Vendor Application - Tshwane University of Technology by hedongchenchen

VIEWS: 26 PAGES: 18

									  VENDOR
REGISTRATION
   APPLICATION




        1
                    Supplier Database
              Tshwane University of Technology


 The Tshwane University of Technology is developing a vendor database which will
                assist with requests for quotations and tenders.



   These forms must be completed and returned to the following address:




                                  Tender Box
                               Pretoria Campus
                           Building 6, Ground Level,
                             Staatsartillerie Road,
                                 Pretoria West




           Please complete the forms in all detail – use black pen.
                Please print so that all information is legible.
          Forms that are not readable or incomplete will be rejected.



               New Application              Yes           No

 If No, please supply current creditor number.


PLEASE KEEP COPIES OF THE REGISTRATION FORM AND ALL
DOCUMENTATION SUBMITTED FOR YOUR OWN RECORDS AS
     NO COPIES WILL BE MADE BY THE UNIVERSITY




                                       2
                     -        POINTS TO REMEMBER                            -

        COMPLETING VENDOR REGISTRATION APPLICATION FORM


   Mandatory fields – Certain fields and documents are mandatory to certain business types only.
    Please ensure that all fields mandatory to your business type which are marked as “Mandatory
    Field” have been completed and if a field is not applicable to your business type, clearly mark it as
    N/A.
   Required documentation – Please refer to the attached table (Following page) to determine the
    mandatory supporting documentation required for your business type. Please ensure that all copies
    of Mandatory documents (certified copies where applicable) are attached.
   Completion of questions – Clearly state Yes, No or N/A to questions asked. Do not leave any
    Mandatory fields blank.
   Certified Documents – Please ensure that a Commissioner of Oaths has certified your Company
    Registration document and Proof of Shareholding Certificates. The stamp of certification should be
    on the front of the document.
   Copies of Documents - Please keep copies of the registration form and all supporting
    documentation submitted for your own records and to ensure that all data is maintained and up to
    date on a continual basis.
   Owners, Shareholders and Partners – Please ensure that the percentage of ownership
    calculated up to 100% and that a field is completed for each of the business owners.
   Certification of Correctness – Please ensure that the Certification of Correctness is signed and
    dated once all required documents and information have been submitted.
   Collection points – Completed registration forms and supporting documentation can be delivered
    to the address on the registration form.
   Processing of registration – Your completed registration will be processed and once verified, will
    be approved and you will be issued with a Vendor Registration Number to be used in all future
    communication with Tshwane University of Technology. The letter of verification will be dispatched
    to the correspondence details supplied on page three. Please note that this administration process
    will take a minimum of 5 days. Once your registration has been included on the TUT Database your
    details will be accessible to the purchasing officers of TUT.
   Business Opportunities – Please note that registration on the TUT Supplier Database does not
    guarantee business opportunities. Inclusion of the name in a database does not in any way
    guarantee any persons, company, service provider, vendor, etc. any business from the Tshwane
    University of Technology. All procurement will be subjected to the Procurement- and Tender
    policies of Tshwane University of Technology.
   Amendments – Please notify the Tshwane University of Technology – Procurement Department
    immediately of any changes to the verified information submitted.
   Queries – Should you have any queries or if you require assistance completing the registration
    form, please contact the Procurement office on (T) 012-3825207.
   If a company has more than one office, each office must fill in a separate from unless the point of
    transaction is centralized in the company’s head office.
   Please note that the key facilities in the database are classified as commodities and each potential
    vendor must indicate the commodity/commodities in which it would like to register for RFQ’s.
   The main objective of this process is to enhance transparency and equality on the part of the
    University and to facilitate effective communication with its vendors.
   Applications must be delivered by hand and must be fully completed with all the relevant
    documentation attached.
   It is a condition of bidding that a vendor’s taxes must be in order or satisfactory arrangements must
    have been made with the Receiver of Revenue to meet his/her tax obligations. In bids where
    consortia/joint ventures/sub contractors are involved, each party must submit a separate valid Tax
    Clearance Certificate.




