Vendor registration

Procurement Agent & Vendor Application Form

Join our global biomedical sourcing network by applying as an approved procurement agent or vendor. All applications are evaluated based on financial capacity, sourcing capability, and regulatory compliance.

Company / Applicant Information/h3>

Full Legal Name of Company / Applicant

Business Registration Number:

Country of Registration:

Company Type

Limited
Partnership
Sole Proprietor

Primary Contact Name

Position / Title

Phone Number

Email Address

Company Website (if applicable):

Registered Business Address:

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Tier Level Application

Please indicate the Tier level you are applying for (tick one):

Tier 1 – Up to £100,000 per contract
Tier 2 – Up to £1,000,000 per contract
Tier 3 – Up to £10,000,000 per contract
Tier 4 – Up to £50,000,000 per contract

Biomaterials You Can Supply

Select the categories of biomedical materials you are capable of sourcing and supplying (tick all that apply):

Plant-Derived Compounds (alkaloids, flavonoids, glycosides, including Zilicon Herbal Oil Extract V45)
Marine Bioactives (peptides, seaweed extracts, carrageenan)
Animal-Derived Materials (collagen, hormones, venoms)
Human-Derived Biomaterials (plasma proteins, stem cells)
Synthetic/Engineered Biopolymers (recombinant proteins, nanoparticles)
Other (please specify below)

If other, please specify

Financial Attestation

Confirmation

I hereby confirm that I/we possess the financial liquidity and operational capacity to fulfill contracts within the tier level selected above.

Sourcing Capability

Countries or regions you currently source from

Certified laboratory/test facility partners (if any)

Logistics and delivery capabilities

Logistics and delivery capabilities (copy)

Previous experience with pharmaceutical clients (brief description):

Additional Supporting Documents or Information

Please list or describe any additional documents or information that may support your application

Declaration

I hereby declare that the information provided in this application is accurate and complete to the best of my knowledge. I authorize DE ROTHSCHILD MEDICAL AND RESEARCH CENTRE (DRMRC) to verify all submitted details and documents.

Full Name

Signature

Clear Signature

Date

Full the additional

File Upload (Optional)

Click or drag files to this area to upload. You can upload up to 10 files.

Submission Instructions

Please email the completed form and all supporting documents to
Email: vendors@drmrc.com
Subject: Procurement Agent/Vendor Application