Chief Albert Luthuli Municipality – Database Form

Chief AlbertLuthuliMunicipality Supplier Database

2013/14

Application for Registration to a Database for Emerging Service Providers

Free of Charge

The Chief Albert Luthuli Municipalityis developing a vendor database whichwill assist with request for quotation (RFQ’S)

This form must be completed and returned to the following address:

Supply Chain Management

Chief Albert Luthuli Municipality

28Kerk Street

Carolina

1185

Contact: 017-8434000

Please complete the form fully – use a black pen.

Please print so that all information is legible.

Forms that are not readable or incomplete will berejected.

NAME OF ORGANISATION/FIRM______

PLEASE KEEP COPIES OF REGISTRATION FORM AND ALLDOCUMENTATION SUBMITTEDFOR

YOUR OWN RECORDS AS NO COPIESWILL BE MADE BY THE COUNCIL

2

FOR OFFICE USE ONLY

VENDOR NUMBER

POINTS TO REMEMBER

COMPLETING THE CHIEF ALBERTLUTHULIMUNICIPALITY VENDOR REGISTRATION APPLICATION FORM

  • Mandatory fields – Certain fields and documents are mandatory to certain business types only. Please ensure thatall fields mandatory to your business type, which are marked as “Mandatory Field”, have been completed, and if afield 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 mandatorysupporting documentation required by 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 fieldsblank.
  • Certified Documents – Please ensure that a Commissioner of Oaths has certified your Company RegistrationDocument, Proof of Shareholding Certificates. The stamp of certification should be on the front of thedocument.
  • 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 percentages of ownership amount to 100% and thatevery field is completed for each of the business owners.
  • Holding Companies & Trusts – Please contact the Chief Albert Luthuli Municipality on (T) 017-843 4000should your business be owned by a holding company or a trust to request an alternative point 9.
  • Certification of Correctness – Please ensure that the Certification of Correctness is signed and dated once allrequired documents and information have been submitted.
  • Collection points – Completed registration forms and supporting documentation can be delivered to the addresson the registration form.
  • Processing of registration – Your completed registration will be processed, and, once verified, will be approvedand you will be issued with a Supplier Database Registration Code to be used in all future communication with allof the above role players. This letter of verification will be dispatched to the correspondence details supplied onthe third page. Please note that this administration process will take a minimum of 5 days. Once your registrationhas been included on the Chief AlbertLuthuli Supplier Database your details will be accessible to the Chief AlbertLuthuliMunicipality
  • Business Opportunities – Please note that registration on the Chief Albert Luthuli Supplier Database does not guaranteebusiness opportunities.
  • Amendments – Please notify the Chief AlbertLuthuliMunicipality immediately of any changes to theverified information submitted.
  • Queries – Should you have any queries or if you require assistance completing the registration form, pleasecontact Chief AlbertLuthuliMunicipality on (T) 017-8434000.
  • If a company has more than one office, each office must fill in a separate form, unless the point of transaction iscentralised in the company’s head office.
  • Please note that the key facilities in the database are classified as commodities and each potential vendor mustindicate the commodity/commodities in which it would like to register for RFQ’s. (See list p5).
  • The main objective of this process is to enhance transparency and equality on the part of the Council and tofacilitate effective communication with its vendors.
  • Applications must be delivered by hand and must be fully completed with all the relevant documentation attached.
  • Please note that inclusion of the name in a database does not in any way guarantee any persons, company,service provider vendor, etc. any business from the Chief Albert Luthuli Municipality. All procurementwill be subject to the Procurement Policy of the Chief AlbertLuthuliMunicipality.
  • It’s a condition of bidding that a vendor’s taxes must be in order, or satisfactory arrangements must have beenmade with the Receiver of Revenue to meet his/her tax obligations. In bids where consortia/joint ventures/subcontractors are involved, each party must submit a separate Tax Clearance Certificate.