                                                 3
      PLEASE KEEP COPIES OF REGISTRATION FORM AND ALL DOCUMENTATION SUBMITTED

FOR OFFICIAL USE ONLY
Name of Business


Registration Number


Documents                                                                                                          Where to
required                                        Business         Type                                              get documents
                               Close
               Sole            Corporation      Partnerships     Public           Business        Non Profit
               Proprietor      and Private                       Company          Trust           Organizations
                               Companies
Company                        Certificate of                    Certificate of                   Certificate of   Registrar of
Registration       N/A         incorporation     Partnership     incorporation      Trust         incorporation    Close
Certified                        CK1/CK2         agreement           CM3          agreement         Section 21     Corporations &
Copies                                                                                                             Companies
Proof of                       Certificate of                    Certificate of      Trust          Auditor’s      Registrar of
Ownership          N/A         incorporation     Partnership     incorporation      details:       letter – no     Close
Certified                        CK1/CK2         agreement           CM3           Letter of      shareholding     Corporations &
Copies                                                                             Authority                       Companies
Regional                                                                                                           City of
Services           Yes         Yes              Yes              Yes              Yes             Yes              Tshwane/Local
Council                                                                                                            Authority if not
                                                                                                                   based in
                                                                                                                   Tshwane
Proof of           Bank        Bank             Bank             Bank             Bank            Bank             Branch of Bank
Banking        Statement/      Statement/       Statement/       Statement/       Statement/      Statement/       where account
               cancelled       cancelled        cancelled        cancelled        cancelled       cancelled        is held
                 cheque        cheque           cheque           cheque           cheque          cheque
Income Tax       For the          For the          For the          For the                                        Receiver of
                owner or        company/cc       partnership       company          For the       For the Trust    Revenue
                    the                                                              Trust                         (SARS)
                business
Tax              For the         For the           For the            For the                                      Receiver of
Clearance       owner or       company/cc        partnership         company        For the       For the Trust    Revenue
certificate         the                                                              Trust                         (SARS)
                business
P.A.Y.E        If staff are    If staff are     If staff are     If staff are     If staff are    If staff are     Receiver of
               employed        employed         employed         employed         employed        employed         Revenue
                                                                                                                   (SARS)
VAT            If registered   If registered    If registered    If registered    If registered   If registered    Receiver of
Registration      for VAT      for VAT          for VAT          for VAT          for VAT         for VAT          Revenue
                                                                                                                   (SARS)
U.I.F          If staff are    If staff are     If staff are     If staff are     If staff are    If staff are     Department of
Certificate    employed        employed         employed         employed         employed        employed         Labour
Workman’s      If staff are    If staff are     If staff are     If staff are     If staff are    If staff are     Department of
Compensation   employed        employed         employed         employed         employed        employed         Labour
Security       If applicable   If applicable    If applicable    If applicable    If              If applicable    Security Service
Officer’s           – for      – for security   – for security   – for security   applicable      – for security   Industry
Board             security     industry         industry         industry         – for           industry         Regulatory
                  industry                                                        security                         Authority
                                                                                  industry
Proof of       If owner is     If owner is      If owner is      If owner is      If owner is     If owner is      Medical
Disability      disabled       disabled         disabled         disabled         disabled        disabled         Practitioner
Proof of       Clear copy        Clear copy     Clear copy of      Clear copy      Clear copy     Clear copy of    Department of
Identity       of Owner’s        of Owner’s       Owner’s ID       of Owner’s      of Owner’s       Owner’s ID     Home Affairs
                 ID doc.           ID doc.           doc.            ID doc.         ID doc.           doc.




                                                                 4
                                                              Department of Labour (U.I.F certificates)
CONTACT DETAILS                                               94 Church street, Pretoria
                                                              012 337 1802

Registrar of Close Corporations & companies                   Department of Labour (Workman’s Compensation
Zanza Building, 116 Proes Street, Pretoria                    Compensation House, Cnr Hamilton & Soutpansberg Rd,
086 184 3384                                                  Pretoria
City of Tshwane/Local Authority if not based in               012 319 9111
Tshwane                                                       Security Service Industry Regulatory Authority
HB Phillip Building, 320 Bosman Street, Pretoria.             481 Belvedere Street, Arcadia
012 337 4000                                                  012 337 5500
Receiver of Revenue (SARS)
c/o Schoeman & v.d. Walt Street, P.O. Box 436, Pretoria
0001
012 317 2000




