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SUPPLIER DATABASE REGISTRATION Department of Justice and

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SUPPLIER DATABASE REGISTRATION Department of Justice and Powered By Docstoc
					          SUPPLIER DATABASE REGISTRATION

NAME OF SERVICE PROVIDER: _________________________________
                      (To be completed by supplier)




                    FOR OFFICIAL PURPOSES

Verified By:

Verified by: ________________             Persal No: ______________

Signature: ________________               Date: ______________


Captured By:

Captured by: ________________             Persal No: ______________

Signature: ________________               Date: ______________


Entity Maintenance No:

Captured by: ________________             Persal No: ______________

Signature: ________________               Date: ______________


               APPLICATION ACCEPTED                   APPLICATION
                                                       REJECTED

                     DoJ & CD
                  Supplier Number
                    SUPPLIER DATABASE REGISTRATION

The Department of Justice and Constitutional Development (DoJ&CD) is an outwardly
focused, customer-centred government department mandated to uphold and protect the
Constitution and Rule of Law in the interest of a safer and more secure South Africa. DoJ
& CD, pursuant to the provisions of the Public Finance Management Act (PFMA), Act 1
of 1999) read with DoJ&CD Supply Chain Management Policy invites service providers
to register on DoJ&CD’s database of suppliers/services as official vendors and suppliers
for the 2012 to 2013 Financial Year.

Suppliers and service providers currently registered as vendors on the DoJ&CD
database should also re-apply for considerations to be re-registered on the DoJ&CD
vendor/supplier database.

A list of commodities requirements are enlisted in the supplier database application form.
Prospective suppliers/service providers may apply to be enlisted on the supplier
database for a maximum of five (5) commodities specific as per their principle business,
other than those suppliers on SITA transversal contracts. Failure to comply with this
condition will invalidate the applications and would not be evaluated further. Supplier
Database registration forms are obtainable from: Website: www.justice.gov.za

Physical Address:         Momentum Centre      Postal address: Private Bag X81
                          329 Pretorius Street                 Pretoria
                          Pretoria                             0001
                          0001

Enquiries should be forwarded to:

                       Tel No:                  E-mail Address              Fax No.

N.Skosana            012 357 8583          nskosana@justice.gov.za       086 640 3113

J. Mokgothu          012 315 1682          jmokgothu@justice.gov.za      086 641 3835

B. Mokhutle         012 315 1546           bmokhutle@justice.gov.za      086 678 2168

K. Masilo           012 357 8198           kmasilo@justice.gov.za        086 642 3759


Closing date: 28 September 2012 at 11:00

Completed registration forms must be hand delivered or posted to the above mentioned
postal address on or before closing date and time for attention: The Director: Supply
Chain Management (DoJ & CD).




                                                                                  2 of 26
                              SUPPLIER REGISTRATION FORM


                                            IMPORTANT NOTES
                        Please read carefully before completion of registration form

       To be completed by all vendors seeking registration as an approved supplier;
       The supplier registration form must be completed in full and be signed, and forwarded to the
        National Department of Justice and Constitutional Development at Pretoria with all supporting
        documentation;
       A company profile must accompany the registration form but will not be accepted as substitute for
        the application form – all fields on application form MUST be completed by applicant;
       Successful applicants will be contacted via fax and/or email and must therefore submit an operating
        fax number and/or email address; failure to comply will result in excluding the supplier from the
        database;
       Only successful suppliers will be notified in writing on their application been accepted;




                                                                                          Submitted
                            Information Checklist
                                                                                    Yes               No
Telephone / Cell number as contact
Physical address and Postal address
Fax number or E-mail address
Valid and Original SARS Tax Clearance Certificate
Original or certified copy of B-BBEE certificate
Original latest Bank Statement or Bank Letter with a bank stamp
Company / CC Registration Certificate (Issued by CIPRO).
Certified copy of identity documents (ID) of all shareholders/members/Directors
or sole traders
Latest entity’s original or certified water /electricity Utility bill
A Business profile of not more than five (5) pages
Commodity listed only five (5) may be selected
Location where goods and/or services may be required

Fill all forms completely
Sign all forms




                                                                                                3 of 26
1.  SUPPLIER DETAILS (All fields are mandatory) 
                                                                         
Company Details: 
Legal Name:  
                                                               
Trading Name: 
                                                               
Registration Number:             

VAT Number: 
                                                               
Income Tax Number: 
                                                               
                                                                         
Company Contacts: 
Telephone Number: 
                                                               
Fax Number: 
                                                               
E‐mail Address: 
                                                               
Website Address                  

                                                               
Postal Address:                                                
                                                               
                                                               

Physical Address:                                              
                                                               
                                                               
                                                                         
Main contact: 
Name: 
                                                               
Surname: 
                                                               
Position: 
                                                               
Telephone Number: 
                                                               
Facsimile Number: 
                                                               
Cellular Number: 
                                                               
E‐mail Address: 
                                                               

                                                                        4 of 26
2. SUPPLIER GROUPING DETAILS: (Please mark with an X the relevant box) 
                                                                                             
1. Public Company (LTD)                                7. Foreign Company                    
2. Private Company (PTY) LTD                           8. Joint Venture / Consortium             
3. Closed Corporation (CC)                             9. Section 21 Company                 
4. Sole Proprietor                                     10. Government / Parastatals          
5. Partnership                                         11. Co‐operative                      
6. Trust                                               11. Other (Please specify)            
                                                                                             
3. BROAD‐BASED BLACK ECONOMIC EMPOWERMENT (B‐BBEE) VENDOR PROFILE  
                                                                                             
List all partners / owners and shareholders (Compulsory)                                     
Name and Surname                   Position            Citizenship             ID Number 
                                                                                          
                                                                                          
                                                                                          
                                                                                          
                                                                                          
                                                                                          
                                                                                          
Note: Where owners are themselves a company or partners, owners of the holding firm must be 
identified. Certified ID copies of partners, members, shareholders or owners must be attached.   