4

PLEASE KEEP COPIES OF REGISTRATION FORM AND ALL DOCUMENTATION SUBMITTED

FOR OFFICIAL PURPOSES ONLY

Name of Business
Registration No.
DOCUMENTS REQUIRED / BUSINESS TYPE / WHERE TO GET DOCUMENTS
Sole
Proprietor / Close
Corporations
and Private
Companies / Partnerships / Public
Company / Business
Trust / Non Profit
Organizations
(NPO)
Company
Registration
CERTIFIED COPIES / N/A / Certificate of
incorporation
CK1 / CK2 / Partnership
Agreement / Certificate of
Incorporation
CM3 / Trust
agreement / Certificate of
Incorporation
Section 21 / Registrar of Close
Corporations &
Companies
Proof of
Ownership
CERTIFIED COPIES / N/A / Certificate of
incorporation
CK1 / CK2 / Partnership
Agreement / Shareholding
CM3 / Trustees details:
Letter of
Authority / Auditor's
letter - no
shareholding / Registrar of Close
Corporations &
Companies
Proof of Banking / Bank statement/
cancelled
cheque / Bank statement/
cancelled
cheque / Bank statement/
cancelled
cheque / Bank statement/
cancelled
cheque / Bank statement/
cancelled
cheque / Bank statement/
cancelled
cheque / Branch of bank
where account
is held
Income Tax / For the
owner or the
business / For the
company/cc / For the
Partnership / For the
company / For the trust / For the NPO / Receiver of
Revenue
(SARS)
Tax Clearance
Certificate / For the
owner or the
business / For the
company/cc / For the
Partnership / For the
company / For the trust / For the NPO / Receiver of
Revenue
(SARS)
P.A.Y.E / If staff are
employed / If staff are
employed / If staff are
Employed / If staff are
employed / If staff are
employed / If staff are
employed / Receiver of
Revenue
(SARS)
VAT Registration / If registered
for VAT / If registered
for VAT / If registered
for VAT / If registered
for VAT / If registered
for VAT / If registered
for VAT / Receiver of
Revenue
(SARS)
U.I.F Certificate / If staff are
employed / If staff are
employed / If staff are
Employed / If staff are
employed / If staff are
employed / If staff are
employed / Department
of Labour
Workman’s
Compensation / If staff are
employed / If staff are
employed / If staff are
Employed / If staff are
employed / If staff are
employed / If staff are
employed / Department
of Labour
Security
Officer’s Board / If applicable
- for security
industry / If applicable
- for security
industry / If applicable
- for security
Industry / If applicable
- for security
industry / If applicable
- for security
industry / If applicable
- for security
industry / Security Service
Industry Regulatory
Authority
Proof of
Disability / If owner is
disabled / If owner is
disabled / If owner is
Disabled / If owner is
disabled / If owner is
disabled / If owner is
disabled
Proof of Identity / Clear Copy of
Identity
Document / Clear Copy of
Identity
Document / Clear Copy of
Identity
Document / Clear Copy of
Identity
Document / Clear Copy of
Identity
Document / Clear Copy of
Identity
Document
CONTACT DETAILS
Registrar of Close Corporations & Companies
ZanzaBuilding, 116 Proes Street, Pretoria
086 184 3384 / Chief AlbertLuthuliMunicipality
28 KERK Street, Carolina
017-8434000
Receiver of Revenue (SARS)
c/o Schoeman & v.d. Walt Street, P.O. Box 436 Pretoria 0001
012 317 2000 / Department of Labour (U.I.F. certificates)
94 Church Street, Pretoria
012 337 1802
Department of Labour (Workman’s Compensation)
Compensation House, CnrHamiltonSoutpansberg Rd,
Pretoria
012 319 9111 / Security Service Industry Regulatory Authority
481 Belvedere Street, Arcadia
012 337 5500

PLEASE NOTE:

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

Commodity group
(Please tick relevant boxes) / Description of commodity group / Commodity group
(Please tick relevant boxes) / Description of commodity group
0001 / Printing & Stationery / 0036 / Risk management
0002 / Catering Services / 0037 / Fleet management
0003 / Office Furniture / 0038 / Plant Hire
0004 / Air conditioning supply / 0039 / Consultants
0005 / Special Events / Functions, Stage, sound and multi-media / 0043 / Legal Services
0007 / Financial Management
0008 / Tax consultants and Accounting consultants
0010 / Asset management
0011 / Debt collection
0013 / Training and development
0014 / Computer Hardware & Software Supplies a
0015 / IT professionals
0016 / Registered quantity surveyor
0017 / Contractors (registered CIDB)
0018 / Environmental Consulting
0019 / Town & regional planner
0021 / Waste management
0022 / LED strategy
0023 / Air quality & climate change
0024 / Fire uniform and protective clothing
0025 / Fire equipments
0026 / Car dealers
0027 / Transport Service
0030 / Security Services
0031 / Building renovations
0032 / Cleaning services
0033 / Land Survey
0034 / Social researchers
0035 / Forensic audit

NB: All fields marked with are mandatory. All fields marked with are mandatory only if applicable

Documents attached / Please tick box
Y / N / NA
Workman’s Compensation Certificate (Certified)
Regional Council/District Registration (Certified)
VAT 103 (Certified)
P.A.Y.E. / SDL / UIF (EMP 103) (Certified)
Company Registration Document (Certified)
Proof of Ownership / Shareholder certificate (Certified)
B-BBEE Verification Certificate
Tax Clearance Certificate (Original)
Proof of Banking Document
Disability Documents (Certified)
Security Officer’s Board Registration (Certified)
Municipal Account for the current month
Labour Broker

Please Note: Proof of documents for all of the above are required to ensure successful registration on the Supplier Database. In the event ofa document not being required please tick the N/A box. Please refer to Page 4 for detailed information with regard to documents required.

  1. COMPANY REGISTRATION DOCUMENTS

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

COMPANY TYPE(NB Documentary Proof of registration must be provided)

PUBLIC COMPANY LTD / CERTIFIED COPY OF CERTIFICATE OF INCORPORATION (CM 3)
PRIVATE COMPANY (PTY) LTD / CERTIFIED COPY OF CERTIFICATE OF INCORPORATION (CM 3)
CLOSE CORPORATION CC / CERTIFIED COPY OF CK 1 DOCUMENT OR CK 2 IF APPLICABLE
PARTNERSHIP / PARTNERSHIP AGREEMENT
BUSINESS TRUST / CERTIFIED COPY OF REGISTRATION DOCUMENT
OTHER (If Joint Venture) / CERTIFIED COPY OF REGISTRATION DOCUMENT
Company or CK number
Income Tax No.
VAT Registration No.
Have you attached your Company Registration document? / Y / N / NA
Have you attached proof of shareholders documents?
Have you attached proof of banking document (Cancelled cheque/letter from bank)? 
Have you attached your tax clearance document?
Have you attached your B-BBEE Verification document?
Have you attached your Workman’s Compensation document?
Have you attached your Security Officers Board Registration document?
Have you attached your proof of disability document?

NB: All fields marked with are mandatory. All fields marked with are mandatory only if applicable

  1. BUSINESS PARTICULARS

2.1 Name of Business 

2.1.1 Physical address

City / Code
Province

2.1.2 Postal address

City / Code
Province

2.1.3 Telephone No.

2.1.4 Fax No.

2.1.5 Cell No.

2.1.6 E-mail Address

2.1.7 Web-Page Address

Contact Person for correspondence 

Title / Name
Surname

NB: All fields marked with are mandatory. All fields marked with are mandatory only if applicable

9

  1. SALES AND ACCOUNTS DEPARTMENTS

3.1 Sales Department

Contact Name
Cell No.
Email address
Telephone / Fax

3.2 Accounts Department

Contact Name
Cell No.
Email address
Telephone / Fax

4.1 CORE BUSINESS OPERATION

(Mark with X in applicable fields)

Prime Contractor / Sub-contractor (less than 25% generated turnover as prime contractor / Labour-only Contractor
Supplier / Manufacturer / Labour Agency
Professional Services / Education, Development & training Service Provider / Construction (CIDB)

Other, please specify: ______

4.2 ANNUAL AVERAGE TURNOVER

R

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

NB: All fields marked with are mandatory. All fields marked with are mandatory only if applicable

5. FINANCIAL DETAILS (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)

6. PREVIOUS BUSINESS INFORMATION

6.1 Did your business exist under a previous name? / Y / N
6.2 If yes, what name did it trade under?
6.3 Previous business registration number?

