Silverchain - Supplier Registration

Please select the most appropriate option for your business

Sole trader Partnership Proprietry limited company (Pty Ltd) Limited company (Ltd) Indigenous organisation Other

DETAILS ABOUT YOUR ORGANISATION

Entity name*

Entity ABN*

Company ACN

Company Trust Name (if operate as a Trust)

Trust ACN

Do you have OR are you in a position to restructure your business to use another ABN/ACN that is associated with a company, partnership, trust instead of a sole trader ABN?

Yes No

YOUR ADDRESS DETAILS

Street address*

Select your state*

Suburb*

Postcode*

POSTAL ADDRESS

Is your postal address different to your street address?

Yes No

YOUR CONTACT DETAILS

Main contact name*

Main contact telephone*

Main contact email*

ARE YOUR CONTACT DETAILS DIFFERENT FOR A “SERVICE REQUEST”

Main contact name

Main contact telephone

Main contact email

WHAT SERVICES ARE YOU ABLE TO PROVIDE?

Terms of payment:

Please confirm that you acknowledge the terms of Silverchain Group and understand that payment will be made 30 business days from receipt of a valid tax invoice

How many of your staff will be providing a service to our clients?

How many of your staff will be providing a service to our clients?*

WHICH REGION BEST REPRESENTS THE AREA/S YOU SERVICE?

Please list the city/area/suburbs/towns in which you are prepared to work

DECLARATION

Additional comments:

Are all your staff vaccinated against COVID-19

Yes No

UPLOAD DOCUMENTATION (most appropriate for your business)

Public liability insurance certificate

Please select a file

HSE policies and/or HSE management plan

Please select a file

Professional indemnity insurance certificate

Please select a file

Workers’ compensation certificate

Please select a file

AHPRA registration/trade licences

Please select a file

Police clearance certificates or company policy

Please select a file

NDIS Worker Screening Clearance

Please select a file

Price schedule

Please select a file

Price schedule (if not attached)

Accreditation and / or Quality Certificate

Please select a file

Other

Please select a file

Privacy collection statement

Your personal (including sensitive) information (Your Information) will be collected and used by Silver Chain Group Limited and its related companies (collectively Silverchain, we, us or our) to assess your application to provide services to Silverchain and to prepare a contract (if applicable) for those services and for related purposes, and for any other purpose described in our Privacy Policy. We may disclose Your Information to other persons and organisations including to our related companies and service providers. Some of these service providers may be located overseas and Your Information may be held or disclosed overseas. A list of the countries in which these service providers are located is available on our website. If you do not provide your information, we may be unable to process your application or progress your contract. Please refer to Silverchain's Privacy Policy https://silverchain.org.au/privacy/ for more information about how we handle Your Information including how to seek access to or correct your information or submit a privacy complaint and how that complaint will be handled. You can contact us on 1300 650 803 if you have any queries about the manner in which we handle your information.

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