BROAD‐BASED BLACK ECONOMIC EMPOWERMENT (B‐BBEE) INFORMATION 
                                                                                             
Please mark your B‐BBEE credentials with an (X)                                              
       B‐BBEE Status               B‐BBEE Recognition Level %              Mark with an (X) 
Level 1 Contributor                           135%                 
Level 2 Contributor                           125%                 
Level 3 Contributor                           110%                 
Level 4 Contributor                           100%                 
Level 5 Contributor                            80%                 
Level 6 Contributor                            60%                 
Level 7 Contributor                            50%                 
Level 8 Contributor                            10%                 
Non‐Compliant Contributor                       0%                 
                                                                   
Exempted Micro‐Enterprise(EME)                                     
Any enterprise with an annual total Revenue of R5 million or less qualifies as an Exempted Micro‐
Enterprise (EME). A start‐up enterprise must be measured as an Exempted Micro‐Enterprise for the 
first year following its formation or incorporation. 

I/ We confirm that the information provided is correct as at this date: 

                                                                               
Name and Surname                Signature             Position               Date 


                                                                                            5 of 26
    4. DECLARATION 
 
Verification of information supplied in this document, including attached documents:

I/We, the undersigned, warrant that he / she is duly authorised to do so on behalf of the supplier,
certifies that the information supplied including the annexure, is correct and accurate and
acknowledge that:

If I found that the information supplied is incorrect the Department of Justice and Constitutional
Development will disqualify and remove the supplier from our database permanently.
 
TERMS AND CONDITIONS

     The Department of Justice and Constitutional Development cannot guarantee business
      opportunities. All procurement will be subject to the departmental SCM policy, the general
      conditions of contract, and applicable legislation.
     All suppliers will be subjected to regular performance service review and could be deregistered if
      service levels are not maintained.
     The validity period of a quotation must be at least 30 ( thirty) days
     Certified documents: Please ensure that The Commissioner of Oath has certified your company
      registration documents, Identity Documents and other copies.
     Verification of information supplied will perform against third party source such as SARS, CIPRO
      or CIPC, Safety net, etc.
     Please notify the Department immediately of any change to the provided information.
     Please ensure all fields are completed. Incomplete application forms will not be processed.




          Supplier Name: ____________________________________________________________


         ________________________________________                     __________________________
         Signature of Authorised Representative                           Signatory Name in Print


          ________________________________________                    __________________________
          Signatory Position:                                             Signatory ID Number:


         Signed at __________________________ on this ____ day of________________ 20_____




                                                                                                 6 of 26
                                                                                           Regional Office Only
                                                                                    Region:

                                                                                    Reference Number:


                                                                                    Contact person:

                                                                                    Contact Telephone number:

                       6. SUPPLIER MAINTENANCE FORM:                                Contact Fax number:

                                                                                              Head Office Only
                                                                                    Captured By:
            BAS               JYP              PERSAL
                                                                                    Date Captured:

                                                                                    Authorized By:
                                                                                    Date Authorized:
                                                                                    Supplier code:
                                                                                    SUPPLIER NO




    PLEASE WRITE IN BLOCK LETTERS
    I/We hereby request and authorize you to pay any amounts, which may accrue to me/us to the credit
    of my/our account with the mentioned bank.
    I/we understand that the credit transfers hereby authorized will be processed by computer through a system
    known as "ACB - Electronic Fund Transfer Service", and I/we understand that not additional advice of payment
    will be provided by my/our bank, but that the details of each payment will be printed on my/our bank statement
    or any accompanying voucher. (This does not apply where it is not customary for banks to furnish bank
    Statements).
    I/we understand that the Department will supply a payment advice in the normal way, and that it will indicate
    the date on which the funds will be made available on my/our account.
    This authority may be cancelled by me/us by giving 30 days notice by prepaid registered post.
    Please ensure that the information is validated as per required bank screens
    I/We understand that bank details provided should be exactly as per the records held by the bank.
    I/We understand that the Department will not assume responsibility for any delayed payments, as a result of
    incorrect information supplied.
                                                 Company / Personal Details


Registered Name
Trading Name
Tax Number
VAT Number
Title:
Initials:
First Name:
Surname:


                                                                                                            7 of 26
                                                           Address Detail


  Postal Address

 ( Compulsory if Supplier )




      Postal Code

                                                                    New Detail

       New Supplier information            Update Supplier information



Supplier Type:                Individual                  Department                 Partnership

                              Company                     Trust

                              CC                         Other ( Specify )


  Department Number


                                                     Supplier Account Details
  (Please note that this account MUST be in the name of the supplier. No 3rd party payments allowed).


          Account Name




        Account Number
        Branch Name
        Branch Number

                                       Cheque
              Account Type             Account
                                       Savings
                                       Account

                                       Transmission Account
                                       Bond
                                       Account

                                       Other (Please Specify)



  ID Number                                                                               IF SPOUSE ACC HOLDER


  Passport Number


  Company Registration Number                                   /                /


  *CC Registration


                                                                                                        8 of 26
   *Please include CC/CK where applicable


   Practise Number


                                                                         Bank stamp
   PLEASE ATTACHED A PRINTOUT               It is hereby confirmed that this details have been verified
   FROM THE BANK                            against the following screens:
                                            ABSA-CIF screen
                                            FNB-Hogans system on the CIS4
   PLEASE PROVIDE BANK STAMP                STD Bank-Look-up-screen

   PLUS SIGNITURE OF OFFICIAL               Nedbank- Banking Platform under Client Details Tab