7. BUSINESS INFORMATION

The following table must be completed in order to establish whether a business can be classified as an SMME interms 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 / Sales
Construction / Services
Retail, Motor Trade and Repair Services Importer
Wholesale Trade, Commercial Agents & Allied Services Exporter / Importer
Exporter
Catering, accommodation & other Trade / Repairer
Transport, Storage and Communications / SMME Status
Finance and Business Services Small / Small
Community, Social & Personal Services / Medium
Micro
Established

NB: All fields marked with are mandatory. All fields marked with are mandatory only if applicable

8. LABOUR BROKERS

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

1. Do you render the service to the CHIEF ALBERTLUTHULIMUNICIPALITY through a Company, Close Corporation or Trust? / Y / N
2. Are you an Independent Contractor / Y / N
3. Are you a Labour Broker?
If yes = taxable unless IRP30 certificate is received. If no, see next questions) / Y / N
4. Are the services personally rendered by a person who is a connected person (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 subject to employees tax) / Y / N
5. Does the entity employ four of more full-time employees. (Other than shareholders, members 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). / Y / N
6. Would the person who is rendering the service be regarded as an “employee” of the CHIEF ALBERTLUTHULIMUNICIPALITY? / Y / N
7. Is the person who is rendering the service subject to the control or supervision of the CHIEF ALBERTLUTHULIMUNICIPALITY as to the manner in which duties are performed or as hours of work? / Y / N
8. Do the amounts paid in respect of services rendered include earnings that are 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.) / Y / N
9. Does the Company/Close Corporation or Trust, during its financial year, receive or anticipate to receive more than 80% of the income for this specified service from the CHIEF ALBERT LUTHULI MUNICIPALITY?
If yes to any one of questions 6,7,8, or 9, then taxable, except if an IRP30 certificate can be submitted.
If no to all four questions (6,7,8, and 9) = Not subject to employees tax. / Y / N
Subject to employees tax / Y / N

NB: All fields marked with are mandatory. All fields marked with are mandatory only if applicable

9. HDI INFORMATION

Explanation of abbreviations used in the following tables:

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

Proof of disability provided by a recognised institution in the case ofhandicapped persons must be supplied.

NB: CERTIFIED COPY OF SHAREHOLDER CERTIFICATES OR PROOF OF OWNERSHIP MUST BE SUPPLIED

Multiple copies of this page may be submitted if required.

9.1 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 share / %
Capacity / D / P / R / M / O / Gender / M / F / HDI Status / H / W / D
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) / Y / N
Were you a South African citizen on or before the 26th of April 1994? / Y / N
Are you actively involved in the management and daily business operations of the business?
(Please provide a written breakdown e.g. company profile) / Y / N
12First name
Surname
Identification number
Percentage share / %
Capacity / D / P / R / M / O / Gender / M / F / HDI Status / H / W / D
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) / Y / N
Were you a South African citizen on or before the 26th of April 1994? / Y / N
Are you actively involved in the management and daily business operations of the business?
(Please provide a written breakdown e.g. company profile) / Y / N

NB: All fields marked with are mandatory. All fields marked with are mandatory only if applicable

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

Do you have any previous contract work or tendering experience? / Y / N

If yes, please complete the table below. List the last 2 contracts awarded to you (the tenderer) or previous

experience with other businesses related to this type of work or supply.

Employer/Department
Contact Person
Contact Number
Estimated Contract Value in Rands
R
Year Awarded / Year Completed / Still in Progress
Proof documents attached? / Y / N
Employer/Department
Contact Person
Contact Number
Estimated Contract Value in Rands
R
Year Awarded / Year Completed / Still in Progress
Proof documents attached? / Y / N

In terms of section 37(2) of the Occupational Health and Safety Act 1993 (Act 85 of 1993) asamended the mandatory (contractor) hereby acknowledges that he is an employer in his ownright. He undertakes to determine all risks associated with the work he is required to performand to determine and implement all cautionary measures to mitigate or remove such risk. Themandatory will take all necessary steps to ensure compliance with the Occupational Healthand Safety Act 1993.

Where the mandatory is found not to comply with the requirements of the OccupationalHealth and Safety Act the CHIEF ALBERT LUTHULI MUNICIPALITY or its representative will be able to stop the activities of themandatory, without any cost to the CHIEF ALBERT LUTHULI MUNICIPALITY, until such time as the mandatory complies withthe requirements of the Act.

1314

NB: All fields marked with are mandatory. All fields marked with are mandatory only if applicable

11. CERTIFICATION OF CORRECTNESS OF INFORMATION SUPPLIED IN THIS DOCUMENT