                                         COMMODITY GROUPS

                                               PLEASE NOTE:
       Any vendor may only register for a maximum of four commodity groups




Tick   Cat    Description               Tick   Cat    Description                 Tick    Cat   Description
       No                                      No                                         No
       001    Laboratory equipment             030    Printing Supplies                   059   Brush ware
       002    Fasteners, Bolts, Nuts,          031    General Foodstuffs                  060   Power Tools &
              Rivets & Washers                                                                  Accessories
       003    Containers &                     032    Welding & Flame Cutting             061   Hand Tools &
              Packaging                               Equipment                                 Accessories
                                               033    Office Furniture,                   062   Transport Hire &
       004    Bricks & Blocks                         Components &                              Transport and
                                                      Accessories                               Cartage Services
       005    Canteen, Kitchen &               034    Hospital, Medical &                 063   Catering & Events
              Cooking equipment &                     Surgical Equipment &                      Equipment Hire
              Appliances                              Furniture
       006    Tableware,                       035    Outdoor & Pavement                  064   Engineers &
              Hollowware & Utensils                   Furniture                                 Contractors
       007    Sand, Soil, Cement &             036    Agricultural &                      065   Castors, Ladders,
              Concrete                                Horticultural Equipment                   Trolleys & Wheels
                                                      & Machinery
       008    Home & Industrial                037    Compressors, Blowers &              066   Recreational & Sports
              Fabrics & Textiles                      Vacuum Equipment                          Requisites
       009    Clothing, Safety                 038    Air conditioners,                   067   Artwork, Crafts,
              Clothing & Footwear                     Ventilation, Fans &                       Curios & Gifts
                                                      Coolers
       010    Cordage, Ropes,                  039    Furnaces, Kilns, Ovens              068   Hygiene, Beauty &
              Twines, String & Nets                   & industrial Dryers                       Cosmetic Products
       011    Electronic                       040    Office Machines &                   069   Publications, Videos &
              Components &                            Equipment                                 Films
              Equipment
       012    Computer Hardware &              041    Machine Tools &                     070   Fresh Flowers, Plants
              Supplies                                Accessories                               & Seeds
                                               042    Radio, Television,                  071   Medications &
       013    Computer Software &                     Audiovisual &                             Pharmaceuticals by
              Solutions                               Communication                             General Classification
                                                      Equipment
       014    Electric & Data Cable,           043    Pumps, Engines, Spares              072   Financial, Insurance &
              Wire &Equipment                         & Accessories                             Legal Services
       015    Electric Lamps,                  044    Fertilizers                         073   Analysis, Inspection &
              Lighting & Accessories                                                            Evaluation Services




                                                          5
        016     General Electrical                   045   Animal Feeds                      074   Installation Services
                Equipment & Parts
        017     Control, Process &                   046   Transport Vehicles,               075   Maintenance & Repair
                Measurement                                Trailers, Motorcycles,                  Services
                Instrumentation                            Boats, Aircraft & Spares
                                                           & Accessories
        018     Test & Analysis                      047   Washing, Scrubbing,               076   Manufacturing &
                instrumentation                            Cleaning Plant and                      processing Services
                                                           Supplies
        019     Scopes, Lenses &                     048   Nails, Pins, Screws &             077   Cleaning Services
                Optical Equipment                          Staples
        020     Security Equipment &                 049   Fuels, Petrol, Oils &             078   Administration &
                Requisites, Walling,                       Lubricants                              Management Services
                Fencing & Gates
        021     Signs, Nameplates,                   050   Coatings, Waterproofing           079   Engineering & Related
                Notices & Labels                           & Paints                                Services
        022     Engravers, Die-                      051   Stationery                        080   Advertising &
                Sinkers & Embossers                                                                Marketing Services
        023     Insulation Products                  052   Steel, Pipes and Profiles         081   Consultants
        024     Precious Stones and                  053   Valves and Pressure               082   Communication,
                Materials                                  Vessels                                 Publishing & Printing
                                                                                                   Services
        025     Building requisites,                 054   Pest Control and                  083   Consulting Engineers
                fittings & Materials                       Cleaning materials
        026     Flooring Products                    055   Adhesives                         084   Chemicals &
                                                                                                   Associated Products
        027     Sanitary ware &                      056   Heaters and Heating               085   Security Services
                Accessories                                Equipment
        028     Sewing, Knitting &                   057   Timbers and Timber                086   Food Services
                Textile Machines &                         materials
                Equipment
        029     Printing, Marking,                   058   Plant & Equipment Hire            087   Computer Related
                Engraving & Labeling                                                               Services
                Equipment
        088     Accommodation,                       091   Government Services –
                Tourism &                                  National, Local &
                Entertainment                              Municipal
        089     Agricultural Services                092
        090     Retailers &
                Wholesalers

