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JOHNSON & JOHNSON ROMANIA SRL Supplier creation / change form

(Formular JOHNSON & JOHNSON ROMANIA SRL creare / modificare furnizor)
Creation / creare
Change / modificare

DIRECTIONS FOR SUPPLIER (INSTRUCTIUNI PENTRU FURNIZORI):

Please provide the following Supplier information under the signature and stamp of your company. / Va rugam sa furnizati
urmatoarele informatii folosind documentul de mai jos semnat si stampilat/parafat .
ALL FIELDS ARE MANDATORY. USE N/A (NOT APPLICABLE) WHERE APPROPRIATE / TOATE CAMPURILE SUNT OBLIGATORII.
FOLOSITI N/A (INAPLICABIL) UNDE ESTE CAZUL

Once completed, please forward signed document to your Johnson & Johnson contact person by email or fax 0040 212 071
804. / Va rugam sa trimiteti documentul semnat catre persoana de contact din Johnson & Johnson pe e-mail sau la nr. de fax 0040 212
071 804.
If you are external services provider please be aware that according with Double Tax Treaties by countries you need to
provide us Fiscal Residence Certificate ; In case FRC is not available in our files at the moment of invoice/contract receiving , a 16%
from the total amount should be withheld and paid to the state authorities as being tax on income obtained by foreign suppliers
from Romania.
To /Catre: JOHNSON & JOHNSON ROMANIA SRL
SECTION/SECTIUNEA I - GENERAL DATA/ DATE GENERALE
English/ Engleza
Romanian/ Romana
Denumirea Firmei/ Nume prenume doctor
Legal Entity Supplier / Doctor Name
Cod Unic de Inregistrare fiscala/CNP
Tax identification number, Fiscal code
(VAT,NIF, etc) / Personal identification
number
Registration Number (Commerce Chamber) Numarul de inregistrare Registrul
Suppliers contact in Johnson & Johnson
Full Street Address (Street number, street
name, suite if needed)
City
Country
Postal Code
Phone/Fax Number (Including area code)
E-Mail dedicated for Remittance

Comertului
Reprezentantul furnizorului in Johnson &
Johnson
Adresa completa (Numele strazii, numarul
strazii, Numar imobil/bloc/apartamant,
Sector)
Oras, Judet
Tara
Codul postal
Numarul de telefon/fax (inclusiv prefixul)
E-mail dedicat pentru comunicare

Fill in/ Completati

Federatia Asociatiilor Bolnavilor de cancer
23728748

Cezar Irimia
Bucuresti, Str. Intr. Teleajen nr. 5, sector 2
Bucuresti, sector 2
Romania
021645
00407232423/ 0040212530591
abc_romania@yahoo.com

SECTION/SECTIUNEA II - PAYMENT INFORMATION / INFORMATII DESPRE PLATA

We authorize Johnson & Johnson Romania SRL to make invoice/contract payments validated according to the following instructions /
Autorizam Johnson & Johnson Romania SRL sa faca plati ale facturilor/contractelor validate conform urmatoarelor instructiuni :
English/ Engleza
Romanian/ Romana
Fill in/ Completati
Numele bancii
Bank Name
Credit Europe Bank
Adresa completa a bancii
Bank Street Address (including number,
Sucursala 1 Mai, Bucuresti
suite if needed)
Oras, Judet
City
Bucuresti, sector 1
Tara
Country
Romania
Numarul bancii (Numar sucursala, codul
Bank Number (Branch or Bank Code, Sort
Sucursala 1 Mai Bucuresti
bancii, codul de sortare,sucursala, etc.)
Code, etc.)
Numarul contului bancar
Bank Account Number
Cod IBAN
IBAN Code
RO60FNNB001802247025RO02
Codul SWIFT
SWIFT Code
Moneda in care se factureaza/plateste
Currency of Invoice/Payment (EURO,RON)
RON
(EURO, RON)

SECTION/SECTIUNEA III
We hereby confirm that we are the bank account holder, the above-mentioned data is truthful and correct, and in case a
change occurs for the above data, your Johnson & Johnson Romania SRL contact person will be notified in advance using the
same form. If the above information is not valid or inaccurate, Johnson & Johnson Romania SRL is not responsible if a payment is
delayed, not credited or credited to an incorrect account as specified.
Prin prezenta confirmam ca suntem titularul contului bancar, datele de mai sus sunt adevarate si corecte si in cazul in care
intervine o schimbare in datele de mai sus, persoana de contact din Johnson & Johnson Romania SRL va fi anuntata in avans,
folosindu-se acelasi formular. Daca informatiile de mai sus nu sunt valabile sau precise, Johnson & Johnson Romania SRL nu este
responsabil daca plata intarzie, nu este creditata sau este creditata catre un cont incorect, dupa cum este specificat .

Name and job title/ Nume si functie: Cezar Irimia

Stamp / Stampila (parafa)

Signature / Semnatura ____________

Date / Data: __________