Complete form below to signup as a vendor.

General Information

Company Name *

Business Activity (as per CR)

Activity Code *

Activity Name *

Business Structure *

Address & Contact Details

Office

Name *

Designation *

Email Address *

QID Number *

Mobile Number *

Landline

Address *

Area *

Nearest Landmark

Store

Name *

Designation *

Email Address *

QID Number *

Mobile Number *

Landline

Address *

Area *

Nearest Landmark

Finance Head

Name *

Designation *

Email Address *

QID Number *

Mobile Number *

Landline

Authorized Signatory's

Name *

Designation *

Email Address *

QID Number *

Mobile Number *

Landline

Top Management

Name *

Designation *

Email Address *

QID Number *

Mobile Number *

Landline

Registration & Tax

Commercial Registration Number *

MOPH License Number

Dhareeba Number *

Municipality Number

Paid Up Capital

Establishment Date *

Required Documents (Uploads in .pdf, .png, .jpg, .jpeg - Max 5MB)

Commercial Registration *

Computer Card *

Municipality Registration *

Proof of Authorized signatory *

MOPH License

Copy of ISO Certificate

VAT Registration

Dhareeba

Company Profile

Partner's Id Copy (If applicable)

Bank Information

Account Name *

Account Number *

Name of Bank *

Branch *

Swift Code *

IBAN Number *

Currency *

Financial Information

Credit Limit *

Credit Days *

Payment Mode *

Product Intended to register with Wellcare *

Product Name *

Active Ingredients (if applicable) *

S.No	Active Ingredients	Strength
1
2
3

Indication *

1
2
3

Key selling points *

1
2
3

Patented? *

YES

If Yes, please specify patent

Innovative? *

YES

If Yes, write the innovation

Retail Price *

Wholesale Price *

Wellcare Price *

Net Margin *

Shelf Life (in days) *

Product dimension in centimeters (Click here for info)*

Login Information

Username *

Password *

We hereby confirm that the information provided in this Vendor Registration Form is accurate and Wellcare Pharmacies shall not be liable in any way or form for the information provided.

Note: Failure to completing this form and attaching it together with the mandatory documents may lead to rejection of application. Wellcare Pharmacies reserves the right to reject any company that does not comply with its requirements.

Instructions

Please provide all necessary information while completing the form.
All mandatory fields are highlighted with an asterisk (*).
It is the sole responsibility of the supplier to ensure all information provided is accurate.
For any supplier registration queries, please contact procurement@wellcarepharmacies.com
Local suppliers must submit electronic copies of the following certificates:
1. Commercial Registration (in english)
2. Company Computer Card
3. Municipality Registration
4. MOPH License (mandatory for pharmaceutical company, if applicable)
5. Authorized Person ID
6. Partner's Id copy (if applicable)
These certificates must bear the company stamp, or else the application will be rejected.

Vendor Registration

General Information

Business Activity (as per CR)

Address & Contact Details

Office

Store

Finance Head

Authorized Signatory's

Top Management

Registration & Tax

Required Documents (Uploads in .pdf, .png, .jpg, .jpeg - Max 5MB)

Bank Information

Financial Information

Product Intended to register with Wellcare *

Login Information

Instructions

+974 4462 0901

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