                                                                                               Please tick
                           Documents Attached                                                     box
                                                                                       Yes         No              N/A

Workman’s Compensation Certificate (Certified)

Regional Council/District Registration (Certified)

VAT 103 (Certified)

P.A.Y.E./SDL/UIF (EMP103) (Certified)

Company Registration Document (Certified)

Proof of Ownership/Shareholder certificate (Certificate)

Tax Clearance Certificate (Original)

Proof of Banking Document

Disability Documents (Certified)

Security Officer’s Board registration (Certified)

Municipal Account

Labour Broker




                                                               6
Please note: Proof of documents for all of those above are required to ensure successful registration on the Supplier
Database. In event of a document not being required please tick the N/A box.


                            1. COMPANY REGISTRATION DOCUMENTS

NB. DOCUMENTARY PROOF MUST BE PROVIDED WHERE APPLICALE (Please mark N/A if not applicable.)

NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable

1.1   COMPANY TYPE * (NB. Documentary Proof of Registration must be provided)

PUBLIC COMPANY LTD                                           CERTIFIED COPY OF CERTIFICATE OF INCORPORATION
                                                             (CM 3) and
                                                             REGIONAL COUNCIL REGISTRATION NUMBER

PRIVATE COMPANY (PTY) LTD                                    CERTIFIED COPY OF CERTIFICATE OF INCORPORATION
                                                             (CM 3) and
                                                             REGIONAL COUNCIL REGISTRATION NUMBER

CLOSE CORPORATION CC                                         CERTIFIED COPY OF CK1 DOCUMENT OR CK2 IF
                                                             APPLICABLE and
                                                             REGIONAL COUNCIL REGISTRATION NUMBER

SOLE PROPRIETOR                                              COPY OF REGIONAL COUNCIL REGISTRATION
                                                             DOCUMENT

PARTNERSHIP                                                  COPY OF REGIONAL COUNCIL REGISTRATION
                                                             DOCUMENT and
                                                             PARTNERSHIP AGREEMENT

BUSINESS TRUST                                               COPY OF REGIONAL COUNCIL REGISTRATION
                                                             DOCUMENT and
                                                             CERTIFIED COPY OF REGISTRATION DOCUMENT

OTHER (If Joint Venture)                                     COPY OF REGIONAL COUNCIL REGISTRATION
                                                             DOCUMENT and
                                                             CERTIFIED COPY OF REGISTRATION DOCUMENT




NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable


Company, CK or Regional Council Number

Not applicable to all companies, please specify if N/A.

Did you attach your company Registration document?                                              Y       N      N/A

1.2 PROOF OF SHAREHOLDING DOCUMENTS *

CERTIFIED COPIES of Shareholders certificates or CK members share allocation documents
must be supplied.

Not applicable to all companies, please specify if N/A.



                                                            7
Did you attach your proof of shareholders documents?                       Y   N   N/A

1.3 REGIONAL COUNCIL REGISTRATION DOCUMENTS *

Regional Council Reference Number


Did you attach your proof of shareholders documents?                       Y   N   N/A

1.4 PROOF OF BANKING DOCUMENTS *

Current bank statement or copy of cancelled cheque.

Did you attach your proof of banking document?                             Y   N   N/A
1.5 VAT REGISTRATION NUMBER #

VAT Registration Number

If you qualify for VAT exemption, please attach a VAT exemption document
Not applicable to all companies, please specify if N/A
Did you attach proof of your VAT registration (VAT 103)?                   Y   N   N/A
1.6 P.A.Y.E. DOCUMENT #

Not applicable to all companies, please specify if N/A

Did you attach proof of your P.A.Y.E. document?                            Y   N   N/A

NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable

1.7 UNEMPLOYMENT INSURANCE FUND DOCUMENTS #

U.I.F Number

Not applicable to all companies, please specify if N/A
Did you attach proof of your UIF document?                                 Y   N   N/A

1.8 WORKMAN’S COMPENSATION FUND DOCUMENTS #

Workman’s Compensation Fund No.

