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A. Goods & Services
B. Workforce Training
C. Supplier Development
D. Investments in Fixed Assets
Bonus 0
ICV+
R. Revenue in Qatar
Total Cost

Company Information

1. General Information


Company Name -	Company Address -
Commercial Registration Number -	Financial Statement Year End

2. Financial Information


Total Revenue, for the financial statement year end QAR 0	Total Costs, for the financial statement year end QAR 0

3. Contact Information

#	Contact Name	Email	Phone

4. Business Description

Select your company’s business activities.

#	Main Activity	Sub-Activity 1	Sub-Activity 2	Other Business Activity

5. ICV Participation

Provide the following numbers:


Total number of laid off Qatari national employees or employees with salaries above 6,000 QAR -	Total number of newly hired Qatari national employees or employees with salaries above 6,000 QAR -

Provide a brief description of the steps that have been taken to increase ICV in Qatar across the following areas:


A. Goods and Services -	B. Workforce Training -
C. Supplier Development -	D. Investment in Fixed Assets -

6. Company Ownership Structure

Complete the below table with all related parties and their percentage ownership.

#	Company/Individual Name	Ownership(%)	Industry	Commercial Registration no./ID no.

A1. Goods

1. Spend on Government Regulated Goods, by Entity

QatarEnergy Marketing (Muntajat)


Total Spend QAR 0	ICV Contribution QAR 0

Qatar Steel Company


Total Spend QAR 0	ICV Contribution QAR 0

Totals


Total Spend: QAR 0	Total ICV Contribution: QAR 0

2. Top 80% of Goods Consumed, by Supplier

List respective spend for each supplier, in descending order, for the financial year.

#	Supplier Name	Commercial Registration no.	Goods Category	Goods Sub-Category	Description	Total Spend(QAR)	ICV Score(%)	ICV Contribution(QAR)

Inventory Movement Spend

For goods consumed during the year that cannot be identified per supplier, provide the Beginning Inventory and Ending Inventory, for the financial year.


Beginning Inventory QAR 0	Ending Inventory QAR 0


Inventory Movement QAR 0	Inventory Movement ICV Contribution QAR 0

Totals


Total Spend: QAR 0	Total ICV Contribution: QAR 0

3. Remaining 20% of Goods Consumed, by Supplier Type

List respective spend, by supplier type, for the financial year.

Local Farm


Total Spend QAR 0	ICV Contribution QAR 0

Local Manufacturers


Total Spend QAR 0	ICV Contribution QAR 0

Other Local Suppliers


Total Spend QAR 0	ICV Contribution QAR 0

International Suppliers


Total Spend QAR 0	ICV Contribution QAR 0

Totals


Total Spend: QAR 0	Total ICV Contribution: QAR 0

A2. Services

1. Manpower Compensation

Provide the total annual compensation details related to eligible manpower, for the financial year.


Total Eligible Compensation QAR 0

2. Overhead Spend on Services, by Category

List respective spend by category type, for the financial year

Corporate Social Responsibility (CSR)


Total Spend QAR 0	ICV Contribution QAR 0

Insurance


Total Spend QAR 0	ICV Contribution QAR 0

Government Fees


Total Spend QAR 0	ICV Contribution QAR 0

Utilities


Total Spend QAR 0	ICV Contribution QAR 0

Fuel


Total Spend QAR 0	ICV Contribution QAR 0

Rent


Total Spend QAR 0	ICV Contribution QAR 0

Totals


Total Spend: QAR 0	Total ICV Contribution: QAR 0

3. Top 80% of Services Consumed, by Supplier

List respective spend for each supplier, in descending order, for the financial year.

#	Supplier Name	Commercial Registration no.	Type of Service	Total Spend(QAR)	Description	ICV Score(%)	ICV Contribution(QAR)

Loss on Sales of Assets

Provide the loss on sale of fixed assets located in Qatar, by asset class, for the financial year.

