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1 Mnambithi TVET College-SCM-Database Form November 2015

SUPPLIER DATABASE APPLICATION FORM

HAND DELIVER TO:

PROCUREMENT UNIT MNAMBITHI TVET COLLEGE CENTRAL OFFICE 77 MURCHISON STREET LADYSMITH 3370

OR POST TO:

PROCUREMENT UNIT MNAMBITHI TVET COLLEGE PRIVATE BAG X 9903 LADYSMITH 3370

ALL ENQUIRIES TO BE DIRECTED TO: PROCUREMENT UNIT TELEPHONE: 036 – 638 3800 FAX : 036 – 631 4146

FOR OFFICE USE:

Suppliers Name :

Registration No :

Captured By : Date :

Approved By : Date :


IMPORTANT NOTES:

Please read carefully To be completed by all vendors seeking registration as an approved supplier. Form must be completed in full and must be signed. Suppliers must comply with registration criteria for registration to be finalised, failure to do so

may result in the application being declined. Suppliers will not be notified whether the application was accepted or not but will be advised

of the outcome if telephonically requested. Documents must be hand delivered at or posted to the above address. Faxed documents will

not be accepted. Only black pen to be used.

SUBMISSION OF DOCUMENTATION

The following documents must accompany your application: Please indicate with YES/NODocuments Original certified copies of Identity Documents of shareholdersValid SARS Tax Clearance Certificate (Original documents only)CK1–Certificate of incorporation/CK2–Close Corporation (Certified)Original or Certified Proof of ResidenceICT Service Accreditation certificate (if applicable)Training Institution (SETA Accreditation Certificate)Company profileValid Board-Base Black Economic Empowerment (BBBEE) CertificateCopy of Bank Statement (not older than 3 months) or cancelled chequeConstruction Industry Development Board Registration Certificate (CIDB)PSIRA Certificates if applicableVAT Registration DocumentWorkman’s Compensation Document

The form consists of sections A to H. Section A, B, C, D, E, and G & H must be completed in full and submitted together with all required substantiating documentation as outlined above in order for the application to be considered.

SECTION A - PARTICULARS OF THE SUPPLIER

SECTION B - BANKING DETAILS

SECTION C - SERVICE TYPE AND CATEGORIES

SECTION D - SMME STATUS OF THE ENTERPRISE

SECTION E - SAFETY

SECTION F - CONDITIONS OF PURCHASE

SECTION G - REFERENCES

SECTION H - DECLARATION


SECTION A: PARTICULARS OF THE SUPPLIER

Please note that all information will be treated confidentially.

Where a supplier is a joint venture the individual members of the venture are to separately provide their information.

1.1 REGISTERED NAME OF THE SUPPLIER:

1.2 TRADING NAME:

1.3 TYPE OF ORGANISATION :( please mark with an X)

PTY ( Ltd)

CC Sole Trader Section 21

Public Co.

Other (Specify)

1.4 COMPANY REGISTRATION NUMBER:

1.5 INCOME TAX REGISTRATION NUMBER:

1.6 VAT REGISTRATION NUMBER:

1.7 UIF REGISTRATION NUMBER:

1.8 PAYE NUMBER:

1.9 CONSTRUCTION INDUSTRY DEVELOPMENT BOARD REGISTRATION NUMBER (CIDB):

1.10 COMPENSATION COMMISSIONER REGISTRATION NUMBER:

1.11 BUSINESS PHYSICAL ADDRESS: BUSINESS POSTAL ADDRESS:

POSTAL CODE POSTAL CODE


1.12 CONTACT PERSON (Full name) AND DESIGNATION:DESIGNATION

1.13 CONTACT DETAILS: EMAIL :

TELEPHONE NUMBER:

CELL NUMBER:

FAX NUMBER:

SECTION B: BANKING DETAILS

BANK ACCOUNT TO WHICH PAYMENTS ARE TO BE MADE

NAME IN WHICH ACCOUNT IS HELD: _________________________________________________________NAME OF BANK: ___________________________________________________________________________BRANCH: _________________________________________________________________________________

BANK CLEARING NUMBER:

ACCOUNT NUMBER :

ACCOUNT TYPE: ………………………………………………

Important: Please ensure that you have included a certified copy of your identification and acopy of a cancelled cheque or bank statement as per the documents required.

BEFORE RETURNING, THIS SECTION MUST BE COMPLETED BY YOUR BANK

I/We confirm that the above information on the clients account at this bank is correct.

______________________ Bank Stamp:

Signed on behalf of Bank

_____________________ Name


_____________________Capacity

SECTION C: SERVICE TYPE AND CATEGORIES

VENDOR TYPE AND SERVICE CATEGORIES Please indicate your Service Type by marking the appropriate box with an X.

