APPLICATION FORM FOR REGISTRATION OF CONTRACTORS, SUPPLIERS AND by JaymesChapman

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									                                                                              PPF Tower 8th Floor
                                                                              Ohio Street/Garden Avenue
                                                                              P.O. Box 49,
                                                                              Dar-es Salaam, TANZANIA
                                                                              Tel: 2133466, 2121236/7
                                                                              Fax: 2121238
                                                                              E-mail: ceo@ppra.go.tz
                                                                              Web: www.ppra.go.tz

APPLICATION FORM FOR REGISTRATION OF CONTRACTORS, SUPPLIERS AND
SERVICE PROVIDERS FOR THE PURPOSE OF PREFERENCE SCHEME IN
ACCORDANCE WITH REGULATION 27 (1) OF THE PUBLIC PROCUREMENT (GOODS,
WORKS, NON CONSULTANTS SERVICES AND DISPOSAL OF PUBLIC ASSETS BY
TENDER) REGULATIONS 2005

                                         For Official Use Only
 Application form received on:                     Application Received by:



 Application submitted to the
 Board of Directors                                Approved:                    Not Approved



NOTES :        Should the space provided on the questionnaire prove insufficient, additional details may
               be provided on a separate sheet of paper.

                                 SECTION I: COMPANY PROFILE

1.      Firm’s Name in full _____________________________________________________

2.     Address of Head Office:

       a)      Physical address     _______________________________________________________
       b)       Box number __________________________________________________________
       (c)     Telephone No.__________________________________________________________
       (d)     Fax No.           __________________________________________________________
       e)      E-Mail            __________________________________________________________
       f)      Website           __________________________________________________________
4.     Type of business1         __________________________________________________________

5.     No. of Certificate of incorporation / Registration of business Names _______________
       (Photocopy of the certificate required)

6.     (a) Authorized Share Capital            ________________________________________
       (b) Issued share Capital                ________________________________________
       (c) Paid up share capital               ________________________________________
       (Applicable to companies which are limited by shares as shown in their Memorandum and
       articles of association)

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7.   Name and nationality of shareholders or partners.


       S/No.               Name                     Nationality              % of Share




8.
      Current Business License

      Number…………………………………………………………

      Date Issued ………………………………..                      Placed Issued ……………………….


                               SECTION II: DECLARATION

9.   I/We the undersigned hereby declare as follows

     (i)     My/our signing of this application form implies acceptance of responsibility for
             the veracity and accuracy of all information submitted therein or herewith.

     (ii)    The information given will be used by the Public Procurement Regulatory
             Authority for the evaluation of this application for registration. Such registration
             will be approved at the sole discretion of the Authority.


     (iii)   Failure to complete any part of this application form may result in not being
             Registered.

             Dated this …………………….. day of ……………………….. 20 ………………

     (i)     Signed by ………………………………………………………… (name in Block
             letters)

             In the capacity of ………………………………………………… (status in the Firm)

             ………………………………………….
                   Signature




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                                             SECTION III

                         LIST OF ATTACHMENTS TO BE SUBMITTED2


(a)             Company Memorandum & Articles of Association or Extract from Registrar of
                Companies

(b)             Certificate of incorporation / Registration

(c)             Certified copies of shareholders certificates

(d)             Current copy of business License




1
  State whether: For contractors: Civil, Building, Mechanical, Electrical or Specialist. Specialist
contractors should state clearly the field of specialization e.g. Air-conditioning, drilling, glazing: For
suppliers: computers, motor Vehicles, Motor cycles. Stationeries ect; and For service
providers:clearing ,cleaning, security etc.
2
  Tick against those attachments you have submitted. Additional attachments may be listed separately on
covering letter.
Attachments must be arranged and marked in the order shown above.




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