                                             Contact Details
   Business
                          Area
                          Code                                                              Extension
   Home
                          Area
                          Code                                                              Extension
   Fax
                          Area
                          Code
   Cell
                          Cell
                          Code
  Email Address
 Contact Person:




     Supplier Signature



          Print Name




      /         /
Date
(dd/mm/yyyy)
NB: All relevant fields must be completed




                                                                                                  9 of 26
          6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED

PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE
GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY.
FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE
SUPPLIERS APPLICATION.
                                 Eastern Cape
           Location         Mark                  Location                Mark
                            with X                                        with X
Aberdeen                                 Matatiele                     
Adelaide                                 Mdantsane                     
Albany                                   Middelburg                    
Albert                                   Middledrift                   
Alexandria                               Molteno                       
Aliwal North                             Mount Ayliff                  
Barkly East                              Mount Fletcher                
Bathurst                                 Mount Frere                   
Bedford                                  Mpofu (Stockenström)          
Bizana                                   Mqanduli                      
Butterworth                              Ngqeleni                      
Cathcart                                 Nqamakwe                      
Cradock                                  Ntabathemba                   
East London                              Pearston                      
Elliot                                   Peddie                        
Elliotdale                               Port Elizabeth                
Engcobo                                  Port St Johns (Umzimvubu)     
Flagstaff                                Queenstown                    
Fort Beaufort                            Qumbu                         
Glen Grey                                Somerset East                 
Graaff-Reinet                            St Marks                      
Hankey                                   Sterkstroom                   
Herschel                                 Steynsburg                    
Hewu                                     Steytlerville                 
Hofmeyr                                  Stutterheim                   
Humansdorp                               Tabankulu                     
Idutywa                                  Tarka                         
Indwe                                    Tsolo                         
Jansenville                              Tsomo                         
Joubertina                               Uitenhage                     
Keiskammahoek                            Umtata                        
Kentani                                  Umzimkulu                     
King William’s Town                      Venterstad                    
Kirkwood                                 Victoria East                 
Komga                                    Willowmore                    
Lady Grey                                Willowvale (Gatyana)          
Libode                                   Wodehouse                     
Lusikisiki                               Xalanga (Cala)                
Maclear                                  Zwelitsha                     


                                                                             10 of 26
            6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED

PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE
GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY.
FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE
SUPPLIERS APPLICATION.

                                  Free State
            Location          Mark                     Location            Mark
                              with X                                       with X
Bethlehem                                   Marquard                    
Bethulie                                  Memel                         
Bloemfontein                              Odendaalsrus                  
Boshof                                    Parys                         
Bothaville                                Paul Roux                     
Botshabelo                                Petrusburg                    
Brandfort                                 Petrus Steyn                  
Bultfontein                               Philippolis                   
Clocolan                                  Reddersburg                   
Dealesville                               Reitz                         
Dewetsdorp                                Rouxville                     
Edenburg                                  Sasolburg                     
Edenville                                 Senekal                       
Excelsior                                 Smithfield                    
Fauresmith                                Springfontein                 
Ficksburg                                 Steynsrus                     
Fouriesburg                               Thaba ’Nchu                   
Frankfort                                 Theunissen                    
Harrismith                                Trompsburg                    
Heilbron                                  Ventersburg                   
Hennenman                                 Viljoenskroon                 
Hertzogville                              Villiers                      
Hobhouse                                  Virginia                      
Hoopstad                                  Vrede                         
Jacobsdal                                 Vredefort                     
Jagersfontein                             Warden                        
Kestell                                   Welkom                        
Koffiefontein                             Wepener                       
Koppies                                   Wesselsbron                   
Kroonstad                                 Winburg                       
Ladybrand                                 Witsieshoek                   
Lindley                                   Zastron                       




                                                                            11 of 26
           6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED

PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE
GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY.
FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE
SUPPLIERS APPLICATION. 

                                        Gauteng
             Location               Mark          Location           Mark
                                    with X                           with X
Alberton                                                          
Benoni                                                            
Daveyton                                                          
Boksburg                                                          
Brakpan                                                           
Bronkhorstspruit                                                  
Cullinan                                                          
Germiston                                                         
Heidelberg                                                        
Johannesburg Regional Office
                                                                  
Kempton Park                                                      
Tembisa                                                           
Krugersdorp                                                       
Meyerton                                                          
Nigel                                                             
Oberholzer                                                        
Pretoria ( Include Supply to the
National Office)                                                  
Atteridgeville                                                    
Pretoria North                                                    
Mamelodi                                                          
Randburg                                                          
Randfontein                                                       
Roodepoort                                                        
Soshanguve                                                        
Springs                                                           
Vanderbijlpark                                                    
Sebokeng                                                          
Vereeniging                                                       
Westonaria                                                        




                                                                        12 of 26
            6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED

PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE
GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY.
FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE
SUPPLIERS APPLICATION.
 