Not applicable to all companies, please specify if N/A
Did you attach proof of your Workman’s Compensation Fund Number?           Y   N   N/A



                                                 8
1.9 SECURITY OFFICERS BOARD REGISTRATION #

Security officers board registration no.

Not applicable to all companies, please specify if N/A
Did you attach proof of your Security Officers Board Registration?   Y   N   N/A

1.10    DISABILITY DOCUMENTS #

Not applicable to all companies, please specify if N/A

Did you attach proof of your disability?                             Y   N   N/A

1.11    INCOME TAX REGISTRATION #

Income Tax Registration No.

Not applicable to all companies, please specify if N/A
Did you attach proof of your Income Tax Registration?                Y   N   N/A

1.12    TAX CLEARANCE CERTIFICATE *

Original of valid Tax Clearance Certificate must be supplied

Did you attach a valid Tax Clearance Certificate?                    Y   N   N/A

1.13    CIDB REGISTRATION #

CRS Registration No.
Current CIDB Grading

Not applicable to all companies, please specify if N/A
Did you attach proof of your CIDB Registration?                      Y   N   N/A

1.14    NHBRC REGISTRATION #


NHBRC Registration No.

Not applicable to all companies, please specify if N/A
Did you attach proof of Registration?                                Y   N   N/A




                                                  9
1.15    TRANSPORT OPERATORS #

PDP Permit No.

Not applicable to all companies, please specify if N/A
Did you attach a copy of your PDP Permit?                      Y     N     N/A

NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable

                               2. BUSINESS PARTICULARS *

2.1 Name of Business*




2.2 Physical address *



City                                                                Code
Province

2.3 Postal address *



City                                                                Code
Province

2.4 Telephone Number. *



2.5 Fax Number. *



2.6 Cell Number. *



2.7 E-Mail Address. *



2.8 Web-Page Address. *




                                                10
2.9 How would you like to receive your correspondence from us? *
Post               Fax               E-Mail


2.10 Correspondence Address *



City                                                                    Code
Province


NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable


Contact Person for correspondence as per 2.10
Title                    Name
Surname




                           3. SALES AND ACCOUNTS DEPARTMENT *

3.1 Sales Department *
Contact Name
Cell No
E-Mail Address
Telephone                                             Fax

3.1 Accounts Department *
Contact Name
Cell No
E-Mail Address
Telephone                                             Fax

                                4. CORE BUSINESS OPERATION *

(Mark with X in applicable fields)

        Prime Contractor        Sub-Contractor (Less than 25% gene-   Labour-only Contractor
                                rated turnover as prime contractor

        Supplier                  Manufacturer                        Labour Agency


        Professional Services     Education, Development &            Construction (CIDB)
                                  Training Service Provider



                                                 11
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable

Other, please specify ………………………………………………………………………………………

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


                            5. ANNUAL AVERAGE TURNOVER *


Indicate annual average turnover excluding Value Added Tax during the past three years:

R                                    .

                             6. FINANCIAL DETAIL (BANKING) *


Banking institution name

Branch

Town/City

Banking account number

Account type

Account holder’s name

NB. DOCUMENTARY PROOF OF BANKING INSTITUTION MUST BE SUPPLIED (Cancelled
Cheque/ Bank Statement)


                         7. PREVIOUS BUSINESS INFORMATION *

7.1      Did your business exist under a previous name?                        Yes        No
7.2      If Yes, what name did it trade under?

