul.islam.ce@gmail.com

First Name*: Aminul

Last Name*: Islam Will this person have a role in Wave? Yes
Job Title: Deputy Director If yes, what will be that role? Manages invoices
and payments
Email*: aminulislamshaheen@gmail.
com

I hereby certify that the information above are true and correct. I am also authorizing IOM to validate all claims with
concerned authorities.

Printed Serajul Islam List of attachments

Name*:
☒ Taxpayer ID/Tax registration number certificate.
☒ Business License
☐ Id. of the owner
Signature*: ☒ Signed UN Supplier Code of Conduct
Job Title Chief Executive ☐ Proof of women ownership share of the company
Date 20.04.2025 ☒ Evidence of commitment to anti-racism
☒ Evidence of entity’s disability inclusive policy
☐ Other:__ Other Bank Account Information__________________________

SPEND AUTHORIZED SUPPLIER INFORMATION SHEET

Supplier Details
Supplier´s Name*: Proshika Manobik Unnayan Kendra
Supplier Number*: UNGM#862661

Payment Details
Payment Method*: ☒ Bank transfer IMPORTANT
☐ Check** All fields marked with * are mandatory.
☐ Cash** The form will be returned if mandatory field/s
is/are empty
☐ Others**:____________________________ The Vendor Name should match ID or registratio
documents

**If a Non-Bank Payment N/A

Method was selected,
please provide
justification:

Bank Details* (This information is mandatory if payment method is via Bank Transfer)
Bank Name* Pubali
BankPLC
Address Darus Salam Road NOTES
City* Mirpur, Dhaka Payment currency must be
clearly
Postal Code 1216 indicated to avoid delays and
additional
Country* Bangladesh bank charges
Bank Account Name* Proshika Manobik Unnayan
Kendra(RLF)
Account Currency Taka If the company has multiple
bank
Bank Account Number 2990102000124 accounts, indicate the default
account
Swift Code/BIC (outside PUBABBDH Fill only the code that this form and add an extra
U.S.A.) sheet with
IBAN Number corresponds to your full information of other
accounts
Clearing Number location*
(Switzerland)
ABA No. for ACH (U.S.A.)
PLEASE, FILL IN THE CONTACT INFORMATION ONLY IF IT NEEDS TO BE UPDATED IN THE SUPPLIER PROFILE
Contact Information

First Name: Serajul

Last Name: Islam Will this person have a role in Wave? Yes
Job Title: Chief Executive If yes, what will be that role? Manages
agreements and
deliverables
Email*: pmuk@proshikabd.com

First Name: Md. Aminul

Last Name: Islam Will this person have a role in Wave? Yes
Job Title: Deputy Director If yes, what will be that role? Manages invoices
and payments
Email*:

I hereby certify that the information above are true and correct. I am also authorizing IOM to validate all claims with concerned
authorities.

Printed Serajul Islam List of attachments

Name*:
☒ Bank Account Certificate
☒ Declaration of Conformity was signed in solicitation documents
Signature*: ☐ Other:__Annex required ________________________________
Job Title Chief Executive
Date 20.04.2025