Vendor Compliance Self-Assessment Form

A structured self-assessment form for vendors to report compliance with company policies, certifications, insurance requirements, and operational controls.

Submission Notice

• Submission type
• Primary contact name
• Primary contact email
• I confirm I am authorized to submit this self-assessment on behalf of my organization and understand the information may be reviewed for compliance and audit purposes.

Vendor Profile

• Legal company name
• Doing business as (DBA), if applicable
• Company website
• Country of incorporation
• Service categories provided

Policies and Certifications

• Do you maintain and enforce a code of conduct or equivalent ethics policy?
• Certifications or attestations held
• Other certifications or attestations
• Next certification expiration date
• If any required policy or certification is missing, describe the gap and remediation plan

Insurance Coverage

• Do you maintain general liability insurance?
• Do you maintain professional liability or errors and omissions insurance?
• Do you maintain cyber liability insurance?
• Insurance carrier name
• Insurance expiration date

Operational Controls

• Access control practices
• Data protection measures in place
• Do you have a documented incident reporting process?
• Do you maintain a business continuity or disaster recovery plan?
• Describe any gaps in operational controls and your remediation timeline

Supporting Documents and Attestation

• Supporting documents
• I attest that the information provided is accurate and complete, and I agree to notify the company of material changes to our compliance status.
• Name of authorized signatory
• Date signed