Code Service Type X Code Service Type X

Cons Consultant Supp Supplier

Cont ContractorService providers may choose MAXIMUM OF 3 (three) categories by marking the appropriate box with an X.

*If more than 3 services are indicated, only the first three will apply** If your service is not indicated, write it clearly under “OTHER”

100 Construction Equipment And Supplies X 500 General Services X

101 Construction Equipment 501 Catering102 Building materials 502 Cleaning and Gardening Services103 Electrical materials 503 Conference & Event

Management104 Plant hire equipment 504 Courier105 Plumbing 505 General Maintenance200 Construction Services X 506 Laundry and Dry Cleaning201 Civil 507 Pest Control202 Electrical 508 Photographic & Graphic Design203 Mechanical 509 Printing300 Professional Services X 510 Security and Safety301 Accounting, Auditing, Financial 511 Transport ( buses / minibuses )302 Architectural and Quantity Surveying 600 Office and Facilities Supplies X303 Arts and Culture 601 Audio Systems304 Auctioneering 602 Clothing and Corporate gifts305 Consulting Civil Engineer 603 Fire protection equipment306 Consulting Electrical Engineer 604 Groceries307 Consulting Geo- technical Engineer 605 IT – hardware/ software308 Consulting Mechanical Engineer 606 Office Furniture and equipment309 Fire and Safety 607 Stationery310 GIS and Mapping and Data Collection 700 Vehicles X311 Occupational Health& Safety 701 Alarms and tracking systems312 Land and Property Valuers 702 Mechanical repairs Maintenance313 Land Surveying 703 Electrical repairs & maintenance314 Legal Services 704 Panel Beating315 Recruitment 705 Spares and parts316 Town and Regional Planners 706 Towing317 Training and Development 707 Vehicle dealership& Fleet318 Translation and Interpretation 800 Other X


400 Miscellaneous Supplies X 801601 Functions Equipment Hire 802602 Sports

803


SECTION D: SMME STATUS OF YOUR ENTERPRISE

Please use this table to determine the SMME status of your enterprise. Please select (X) the relevant box in each columnA. Sector B.

Full time employees

C.Annual Turnover(millions)

D.Total Gross asset value(property excluded)

Medium Small Very Small

Micro Medium Small Very Small

Micro Medium Small Very Small

Micro

Agriculture 100 50 10 5 4 2 0.4 0.15 4 2 0.4 0.1Mining & Quarying

200 50 20 5 30 7.5 3 0.15 18 4.5 1.8 0.1

Manufacturing 200 50 20 5 40 10 4 0.15 15 3.75 1.5 0.1Construction 200 50 20 5 20 5 2 0.15 4 1 0.4 0.1Retail & Motor Trade

100 50 10 5 30 15 3 0.15 5 2.5 0.5 0.1

Wholesale trade

100 50 10 5 50 25 5 0.15 8 4 0.5 0.1

Catering, Accommodation

100 50 10 5 10 5 1 0.15 2 1 0.2 0.1

Transport, Storage

100 50 10 5 20 10 2 0.15 5 2.5 0.5 0.1

Finance, Business, Consultancy

100 50 10 5 20 10 2 0.15 4 2 0.4 0.1

Repair/Allied Services

100 50 10 5 30 15 3 0.15 5 2.5 0.5 0.1

Communications 100 50 10 5 20 10 2 0.15 5 2.5 0.5 0.1Personal Services

100 50 10 5 10 5 1 0.15 5 2.5 0.5 0.1

Commercial Agents

100 50 10 5 50 25 5 0.15 8 4 0.5 0.1

Community & Social Services

100 50 10 5 10 5 1 0.15 5 2.5 0.5 0.1

Other Trade 100 50 10 5 20 10 2 0.15 5 2.5 0.5 0.1


A. Select (X) where relevant

MicroVery smallSmallMediumLarge

B. List all board members (in case of a cooperative) and partners, proprietors and shareholders for all other companies (compulsory)

Name Position Occupied Citizenship ID Number

C. HDI Ownership Status:

(Failure to complete this section will result in the application being declined)

HDI Status %Previously Disadvantage IndividualsWomen EquityDisabledYouth

Declaration of any conflict of interest

I/we the undersigned acknowledge(s) that:

:The information furnished is true and correct:The equity ownership claimed is in accordance with the general conditions:Any conflict of interest will be declared in the comment space below

SIGNATURE OF OWNER OR AUTHORISED REPRESENTATIVE:

________________________________________________

_______________________________________________DATE

COMMENTS:

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


SECTION E: SAFETY

Do you conduct your business in compliance with the requirement of the Occupational Health and Safety Act? (OHS Act No. 85 of 1993) (Yes / NO)…………………………………………………………………….