                                   Kwazulu Natal
            Location           Mark                     Location           Mark
                               with X                                      with X
    Babanango                                Manguzi                    
    Bergville                                Maphumulo                  
    Camperdown                               Matatiele                  
    Chatsworth                               Melmoth                    
    Colenso                                  Mooiriver                  
    Dannhauser                               Mpumalanga                 
    Dukuza                                   Msinga                     
    Dundee                                   Mtubatuba                  
    Durban                                   Mtunzini                   
    Emlazi                                   Ndwedwe                    
    Ekuvukeni                                New hanover                
    Empangeni                                Newcastle                  
    Emzumbe                                  Nkandla                    
    Enseleni                                 Nongoma                    
    Eshowe                                   Nqutu                      
    Estcourt                                 Ntuzuma                    
    Emnabithi                                Ongoye                     
    Glencoe                                  Paulpietersburg            
    Greytown                                 Phungashe                  
    Harding                                  Pietermaritzburg           
    Himeville                                Pinetown                   
    Hlabisa                                  Pongola                    
    Hlanganani                               Port shepstone             
    Howick                                   Richmond                   
    Impendle                                 Scottburgh                 
    Ingwavuma                                Simdlagentsha              
    Inkanyezi                                Stanger                    
    Ixopo                                    State attorney             
    Izingolweni                              Ubombo                     
    Kokstad                                  Umbumbulu                  
    Kranskop                                 Umzimkhulu                 
    Kwamsane                                 Utrecht                    
    Ladysmith                                Verulam                    
    Louwsburg                                Vryheid                    
    Madadeni                                 Vulamehlo                  
    Magudu                                   Weenen                     
 
    Mahlabatini                                                         



                                                                             13 of 26
         6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED

PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE
GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY.
FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE
SUPPLIERS APPLICATION.
                                   Limpopo
        Location          Mark                     Location           Mark
                          with X                                      with X
Bochum                                   Phalala                   
Bolobedu                                 Polokwane                 
Dzanani                                  Pietersburg               
Ellisras                                 Potgietersrus             
Giyani                                   Praktiseer                
Hlanganani                               Ritavi                    
Letaba                                   Sekgosese                 
Lulekani                                 Sekhukhuneland            
Malamulele                               Seshego                   
Mankweng                                 Soutpansberg              
Mapulaneng                               Thabamoopo                
Messina                                  Thabazimbi                
Mhala                                    Thohoyandou               
Mokerong                                 Tshilwavhusiku            
Mutale                                   Tshitale                  
Namakgale                                Vuwani                    
Naphuno                                  Warmbaths                 
Nebo                                     Waterberg                 
Phalaborwa                               Tshitale                  
                              Mpumalanga
        Location          Mark                     Location           Mark
                          with X                                      with X
Amsterdam                                Lydenburg                 
Amersfoort                               Mbibana                   
Balfour                                  Mdutjana                  
Barberton                                Middelburg                
Belfast                                  Mkobola                   
Bethal                                   Morgenzon                 
Breyten                                  Moutse                    
Carolina                                 Nelspruit                 
Delmas                                   Nkomazi                   
Eerstehoek                               Nsikazi                   
Ekangala                                 Piet Retief               
Ermelo                                   Sabie                     
Evander                                  Standerton                
Graskop                                  Volksrust                 
Groblersdal                              Wakkerstroom              
Hendrina                                 Waterval Boven            
Kriel                                    White River               
KwaMhlanga                               Witbank                   

                                                                         14 of 26
         6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED

PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE
GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY.
FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE
SUPPLIERS APPLICATION.

                                  Northern Cape
         Location             Mark                   Location              Mark
                              with X                                       with X
Barkly West                                 Keimoes                     
Britstown                                   Kenhardt                    
Calvinia                                    Kimberley                   
Carnarvon                                   Kuruman                     
Colesberg                                   Noupoort                    
De Aar                                      Olifantshoek                
Douglas (Herbert)                           Philipstown                 
Fraserburg                                  Pofadder                    
Galeshewe                                   Port Nolloth                
Garies                                      Postmasburg                 
Griekwastad (Hay)                           Prieska                     
Groblershoop                                Richmond                    
Hanover                                     Springbok (Namakwaland)     
Hartswater                                  Sutherland                  
Hopetown                                    Upington (Gordonia)         
Jan Kempdorp                                Victoria West               
Kakamas                                     Warrenton                   
Kathu                                       Williston                   
                                                                        
                                   North West
         Location             Mark                   Location          Mark
                              with X                                   with X
Bafokeng                                    Mankwe                      
Bloemhof                                    Marico                      
Brits                                       Molopo                      
Christiana                                  Moretele                    
Coligny                                     Odi                         
Delareyville                                Potchefstroom               
Ditsobotla                                  Rustenburg                  
Ganyesa                                     Schweizer-Reneke            
Klerksdorp                                  Swartruggens                
Koster                                      Taung                       
Kudumane (Tlhaping-Tlharo)                  Ventersdorp                 
Lehurutshe                                  Vryburg                     
Lichtenburg                                 Wolmaransstad               
Madikwe                                                                 




                                                                              15 of 26
           6. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED

PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE
GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY.
FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE
SUPPLIERS APPLICATION.


                               Western Cape 
             Location           Mark                  Location        Mark
                                with X                                with X
Albertinia                                    Montagu                  
Atlantis                                      Moorreesburg             
Beaufort West                                 Mossel Bay               
Bellville                                     Murraysburg              
Bonnievale                                    Oudtshoorn               
Bredasdorp                                    Paarl                    
Caledon                                       Piketberg                
Calitzdorp                                    Porterville              
Cape Town                                     Prince Albert            
Ceres                                         Riversdale               
Clanwilliam                                   Robertson                
George                                        Simon’s Town             
Goodwood                                      Somerset West            
Grabouw                                       Stellenbosch             
Heidelberg                                    Strand                   
Hermanus                                      Swellendam               
High Court Cape Town                          Tulbagh                  
Hopefield                                     Uniondale                
Khayelitsha                                   Van Rhynsdorp            
Knysna                                        Vredenburg               
Kuils River                                   Vredendal                
Laaiplek                                      Wellington               
Ladismith                                     Wolseley                 
Laingsburg                                    Worcester                
Malmesbury                                    Wynberg                  
Mitchells Plain                               Riversdale               




