Note: Fields marked with an asterisk (*) must be completed.

Part 1: General Information

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Type of Firm:

Is your company or family or companies doing business with Marsh & McLennan Companies or any of its operating companies? Currently      Previously      No

Part 2: U.S. Diversity Status

Diverse Supplier*:  Yes     No

If yes, please complete certification information below and upload a scanned copy of your certification(s).

Certification:

Certifying Agency (1):
Date Certified:		Expiration Date:
Upload File:
Certifying Agency (2):
Date Certified:		Expiration Date:
Upload File:
Certifying Agency (3):
Date Certified:		Expiration Date:
Upload File:

If you have a problem uploading your documentation, PLEASE SCAN AND EMAIL A COPY OF YOUR CERTIFICATION TO GSP.SUPPLIER@MMC.COM OR FAX TO +1 212 948 1523

* A U.S. diverse supplier is defined as an organization that is at least 51% owned, operated and controlled by members of recognized minority group or women. If the business is publically owned, members of the minority group or women must own at least 51% of the voting stock.
The owner(s) must be a US Citizen or lawful permanent resident.
Per the Small Business Act, a small business concern is "one that is independently owned and operated and which is not dominant in its field of operation."

Please type in the code you see above*: