Candidate buyer declaration of intent form

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DECLARATION OF INTENT FORM – CANDIDATE PURCHASER

Ref.: AMI n°2022-01

1. EXPRESSION OF INTENT SUBMITTED BY:

The candidate, or if it is in consortium, the members and the head of the list:

Company name:

Public entity or private entity:

Activities:

Address:

Name of legal representative – signatory:

Title / Function:

Telephone:

email address:

If it is in consortium, please put the same information in annex with the agreement agreed between the members of the consortium.

2. DECLARATION

I, the undersigned, as a signatory authorized by the aforementioned candidate (including understood by all members of the consortium, if applicable), hereby declare that we have reviewed and accept without reservation or restriction the notice of expression of intent for our registration as a verified buyer. We have every intention of submitting an offer within conditions required by exporters and by the regulations applicable in Madagascar and in particular without going below the floor price in force.

3. FINANCIAL CAPACITY

Please complete the following "Financial data" table from your accounts of the three (03) last corporate financial years. If your annual accounts for the last financial year are not yet available, indicate your most recent estimates in italics. For all the columns, the figures must be drawn up on the same basis, so as to allow a direct comparison from one year to the next the other - if the basis for establishing the figures has changed for a year, this should be noted explanation at the bottom of the table. Any clarification, explanation or additional information that may be deemed necessary can also be provided.

Financial data 2 years before

last exercise

1 year before

last financial year Last financial year

annual turnover

Net profit

Balance sheet total

Total equity

Net cash

4. EXPERIENCE

Please complete the table below to summarize the candidate's experience over the past 3 years as a buyer of

Vanilla from Madagascar.

Quantity purchased (kg)

Name of suppliers

Malagasy

2021

2020

2019

5. PERSONAL DATA

The information collected through this declaration of intent is recorded in a file computerized by the National Vanilla Council for the sole purpose of allowing the development of a list of verified buyers. The legal basis for processing is Law 2014-038 on data protection. of a personal nature.

You can access the data concerning you, rectify them, request their deletion or exercise your right to limit the processing of your data by sending an email to the following address: AMICNV2022@gmail.com [Name of candidate operator]

Last name :

Title :

Signature Date:

Stamp


PDF: Formulaire_intention-candidat_acheteur-vfinale.pdf