                                                                          16 of 26
                                                      7. LIST OF COMMODITIES
    PROSPECTIVE SERVICE PROVIDERS MUST SELECT ONLY FIVE (5) COMMODITY SPECIFIC AS PER THEIR PRINCIPAL/CORE BUSINESS.
                     FAILURE TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE SERVICE PROVIDERS APPLICATION
                                                              Select                                                                         Select 
Codes                                     Name                   (X)        Codes                                 Name                          (X) 
4713425             ADMIN & SUPPORT STAFF                                   4323425/ 6174425     COMPUTER PERIPHERALS                          
4224425/ 4226425    ADVERTISING ( 4232425/ 4234425)                         4568425              CONSULTING: ACCOUNTANTS & AUDITORS            
4329425/ 6149425  ADVERTISING BOARDS                                        4574525              CONSULTING: COMMUNICATION                     
5210425             AIR CHARTER SERVICES                                    4576425              CONSULTING: FINANCIAL MANAGEMENT              
5048425             ART REQUIREMENTS                                        4578425              CONSULTING: HUMAN RESOURCE                    
4656425             ARTISTS & PERFORMERS                                    4580425              CONSULTING: OCCUPATIONAL SAFETY & HEALTH      
4660425             AUCTIONEERS                                             4582425              CONSULTING: ORGANISATIONAL                    
4273425/ 6025425    AUDIO VISUAL EQUIPMENT                                  4584425              CONSULTING: PROJECT MANAGEMENT                
5050425             AUDIO VISUAL MATERIALS                                  4592425              CONSULTING: QUALIFICATION VERIFICATION        
4662425             AUDIO‐VISUAL SERVICE                                    4586425              CONSULTING: RESEARCH & ADVISOR                
4275425/ 6027425    BAGS                                                    4596425              CONSULTING: TRANSLATION &TRANSCRIPTION        
4847425             BATTERIES                                               4588425              CONSULTING: VALUER                            
5052425             BINDING                                                 4687425              CONTRACTORS: MEDICAL SERVICES                 
5054425             BOOKS & JOURNALS                                        4987425              CORPORATE GEAR                                
4833425             BOOKS & MAGAZINES                                       5214425              COURIER & DELIVERY SERVICES                   
4981425             BROOMS & BRUSHES                                        4333425/ 6152425     CROCKERY & CUTLERY                            
4277425/ 6029425    BUILDING  AIR‐CONDITIONING SYSTEMS                      4989425              CROCKERY & CUTLERY                            
4715425             BURIAL SERVICES                                         4422425              CYCLES                                        
5208425             CAR VALET & WASHING SERVICES                            4532425              DATA LINES                                    
4671425             CASUAL LABOURERS                                        4315425/ 4121425     DESKTOP PC                                    
4472425             CATERING                                                4325425/ 6176425     DESKTOP PRINTING EQUIPMENT                    
4474425             CELL CONTRACT                                           4991425              DISP PAPER/PLASTIC                            
4985425             CELLPHONE ACCESSOR                                      4289425/ 6041425     DOMESTIC EQUIPMENT                            
4279425/ 6031425    CELLULAR PHONES                                         5058425              DRAWING MATERIAL                              
4281425/ 6033425    CELLULAR ROUTERS                                        5216425              DRIVING SCHOOL                                
5080425             CLEANING SERVICES                                       4292425/ 6045425     ELECTRIC WIRE & POWER DISTRIBUTION            
4285425/ 6037425    COMMERCIAL & INDUSTRIAL REFRIGERATORS                   4853425              ELECTRICAL SUPPLIES                           
4283425/ 6035425    COMMERCIAL &INDUSTRIAL GAS CYLINDERS                  4293425/ 6047425       ELEVATOR/ ESCALATING SYSTEMS                  


