Form - Vendor

LIBYA OIL KENYA LIMITED VENDOR INFORMATION REQUEST (to be completed by proprietor or Director) Vendor’s Name (Not exceeding 30 Characters) ………………………………………………………................................ Physical Address (Street/Road/Building)……………………………… ……....................... Postal Address .................................................... Postal code ................ City…………………………………… Country……………………………… Telephone Number……………………………………………. Fax Number…………………………………………………… VAT Number………………………… Company Registration Number …………………………… Tax Authority Name/PIN No. ………………………………… Vendor Bank Name…………………………………… Branch…………………………………… Address…………………………………………………………. City……………………………………………………………… Country…………………………………… Vendor Bank Account Number……………………………… SWIFT Code……………………………………………………. Bank Key……………………………………………………….. DECLARATION:DESIGNATION........................................ (Proprietor or Director) Company stamp

NAME:...........................................................