Are you registered and in good standing with the Compensation Commissioner? (Compensation for Occupational Injuries and Diseases Act No. 130 of 1993) YES / NO..............................

If YES, Please attach a copy of a valid letter of Good Standing. Please note that this is compulsory for all maintenance and building contractors.

(Note: Failure to provide a valid letter of Good Standing when required will result in your Tender not being considered).

SECTION F: CONDITIONS OF PURCHASE

IMPORTANT CONDITIONS PERTAINING TO PURCHASE ORDERS

1. The Seller shall bear the risk of goods being damaged, lost or destroyed until delivery to the College is affected and receipt thereof acknowledged.

2. The Seller shall make provision for suitable packing and preservation in all quotations. Unless otherwise stated all packing containers and packing material shall become the property of the College upon delivery.

3. Unless otherwise stated, all goods shall be new and of the best quality. Goods shall be subject to approval by the College at all times. The Seller shall not be released from its obligations in respect of suitability of the materials and / or the quality of the goods by reason of the fact that the College made no objection, even though the said goods may have been inspected by the College or by reason of the fact that delivery thereof was taken by or on behalf of the College.

4. Should the Seller be unable to fulfil its obligations in terms of the order, it shall advise the College to this effect in writing, in which case the College reserves the right to cancel the order and to purchase the goods from another supplier. The Seller may be obligated to compensate the College for any differences in cost.

5. In as much as delivery of the goods may require the Seller or its authorized agent to enter the College premises, the Seller shall ensure that such precautions as are necessary to protect life and property anywhere on the College premises are taken, and the Seller shall be liable to the College for injury to any person, or damage to College property caused by or incidental upon negligence or default on the part of the Seller or its authorized agent.

6. College order number and VAT number must appear on the delivery note and invoice. Any invoices and delivery notes without an order number will be ignored and returned to your company. Invoices without order numbers are seen as private agreements with individuals.

7. No alteration to an order may be made without the written approval of the Purchasing Division (Mnambithi TVET College).

8. Part deliveries will be accepted only under exceptional circumstances. Payment thereof will be made only when ALL goods/services have been delivered. Part payment can be made ONLY in exceptional cases and must be requested in writing by the supplier.

9. The College reserves the right to cancel any order in the event where the goods or services are not delivered by the agreed date.

10. It is a College requirement that all prospective Suppliers must complete a Supplier Database Application form in full to be registered on its database.

11. All invoices must be forwarded to the address below:

Mnambithi TVET College Central Office No. 77 Murchison St.LADYSMITH3370


12. NB: No deliveries will be accepted outside delivery hours, unless prior arrangements are made with the College, who can be contacted at:

CENTRAL OFFICE: 036 638 3800

DELIVERY TIMES: Monday to Thursday - 07:30 to 16:00 and Friday 07:30 – 13:00

13. Should the supplier accept the order, or should the order not be returned within 10 days of the date thereof, it shall be assumed that the conditions as set out in the paragraphs above are binding.

14. Payment will be made within thirty days after receipt of invoice/ and statement.

SECTION G: REFERENCES

LIST AT LEAST TWO COMPLETED PROJECTS AND THEIR CONTACTABLE REFERENCE. (LIST PER EACH TYPE OF SERVICE REGISTERED FOR)

PROJECT NAME

INSTITUTION NAME

AWARD AMOUNT

REFERENCE NAME AND CONTACT

DATE AWARDED

PROJECT NAME

INSTITUTION NAME

AWARD AMOUNT


DATE AWARDED

PROJECT NAME

INSTITUTIONNAME

AWARD AMOUNT

REFERENCE NAMEAND CONTACT

DATE AWARDED

PROJECT NAME

INSTITUTION NAME

AWARD AMOUNT


DATE AWARDED

PROJECT NAME

INSTITUTION NAME

AWARD AMOUNT


DATE AWARDED

PROJECT NAME

INSTITUTION NAME

AWARD AMOUNT


DATE AWARDED

NB: A supplier can attach additional references per service type. References will be contacted, thus inaccurate contact details or poor service delivery may be used as valid grounds for registration being declined.


SECTION H: DECLARATION

I THE UNDERSIGNED HEREBY DECLARE THAT THE INFORMATION GIVEN IN THIS DOCUMENT IS TO THE BEST OF MY KNOWLEDGE TRUE, AND CORRECT IN EVERY RESPECT.

Full names of owner or supplier representative: ____________________________________________ _________________________________________________________________________________________________Signature: _________________________________ Date: ________________________________

Signed at: _________________________________________________________________________

Supplier name: _____________________________________________________________________

SIGNED AND AFFIRMED BEFORE ME (COMMISSIONER OF OATHS):

Full name: ________________________________________________________________________

_________________________________ _________________________________Signature Date

_____________________________________________________________________Capacity _______________

OFFICIAL STAMP