                                                                                                                                                  17 of 26
                                                          7. LIST OF COMMODITIES
     PROSPECTIVE SERVICE PROVIDERS MUST SELECT ONLY FIVE (5) COMMODITY SPECIFIC AS PER THEIR PRINCIPAL/CORE BUSINESS.
                         FAILURE TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE SERVICE PROVIDERS APPLICATION
Codes                                      Name                  Select        Codes                                      Name                       Select  
4295425/ 6049425    EMERGENCY/ RESCUE EQUIPMENT                                4309425/ 6065425     LAUNDRY EQUIPMENT                                  
4673425             EMPLOYEE WELLNESS                                          5206425              LAUNDRY SERVICES                                   
4676425             EVENT PROMOTERS                                            4358425/6083425      LEARNING/TRAINING/SUPP/LIBRARY EQUIP               
4299425/ 6053425    FIRE FIGHTING                                              4312425              LIBRARY BOOKS                                      
5088425             FIRE PROTECTION                                            4835425              LIBRARY MATERIAL                                   
4889425             FIRST AID KITS                                             4837425              LIBRARY/MEDIA/FILM MATERIAL                        
4332425/ 6150425    FIX INDIVIDUAL & MOVABLE AIR CONDITIONERS                  5011425              LICENCE PLATES                                     
4773425             FLEET SERVICES: BATTERIES                                  4313425              LIFTING &HANDLING EQUIPMENTS                       
4779425             FLEET SERVICES: FUEL,OIL & GREASE                          5013425              LINEN                                              
4783425             FLEET SERVICES: SPARES & ACCESSORIES                       4337425/ 6156425     LINEN & SOFT FURNISHINGS                           
4789425             FLEET SERVICES: TYRES & TUBES                              5060425              MAGAZINES/ NEWSPAPERS                              
4771425             FLEET SERVICES:TRACKING                                    4538425              MAINFRAME TIME                                     
4817425             FOOD SUPPLIES: GROCERIES                                   4711425/ 4667425     MAINTENANCE & REPAIRS INFRASTRUCTURE ASSETS        
5218425             FREIGHT SERVICES & GOODS TRASNPORTATION                    4638425/ 4640425     MEDICAL LAB SERVICES                               
4825425             FUEL, OIL & LUBRICANTS                                     4749425              MEDICAL SERVICES                                   
5092425             FUMIGATION SERVICES                                        4681425              MINT OF DECORATIONS                                
4301425             GARDENING EQUIPMENT                                        6009425              MOTOR VEHICLES                                     
5078425             GARDENING SERVICES                                         5019425              NEEDLE WORK ACCESSORIES                            
5001425             GARDENING SUPPLIES                                         4339425/ 6158425     OFFICE EQUIPMENT                                   
4827425             GENERAL GAS                                                4341425/ 6160425     OFFICE FURNITURE                                   
4679425             GRAPHIC DESIGNERS                                          5021425              PACKING MATERIAL                                   
4855425             HARDWARE                                                   4343425/ 6162425     PAINT/SCULP AND ORNAMENTS                          
4534425             INFORMATION SERVICES (IT SERVICES)                         4857425              PAINTING MATERIAL                                  
5003425             INSECTICIDES                                               4743425              PERSONNEL & LABOUR                                 
4683425             INTERIOR DECORATORS                                        5100425              PEST CONTROL                                       
4735425             INTERNAL AUDITORS                                          4685425              PHOTOGRAPHER                                       
4305425/ 6061425    IRRIGATION EQUIPMENT                                       4376425/ 6101425     PHOTOGRAPHIC EQUIPMENT                             
5005425             IRRIGATION MATERIAL                                        5062425              PHOTOGRAPHIC MATERIAL                              
5056425             IT CONSMABLES                                              4697425              PLANT FLOWERS & OTHER DECORATIONS                  
4307425/ 6063425    KITCHEN APPLIANCES                                         4476425              POST/STAMP/FRANK MACHINES                          
4317425/ 6168425    LAPTOPS                                                    5070425              PRINTING CARTRIDGE                                 
                                                                                                                                                   18 of 26
                                                     LIST OF COMMODITIES
    PROSPECTIVE SERVICE PROVIDERS MUST SELECT ONLY FIVE (5) COMMODITY SPECIFIC AS PER THEIR PRINCIPAL/CORE BUSINESS.
                   FAILURE TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE SERVICE PROVIDERS APPLICATION
                                                                     Select                                                                    Select 
Codes                                    Name                           (X)        Codes                                  Name                    (X) 
5072425             PRINTING PAPER                                                 4394425             SPORT & RECREATION EQUIPMENT              
5232425             PRINTING & PUBLICATIONS SERVICES                               4691425             STAGE AND SOUND CREW                      
4646425             PRIVATE FIRM: LEGAL ADVICE                                     4652425             STATE ATTORNEY: CONVEYANCING              
4648425             PRIVATE FIRM: MESSGER OF COURT                                 4650425             STATE ATTORNEY: LEGAL ADVICE              
4747425             PROFESSIONAL STAFF                                             4654425             STATE ATTORNEY: MESSGER OF THE COURT      
                    PUMP/PLUMBING/PURIFICATION/ SANITATION/ WASTE 
4370425/ 6095425 
                    EQUIPMENTS                                                     5068425             STATIONERY                                
4478425             RADIO AND TV TRANSMISSIONS                                     5246425             STORAGE OF ASSETS & GOODS                 
4382425/ 6107425    RADIO EQUIPMENT                                                5244425             STORAGE OF FILES                          
5023425             REDISTRIBUTIONAL ITEMS                                         4552425             SYSTEM ADVISER                            
5076425             RENTAL & HIRING                                                4554425             SYSTEM DEVELOPER                          
6103425             REPROGRAPHIC EQUIPMENT                                         4321425/ 6172425    TABLET PC                                 
4751425             RESEARCHER                                                     4402425/ 6127425    TELECOM EQUIPMENT ‐ EQUIPMENT             
5102425             SAFE GUARD &SECURITY                                           4398425/ 6123425    TELECOM EQUIPMENT ‐ NETWORK LAN           
4482425             SATELLITE SIGNALS                                              4400425/ 6125425    TELECOM EQUIPMENT ‐ NETWORK WAN           
4386425/ 6111425    SECURITY EQUIPMENTS,SYSTEMS,MATERIAL:FIXED                     4486425             TELEPHONE INSTALLATION                    
4388425/ 6113425    SECURITY EQUIPMENTS,SYSTEMS,MATERIAL:MOVABLE                   4484425             TELEPHONE/FAX/TELEGRAP&TELEX              
4753425             SECURITY SERVICES                                              5033425             TOILETRIES                                
4319425/ 6170425    SERVER/MAINFRAME                                               4785425             TOWING COSTS                              
4327425/ 6178425    SHARE NETWORK PRINTING EQUIPMENT                               4693425             TRACING AGENTS & DEBT COLLECTORS          
4548425/ 6279425    SOFTWARE LICENCE: DEVELOPMENT SOFTWARE                         5198425             TRAINING & DEVELOPMENT                    
4542425/ 6273425    SOFTWARE LICENCE: OFFICE SUITE SYSTEM                          5200425             TRAINING: MATERIAL & MANUALS              
4540425/ 6294425    SOFTWARE LICENCE: OPERATING SYSTEMS                            4424425             TRANSPORT ACCESSORIES                     
4546425/ 6277425    SOFTWARE LICENCE: SECURITY SOFTWARE                            6017425             TRANSPORT ACCESSORIES & TRAILERS          
4544425/ 6275425    SOFTWARE LICENCE: UTILITY SOFTWARE                             4695425             TRANSPORT CONTRACTOR                      
4859425             SPARES & ACCESSORIES                                           5118425             TRANSPORT FOR PUBLIC EVENTS               
4550425             SPECIALIZED COMPUTER SERVICES                                  5035425             TUBE LIGHTS & LIGHT BULB                  
5031425             SPORT & RECREATION CONSUMABLES                                 4861425             TYRES & TUBES                             