7.3      Previous business registration number?




                                                 12
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable


                                    8. BUSINESS INFORMATION *

The following table must be completed in order to establish whether a business can be classified
as an SMME in terms of the National Small Business Act 102 of 1996. Indicate the sector by
ticking the appropriate block in column 1.
Economic Sector                                   Type of Business
   Agriculture                                                ISO Listed
   Mining and Quarrying                                       Manufacturer
   Manufacturing                                              Distributor
   Electricity, Gas and Water                                 Sales
   Construction                                               Services
   Retail, Motor Trade and Repair Services                    Importer
   Wholesale Trade, Commercial gents & Allied Services        Exporter
   Catering, Accommodation & other Trade                      Repairer
   Transport, Storage and Communications
   Finance and Business Services
   Community, Social & Personal Services



                                         9. LABOUR BROKERS

Please answer the questions by marking the appropriate column with an “X”. Please do not leave
out any questions relating to your special circumstances.

1. Do you render service to TUT through a Company, Close Corporation or Trust?           Yes   No


2. Are you an Independent Contractor?                                                    Yes   No

3. Are you a Labour Broker?                                                              Yes   No
  (If yes = taxable unless IRP30 certificate is received. If no, see next questions)


4. Are the services personally rendered by a person who is a connected person            Yes   No
   (shareholder, member, trustee, beneficiary, relative of the afore-mentioned, etc.)
   in relation to the Company/Close Corporation or Trust?
  (If yes, see question 5, 6, 7, 8 and 9. If no = not subjected to employees tax)

5. Does the entity employ four or more employees. (other than shareholders, members      Yes   No
   or connected persons) who are on a full-time basis engaged in the business of
   rendering services to clients?
  (This implies that the tea lady and gardener would not be considered in determining
the full-time staff members rendering services to clients).


6. Would the person who is rendering the services be regarded as an “employee” of TUT? Yes     No


7. Is the person who is rendering the service subject to control or supervision of TUT   Yes   No
   as to the manner in which duties are performed or as hours of work?




                                                         13
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable

8. Do the amounts paid in respect of services rendered include earnings that are             Yes       No
   payable at regular, daily, weekly, monthly or other intervals? (This is normally on
   the basis that you charge your client for the person in question’s salary plus
   commission for your service?

9. Does the Company/Close Corporation or Trust, during its financial year, receive or        Yes       No
   anticipate to receive more than 80% of income for this specified service from TUT?
   (If yes to any of questions 6, 7, 8, or 9, then taxable, except if IRP30 certificate
   can be submitted.
   If no to all four questions (6, 7, 8 and () = Not subject to employees tax.


Subject to employees tax?                                                                    Yes       No


                                         10. HDI INFORMATION *

Explanation of abbreviations used in the tables to follow:

Capacity                    HDI Status
Director                D   HDI                 H
Partner                 P   Women               W
Member                  M   Disabled            D
Proprietor              R
Other                   O

Please note that proof of disability must be provided by a recognized institution and certified copies of such
certification needs to be attached to this application.

NB. CERTIFIED COPY OF SHAREHOLDER CERTIFICATES OR PROOF OF OWNERSHIP MUST BE
SUPPLIED       (Multiple copies of this page may be submitted if required)

10.1 Complete the following for the shareholders who are actively involved in the management and
daily business operation of the business

First Name

Surname

Identification Number
Percentage of Share                                                                                  %
Capacity                            Gender                HDI Status


Disabled (a permanent impairment of a physical, intellectual or sensory function resulting
In restricted or lack of ability to perform in a manner considered normal for a human being) Yes            No

                                                    th
Were you a South African citizen on or before 26 April 1994?
                                                                                               Yes          No

Are you actively involved in the management and the daily business operations
of the business                                                                                Yes          No
(Please provide a written breakdown e.g. company profile)




                                                         14
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable

First Name
Surname

Identification Number

Percentage of Share                                                                                %
Capacity                           Gender              HDI Status


Disabled (a permanent impairment of a physical, intellectual or sensory function resulting
In restricted or lack of ability to perform in a manner considered normal for a human being) Yes            No

                                                th
Were you a South African citizen on or before 26 April 1994?
                                                                                            Yes             No

Are you actively involved in the management and the daily business operations
of the business                                                                           Yes          No
(Please provide a written breakdown e.g. company profile)

First Name

Surname
Identification Number

Percentage of Share                                                                                %
Capacity                           Gender              HDI Status


Disabled (a permanent impairment of a physical, intellectual or sensory function resulting
In restricted or lack of ability to perform in a manner considered normal for a human being) Yes            No

                                                th
Were you a South African citizen on or before 26 April 1994?
                                                                                            Yes             No

Are you actively involved in the management and the daily business operations
of the business                                                                           Yes          No
(Please provide a written breakdown e.g. company profile)


             11. PREVIOUS CONTRACT OR TENDERING EXPERIENCE (Mark with X)

Do you have any previous contract work or tendering experience?
                                                                                          Yes          No

If yes, please complete the table below. List the last 2 contracts awarded to you (the tenderer) or
previous experience with other business related to the type of work or supply your are registering
for.