#	Asset Name	Description	Loss on Sale(QAR)

Totals


Total Spend: QAR 0	Total ICV Contribution: QAR 0

4. Remaining 20% of Services Consumed, by Industry

List respective spend by industry, for the financial year.

Engineering


Total Spend QAR 0	ICV Contribution QAR 0

Construction, Installation and Commissioning


Total Spend QAR 0	ICV Contribution QAR 0

Management and Consultancy


Total Spend QAR 0	ICV Contribution QAR 0

IT


Total Spend QAR 0	ICV Contribution QAR 0

Procurement as a Service


Total Spend QAR 0	ICV Contribution QAR 0

Other (catering, transport, etc.)


Total Spend QAR 0	ICV Contribution QAR 0

International Service Providers


Total Spend QAR 0	ICV Contribution QAR 0

Totals


Total Spend: QAR 0	Total ICV Contribution: QAR 0

B. Workforce Training

Spend on Workforce Training Activities

Provide information about the training activities provided for employees, during the financial year.

#	Training Activity	Training Provider	Training Institute	Training Type	Mode of Training	Number of Employees Trained	Total Spend on Training(QAR)

Totals


Total Spend: QAR 0	Total ICV Contribution: QAR 0

C. Supplier Development

Spend on Supplier Development Activities

Provide information about the development activities provided for suppliers in Qatar, during the financial year.

#	Supplier Name	Development Type	Development Activity	Development Spend(QAR)

Totals


Total Spend: QAR 0	Total ICV Contribution: QAR 0

D. Investment in Fixed Assets

1. Total Depreciation and Amortization for Local Assets

Provide the total annual depreciation and amortization, for the financial year.


Total Amount QAR 0

2. Capital Investment, for the financial year

List the capital investments, for the financial year.


No capital investments Yes

#	Capital Investment Name	Description	Investment Amount(QAR)

Totals


Total Investment Amount: QAR 0

Bonus

1. Productivity and Automation

Smart Industry Readiness Index (SIRI) Assessment

Enter the achieved score, from 0-5, for each of the 16 dimensions, as per the SIRI Assessment results.


Vertical Integration 0	Horizontal Integration 0


Integrated Product Lifecycle 0	Shop Floor Automation 0


Enterprise Automation 0	Facility Automation 0


Shop Floor Connectivity 0	Enterprise Connectivity 0


Facility Connectivity 0	Shop Floor Intelligence 0


Enterprise Intelligence 0	Facility Intelligence 0


Workforce Learning & Development 0	Leadership Competency 0


Inter- & Intra-Company Collaboration 0	Strategy & Governance 0


Productivity and Automation Average 0	Productivity and Automation Bonus(%) 0

2. Capability Building

Spend on Workforce Training Activities


Total Spend QAR 0

Spend on Supplier Development Activities


Total Spend QAR 0	Total Cost 0

Capability Building (%)


Capability Building % 0	Capability Building Bonus (%) 0

3. Investment Growth

Provide information about the investment growth activities, for the financial year.


Equity in Current Financial Statement QAR 0	Equity in Previous Financial Statement 0


Investment Growth (%) 0	Investment Growth Bonus (%) 0

4. Qatarization

Provide information on the employment of Qatari nationals and white-collar employees, within the organization, for the financial year.


Total Number of Qatari Employees 0	Total Number of White Collar Employees 0


Qatarization (%) 0	Qatarization Bonus (%) 0

5. Exports


Revenue from Exports and Re-Exports,for the financial statment year end QAR 0	Total Revenue,for the financial statment year end QAR 0


Exports (%) 0	Exports Bonus (%) 0

6. Research & Development (R&D)


Research & Development (R&D) Expenses QAR 0	Total Cost QAR 0


Research & Development (%) 0	Research and Development Bonus (%) 0

7. Sustainability

Select the certificates obtained from the below list.

ISO 14001 – Environmental Management System
ISO 14067 – Carbon Footprint of Products
ISO 50001 – Energy Management Systems


Sustainability Bonus (%) 0