                                                                                                                                               19 of 26
                                                   7. LIST OF COMMODITIES
     PROSPECTIVE SERVICE PROVIDERS MUST SELECT ONLY FIVE (5) COMMODITY SPECIFIC AS PER THEIR PRINCIPAL/CORE BUSINESS.
                   FAILURE TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE SERVICE PROVIDERS APPLICATION
                                                                 Select                                                              Select 
Codes                                       Name                    (X)        Codes                          Name                      (X) 
5037425              UNIFORM & PROTECTIVE CLOTHING                             5076425    RENTAL & HIRING: GENERATORS                  
4791425              VEHICLE REPAIRS                                           5076425    RENTAL & HIRING: LIGHTS                      
5250425              VEHICLE TRACKING                                          5076425    RENTAL & HIRING: HEATERS                     
5262425              VENUES AND FACILITIES                                     5198425    TRAINING: COMMUNICATION                      
5039425              WASHING/CLEANING DETERGENTS                               5198425    TRAINING: FINANCIAL MANAGEMENT               
4410425/ 6145425     WRAPPING & PACKAGING EQUIPMENT                            5198425    TRAINING: HUMAN RESOURCE                     
 5220425             GIFTS                                                     5198425    TRAINING: OCCUPATIONAL SAFETY & HEALTH       
 4228425             PROMOTIONAL ITEMS                                         5198425    TRAINING: ORGANISATIONAL                     
 4230425             MARKETING                                                 5198425    TRAINING: PROJECT MANAGEMENT                 
 5045425             WORKPLACE DÉCOR                                           5198425    TRAINING: INFORMATION SERVICES               
 6039425/ 4287       CONTAINERS                                                5198425    TRAINING: COMPUTER LITERACY                  
 6154425/ 4335425    DOMESTIC FURNITURE                                                                                                
 6039425/4287425     CONTAINERS                                                                                                        
 5106425             CONSTRUCTION: PLUMBING                                                                                            
5106425              CONSTRUCTION: ELECTRICIAN                                                                                         
5106425              CONSTRUCTION: BRICKLAYING                                                                                         
5106425              CONSTRUCTION: TILING                                                                                              
5106425              CONSTRUCTION: ROOFING                                                                                             
5106425              CONSTRUCTION: PAINTING                                                                                            
5106425              CONSTRUCTION: PARTITIONING                                                                                        
5106425              CONSTRUCTION: PAVING                                                                                              
5106425              CONSTRUCTION: FENCING                                                                                             
 5106425             CONSTRUCTION: WELDING                                                                                             
5076425              RENTAL & HIRING: AUDIO VISUAL EQUIPMENTS                                                                          
5076425              RENTAL & HIRING: TRAILERS & VEHICLES                                                                              
5076425              RENTAL & HIRING: TENTS, CHAIR & TABLES                                                                            
5076425              RENTAL & HIRING: TOILETS                                                                                          

                                                                                                                                    20 of 26
                                                                                            Section 8

                                                                     Declaration of Interest
1.        Any legal person, including persons employed by the state¹, or persons having a kinship
          with persons employed by the state, including a blood relationship, may make an offer or
          offers in terms of this invitation to bid (includes an advertised competitive bid, a limited bid,
          a proposal or written price quotation). In view of possible allegations of favouritism, should
          the resulting bid, or part thereof, be awarded to persons employed by the state, or to
          persons connected with or related to them, it is required that the bidder or his/her
          authorised representative declare his/her position in relation to the evaluating/adjudicating
          authority where-

          -      the bidder is employed by the state; and/or

          -      the legal person on whose behalf the bidding document is signed, has a relationship
                 with persons/a person who are/is involved in the evaluation and or adjudication of the
                 bid(s), or where it is known that such a relationship exists between the person or
                 persons for or on whose behalf the declarant acts and persons who are involved with
                 the evaluation and or adjudication of the bid.

2.        In order to give effect to the above, the following questionnaire must be completed
          and submitted with the bid.

2.1       Full Name of bidder or his or her representative:
          …………………………………………………………………………………………………………

2.2       Identity Number:……………………………………………………………………………………..

2.3       Position occupied in the Company (director, trustee, shareholder², member):

          …………………………………………………………………………………………………………

2.4       Registration number of company, enterprise, close corporation, partnership agreement or
          trust:

          ………………………………………………………………………..………….……………………

2.5       Tax Reference Number: …………………………………………………………………………

2.6       VAT Registration Number: …………………………………..………………………………....

2.6.1     The names of all directors / trustees / shareholders / members, their individual identity
          numbers, tax reference numbers and, if applicable, employee / PERSAL numbers must be
          indicated in paragraph 3 below.
¹“State” means –
          (a) any national or provincial department, national or provincial public entity or constitutional
              institution within the meaning of the Public Finance Management Act, 1999 (Act No. 1 of
              1999);
          (b) any municipality or municipal entity;
          (c) provincial legislature;
          (d) national Assembly or the national Council of provinces; or
          (e) Parliament.

²”Shareholder” means a person who owns shares in the company and is actively involved in the
  management of the enterprise or business and exercises control over the enterprise.




                                                                                                 21 of 26
2.7      Are you or any person connected with the bidder                    YES / NO
         presently employed by the state?