Employer/Department
Contact Person
Contact Number
Contract value in Rands                                        R                                   .

                                                     15
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable

Year awarded                                            Year completed/Still in Progress
Documentary proof attached
                                     Yes   No



Employer/Department
Contact Person
Contact Number
Contract value in Rands                                          R                                   .
Year awarded                                            Year completed/Still in Progress
Documentary proof attached
                                     Yes   No


In terms of section 37(2) of the Occupational health and Safety Act 1993 (Act85 of 1993) as
amended the mandatory (contractor) hereby acknowledges that he is an employer in his
own right. He undertakes to determine all risks associated with the work he is required to
perform and to determine and implement all cautionary measures to mitigate or remove
such risk. The mandatory will take all necessary steps to ensure compliance with the
Occupational Health and Safety Act 1993.

Where the mandatory is found not to comply with the requirements of the Occupational
Health and Safety Act the Tshwane University of Technology or its representative will be
able to stop the activities of the mandatory, without any cost to the University until such
time as the mandatory complies with the requirements of the Act.


   12. CERTIFICATION OF CORRECTNESS OF INFORMATION SUPPLIED IN THIS
                              DOCUMENT *


I/We the undersigned is/are duly authorized to do so on behalf of the firm, hereby certify that:

    1.        The information supplied is correct.
    2.        All copies of relevant information are attached.
    3.        The HDI points claimed are correct and based on owners/shareholders who are actively
              involved in the day to day management of the enterprise.
    4.        I take note that payment will be effected 30 days after delivery was effected if delivered with an
              original invoice.
    5.        If I am classified as a dependant service provider/labour broker as stated in the fourth
              schedule of the Income Tax Act I hereby authorize the University to deduct P.A.Y.E. and
              supply me with a yearly IPR 30 (only if no valid Labour Broker Certificate can be supplied).


    ……………………………………………………….                                       …………………………………………………
      Signature of authorized person                                     Date

    Personal information in block letters

    Name
    Surname




                                                      16
       Telephone No
       Capacity
       ON BEHALF OF
       (Supplier’s name)


       Signed and sworn to before me at ………………………………..on this the …………..day of
       ……………………………………………20…… by the Deponent, who has acknowledge that
       he/she knows and understands the contents of this Affidavit which is true and correct to the
       best of his/her knowledge and that he/she has no objection to taking the prescribed oath and
       that the prescribed oath will be binding on his/her conscience.


                             ……………………………………………………………….
                                    Commissioner of Oaths




                                TSHWANE UNIVERSITY OF TECHNOLOGY


                                          Private Bag X680
                                               Pretoria
                                                0001


  13. AUTHORISATION FOR ELECTRONIC TRANSFER OF FUNDS (EFT) TO
                    VENDOR’S BANK ACCOUNT


PLEASE COMPLETE IN BLOCK LETTERS

Surname/Company name
First Names/Company of Account Holder
Address


Telephone                                                 Fax
Mobile
E-mail
Bank
Branch
Bank Account
Branch Number
Type of Account        Cheque              Savings              Transmission



                                                     17
I, the undersigned hereby authorise the Tshwane University of Technology to credit my account
via EFT as afore mentioned with the amount payable/due to specified beneficiary for goods and
services rendered

Please note: That if a cancelled cheque is not attached, an official stamp should obtained from
the bank to confirm the information given above.

…………………………………………………………                                   ………………………………………………
       Signature                                                Date

          FOR USE OF BANK (In cases where a cancelled cheque is not attached)

Above information checked and confirmed.

Signature: ………………………………………… Bank Stamp:




           FOR OFFICE USE ONLY – TSHWANE UNIVERSITY OF TECHNOLOGY

Information confirmed and submitted for capturing on: ……………………………………………….

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




                                               18

								
To top