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 – 6383800
FAX : 036 – 6314146
FOR OFFICE USE:
Suppliers Name :Registration No :
Captured By : Date :
Approved By : Date :
1 / Mnambithi TVET College-SCM-Database Form November 2015
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/NO
Documents
Original certified copies of Identity Documents of shareholders
Valid SARS Tax Clearance Certificate (Original documents only)
CK1–Certificate of incorporation/CK2–Close Corporation (Certified)
Original or Certified Proof of Residence
ICT Service Accreditation certificate (if applicable)
Training Institution (SETA Accreditation Certificate)
Company profile
Valid Board-Base Black Economic Empowerment (BBBEE) Certificate
Copy of Bank Statement (not older than 3 months) or cancelled cheque
Construction Industry Development Board Registration Certificate (CIDB)
PSIRA Certificates if applicable
VAT Registration Document
Workman’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 SUPPLIERPlease 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.
1.1REGISTERED 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 CODE1 / Mnambithi TVET College-SCM-Database Form November 2015
1.12 CONTACT PERSON (Full name) AND DESIGNATION:
DESIGNATION1.13 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 a
copy 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 CATEGORIESVENDOR TYPE AND SERVICE CATEGORIES
Please indicate yourService Type by marking the appropriate box with an X.
Code / Service Type / X / Code / Service Type / X
Cons / Consultant / Supp / Supplier
Cont / Contractor
Service 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 / Catering
102 / Building materials / 502 / Cleaning and Gardening Services
103 / Electrical materials / 503 / Conference & Event Management
104 / Plant hire equipment / 504 / Courier
105 / Plumbing / 505 / General Maintenance
200 / Construction Services / X / 506 / Laundry and Dry Cleaning
201 / Civil / 507 / Pest Control
202 / Electrical / 508 / Photographic & Graphic Design
203 / Mechanical / 509 / Printing
300 / Professional Services / X / 510 / Security and Safety
301 / Accounting, Auditing,Financial / 511 / Transport ( buses / minibuses )
302 / Architectural and Quantity Surveying / 600 / Office and Facilities Supplies / X
303 / Arts and Culture / 601 / Audio Systems
304 / Auctioneering / 602 / Clothing and Corporate gifts
305 / Consulting Civil Engineer / 603 / Fire protection equipment
306 / Consulting Electrical Engineer / 604 / Groceries
307 / Consulting Geo- technical Engineer / 605 / IT – hardware/ software
308 / Consulting Mechanical Engineer / 606 / Office Furniture and equipment
309 / Fire and Safety / 607 / Stationery
310 / GIS and Mapping and Data Collection / 700 / Vehicles / X
311 / Occupational Health& Safety / 701 / Alarms and tracking systems
312 / Land and Property Valuers / 702 / Mechanical repairs Maintenance
313 / Land Surveying / 703 / Electrical repairs & maintenance
314 / Legal Services / 704 / Panel Beating
315 / Recruitment / 705 / Spares and parts
316 / Town and Regional Planners / 706 / Towing
317 / Training and Development / 707 / Vehicle dealership& Fleet
318 / Translation and Interpretation / 800 / Other / X
400 / Miscellaneous Supplies / X / 801
601 / Functions Equipment Hire / 802
602 / Sports / 803
1 / Mnambithi TVET College-SCM-Database Form November 2015
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 column
- Sector
(millions) / 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 / 0.1
Mining & 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 / 0.1
Construction / 200 / 50 / 20 / 5 / 20 / 5 / 2 / 0.15 / 4 / 1 / 0.4 / 0.1
Retail & 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 / 0.1
Personal 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
1 / Mnambithi TVET College-SCM-Database Form November 2015
- Select (X) where relevant
Micro
Very small
Small
Medium
Large
- 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
- HDI Ownership Status:
(Failure to complete this section will result in the application being declined)
HDI Status / %Previously Disadvantage Individuals
Women Equity
Disabled
Youth
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:
______
1 / Mnambithi TVET College-SCM-Database Form November 2015SECTION 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 PURCHASEIMPORTANT 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 affectedand 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. Inasmuch 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 MurchisonSt.
LADYSMITH
3370
1 / Mnambithi TVET College-SCM-Database Form November 201512. NB: No deliveries will be accepted outside delivery hours, unless prior arrangements are made with the College, who can be contacted at:
CENTRAL OFFICE: 0366383800
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: REFERENCESLIST 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 AWARDEDPROJECT NAME / INSTITUTION NAME / AWARD AMOUNT / REFERENCE NAME AND CONTACT / DATE AWARDED
PROJECT NAME / INSTITUTION
NAME / AWARD AMOUNT / REFERENCE NAME
AND CONTACT / DATE AWARDED
PROJECT NAME / INSTITUTION NAME / AWARD AMOUNT / REFERENCE NAME AND CONTACT / DATE AWARDED
PROJECT NAME / INSTITUTION NAME / AWARD AMOUNT / REFERENCE NAME AND CONTACT / DATE AWARDED
PROJECT NAME / INSTITUTION NAME / AWARD AMOUNT / REFERENCE NAME AND CONTACT / 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: DECLARATIONI 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 STAMP1 / Mnambithi TVET College-SCM-Database Form November 2015