2.7.1    If so, furnish the following particulars:

         Name of person / director / trustee / shareholder/ member: . …....………………………………
         Name of state institution at which you or the person
         connected to the bidder is employed :                      ………………………………………

         Position occupied in the state institution:                  ………………………………………

         Any other particulars:

         ............................................................………………………………………………………………

         ............................................................………………………………………………………………

         ............................................................………………………………………………………………

2.7.2    If you are presently employed by the state, did you obtain         YES / NO
         the appropriate authority to undertake remunerative
         work outside employment in the public sector?

2.7.2.1 If yes, did you attach proof of such authority to the bid           YES / NO
        document?

         (Note: Failure to submit proof of such authority, where
         applicable, may result in the disqualification of the bid.

2.7.2.2 If no, furnish reasons for non-submission of such proof:

         ............................................................………………………………………………………………

         ............................................................………………………………………………………………

         ............................................................………………………………………………………………

2.8     Did you or your spouse, or any of the company’s directors /         YES / NO
         trustees / shareholders / members or their spouses conduct
         business with the state in the previous twelve months?

2.8.1    If so, furnish particulars:

         ............................................................………………………………………………………………

         ............................................................………………………………………………………………

         ............................................................………………………………………………………………

2.9      Do you, or any person connected with the bidder, have              YES / NO
         any relationship (family, friend, other) with a person
         employed by the state and who may be involved with
         the evaluation and or adjudication of this bid?

2.9.1    If so, furnish particulars.

         ............................................................………………………………………………………………

         ............................................................………………………………………………………………

         ............................................................………………………………………………………………
                                                                                       22 of 26
2.10    Are you, or any person connected with the bidder,                          YES/NO
        aware of any relationship (family, friend, other) between
        any other bidder and any person employed by the state
        who may be involved with the evaluation and or adjudication
        of this bid?

2.10.1 If so, furnish particulars.

          ............................................................………………………………………………………………

          ............................................................………………………………………………………………

          ............................................................………………………………………………………………

2.11      Do you or any of the directors / trustees / shareholders / members      YES/NO
          of the company have any interest in any other related companies
          whether or not they are bidding for this contract?

2.11.1 If so, furnish particulars:

          ............................................................………………………………………………………………

          ............................................................………………………………………………………………

          ............................................................………………………………………………………………


3      Full details of directors / trustees / members / shareholders.

Full Name                        Identity Number     Personal Income Tax       State Employee
                                                     Reference Number          Number / Persal
                                                                               Number




                                                                                            23 of 26
4   DECLARATION

    I, THE UNDERSIGNED (NAME)……………………………………………..…………………………

    CERTIFY THAT THE INFORMATION FURNISHED IN PARAGRAPHS 2 and 3 ABOVE IS
    CORRECT.
      I ACCEPT THAT THE STATE MAY REJECT THE BID OR ACT AGAINST ME SHOULD
      THIS DECLARATION PROVE TO BE FALSE.


    …………………………………..             ..……………………………………………
       Signature                          Date


    ………………………………….             ………………………………………………
       Position                         Name of bidder




                                                                  24 of 26
                                                                                                   Section 9

13.       SPECIAL CONDITIONS:

1.        As per section 7 of this supplier registration form entitled “Location where goods and/or
          services may be required”, prospective service providers must indicate by means of an X
          where goods and/or service can be provided based on the location of their entity. Prospective
          suppliers must submit a latest original Utility bill (water and electricity) and a certified copy of
          its entity business registration in respect to the Province applied for. Failing to comply with
          this condition will invalidate the prospective supplier’s application.

2.        Government Procurement General Conditions of contract (GCC) as issued by National
          Treasury will applicable on all instances.       The general conditions is available on the
          National Treasury website (www.treasury.gov.za)


3.        No advance payment would be made for the procurement of goods or services. Payment
          would be made in terms of the deliverables or other unless otherwise agreed upon by other
          parties (DoJ & CD and the contractor). DoJ & CD will pay within the prescribed period
          according to PFMA.


4.        Service providers must complete and submit all relevant information/documentation
          required as insufficient information and non compliance to the conditions set out will
          invalidate your application


5. Successful supplier providers enlisted of the DoJ CD supplier database must submit a new
      valid current Tax Clearance Certificate to the National Office (Pretoria) before the validity of the
      current Certificate expires, in order to ensure that the Department may continuously consider
      quotations submitted by your business.


6. It is imperative that only the DoJ & CD supplier database registration form with supporting
      documentation and Original Signatures be submitted. Applications with copied signatures or
      any part of the supplier application that has been retyped or redrafted will not be considered
      and disqualified for re-registration.


7.    Suppliers providing information incorrectly or fraudulently in their Supplier Database
      Registration form will be restricted from bidding, in addition to any other action the Department
      of Justice and Constitutional Development may institute against such a supplier. Furthermore,
      in the event of the DoJ & CD being prejudiced financially, it reserves the right to take legal
      action against the supplier




                                                                                                    25 of 26
                                                                                    Section 10
                DoJ & CD ANTI-CORRUPTION TOLL-FREE HOTLINE
                                            0800 701 701
The aim of the Hotline is to enhance an honest work ethic and simultaneously provide employees and
persons not employed by the Department with a mechanism to bring any unethical business practices
to the attention of management.
                                         DECLARATION
I, THE UNDERSIGNED (NAME)


CERTIFY THAT I AM AWARE OF DoJ & CD ANTI-CORRUPTION TOLL-FREE LINE, WHERE I CAN FREELY
REPORT POSSIBLE CORRUPT ACTIONS BY SUPPLIERS/SERVICE PROVIDERS/CONTRACTORS OR
POSSIBLE CORRUPT ACTIONS WITHIN THE DEPARTMENT AT ANY TIME AND THAT THE DEPARTMENT
WILL TREAT MY IDENTITY AS STRICTLY CONFIDENTIAL.




   Signature                                                                Date




   Position                                                        Name of Service Provider




                                                                                         26 of 26

				
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