New Creditor Details Form

New Supplier Application Form

Select Entity *

Darwin International Airport (DIA)Alice Springs Airport (ASA)Tennant Creek Airport (TCA)

Company Details

Legal Name *

Trading Name *

ABN **Please write N/A if Not Applicable

ACN **Please write N/A if Not Applicable

Nature of the business *

Is this organisation indigenous owned? *

YesNo

What is the percentage of Indigenous ownership of your organisation? *

Is your organisation a Member of NTIBN (Northern Territory Indigenous Business Network)? *

YesNo

Please attach a copy of the NTIBN Certification *

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Is your organisation registered with Supply Nation? *

YesNo

Please attach a copy of the Supply Nation Certification *

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Is your organisation registered with/member of any other Indigenous business register? *

YesNo

Please attach a copy of your certification *

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Is your organisation required to report under the Modern Slavery Act (Cth) 2018? Modern Slavery Statement? *

YesNo

Please attach a copy of your modern slavery statement(s)

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Is the supplier aware of the existence of modern slavery in its own operations or its supply chain? *

YesNo

Does the supplier have in place appropriate policies and procedures to assess and address risks of modern slavery in its operations and supply chain? *

YesNo

Has the supplier previously been investigated in relation to or received complaints about modern slavery in its operations or supply chain? *

YesNo

Creditor's Location *

Inside Australia Outside Australia

Address *

Street address *

City *

State *

Postcode *

Address *

Street Address *

City *

State *

Postcode *

Country *

The postal address is the same as the physical address.

Postal Address *

PO Box *

City *

State *

Postcode *

Do you have an office located in the Northern Territory?

YesNo

Postal Address *

PO Box *

City *

State *

Postcode *

Country *

Branch Address (If Branch)

Contact Details

SUPPLIER CONTACT DETAILS

Name *

Phone *

Mobile

Email *

ACCOUNTS RECEIVABLE DETAILS

Name *

Phone *

Mobile *

Email *

Payment Method EFT

Please provide the following details to facilitate payment.

Bank Location *

Account Name *

Bank Name *

BSB *

Account No *

SWIFT *

IBAN *

Attach a bank-issued deposit slip or bank statement extract clearly showing account holder name and bank account details *

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Credit terms *

Airport Development Group Contact Person

Please enter the staff contact details who have requested to complete this form.

Name *

Email contact *

Phone

Form submitted by *Please enter your name so the Finance team can contact you if they need more information about your request.

Position *

Email *

Verification from Finance

Are all the details entered by the vendor correct? *

Yes, send it for the authorisationYes, the creditor has an existing account - notify the creditor number to the relevant managerNo, send it back to the vendor for a rectification

Creditor Number *Please enter the creditor number to notify the relevant manager.

Note to the vendor *

Authorisation

Is the form approved? *

YesNo/ Amendments required

Date

Reason for Disapproval/ Comment *

Authoriser Name *

Authoriser's Signature *

Draw signature|Type signatureClear

Finance Staff Use Only

Creditor number *

Entered on *

By *

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