SUPPLIER REGISTRATION FORM

______

TO BE COMPLETED BY POTENTIAL SERVICE PROVIDERS SEEKING REGISTRATION ON THE FP&M SETA’S SUPPLIER DATABASE

Notes:

  1. This questionnaire to be completed by applicant seeking registration in full. If you are unable to complete specific sections or not be prepared to divulge certain information required, kindly advice reasons in a covering letter when returning this questionnaire. Failure to comply may result in the application not being considered.
  2. If called upon arrangements must be made for officials of the FP&M SETA to inspect the company’s premises and documents to assess the technical competency before the company is accepted.
  3. A company profile must accompany the registration form but will not be accepted as a substitute for the application form – all fields on the application form must be completed.
  4. It should be noted that if any information supplied be found to be incorrect, the FP&M SETA reserves the right to exclude the supplier from the Supplier Database at any time prior to or after acceptance.
  5. Completed documents should be posted, couriered or hand-delivered to:

SCM ManagerSCM Manager

FP&M SETAFP&M SETA

P O Box 31276Forum 1b, 2nd floor

BraamfonteinBraampark office park

2017Braamfontein

Johannesburg

2000

  1. It should be noted that the FP&M SETA reserves the right to accept or reject any application without being obliged to give reasons in this respect.
  2. It is the responsibility if the supplier to inform the FP&M SETA of any changes in respect of the company’s details.
  3. No wording or information on this original document is allowed to be amended/deleted as it will invalidate the application.
  4. Information provided will be treated as confidential.
  5. Thank you for your interest in FP&M SETA

For official Use Only
Supplier Code: ______
BBBEE %: ______
Captured by: ______
Approved by: ______
  1. COMPANY/SUPPLIER DETAILS

Legal name of company:
Trading name of company:
Income Tax Reference Number:
Vat registration Number:
Company Registration Number:
Close Corporation Registration Number:
Number of full time employees
  1. ADDRESS DETAILS

Postal address of company (Compulsory)

Physical address of company (Compulsory)

  1. CONTACT DETAILS

Business Telephone

Home Telephone

Fax Number (Compulsory)

Cellphone Number

Web Address

Email Address

Toll Free Number

Main Contact Person in your organization

Name
Company Position
Cell Phone Number
Fax Number
Email Address

Contact Person responsible for sales in your organization

Name
Company Position
Cell Phone Number
Fax Number
Email Address
  1. BANKING DETAILS

Banking details of the supplier

Bank Name
Branch Name
Branch Code
Account Holder
Bank Account Number
Account Type
  1. COMPANY OWNERSHIP

Suppliers are required to submit a certified copy of a BBBEE certificate or the original BBBEE certificate issued by a SANAS approved certification agency or IRBA registered Auditors to be allocated BBBEE points.

Suppliers making a total revenue of less than R5 000 000.00 a year may submit a letter from an accountant or auditor stating the BBBEE status of the supplier. The letter must have the accountant’s or auditor’s practice number.

A trust, consortium or joint venture, will qualify for points for their B-BBEE status level as a legal entity, provided that the entity submits their B-BBEE status level certificate.

A trust, consortium or joint venture will qualify for points for their B-BBEE status level as an unincorporated entity, provided that the entity submits their consolidated B-BBEE scorecard as if they were a group structure and that such a consolidated B-BBEE scorecard is prepared for every separate bid.

Tertiary institutions and public entities will be required to submit their B-BBEE status level certificates in terms of the specialized scorecard contained in the B-BBEE Codes of Good Practice.

A person will not be awarded points for B-BBEE status level if it is indicated in the bid documents that such a bidder intends sub-contracting more than 25% of the value of the contract to any other enterprise that does not qualify for at least the points that such a bidder qualifies for, unless the intended subcontractor is an EME that has the capability and ability to execute the sub-contract.

A person awarded a contract may not sub-contract more than 25% of the value of the contract to any other enterprise that does not have an equal or higher B-BBEE status level than the person concerned, unless the contract is sub-contracted to an EME that has the capability and ability to execute the sub-contract.

B-BBEE Status Level of
Contributor / Number of points
(80/20 system)
1 / 20
2 / 18
3 / 16
4 / 12
5 / 8
6 / 6
7 / 4
8 / 2
Non-Compliant Contributor / 0

NAMES OF ALL OWNERS, DIRECTORS, SHAREHOLDERAND/OR MEMBERS AND THEIR RESPECTIVE DESIGNATIONS

Names of Owners and Members / Designation / Identity Number

Attach registration documents and shareholders agreements

  1. LIST OF COMMODITIES

(Please add a category and a code from the category listing below)

a) Procurement and Administration:
  • Office cleaning (PA1)
  • Printing (PA2)
  • Travel services (PA3)
  • Courier services (PA4)
  • Stationery (PA5)
  • Catering (PA6)
  • Office maintenance (PA7)
  • Office furniture (PA8)
  • Security Services (PA9)
  • Conference facilities (PA10)
  • Off-site Corporate storage facilities (PA11)
  • Audit services (PA12)
  • Legal services (PA 13)
  • Strategic planning (PA14)
  • Insurance Services (PA 15)
  • Taxation (PA 16)
  • Cleaning chemicals and supplies (PA17)
  • Protective Clothing (PA 18)
  • Furniture removal (PA 19)
  • Other related services (PA20)
/ b) Human Resources:
  • Recruitment and placement (HR1)
  • Job evaluation consultants (HR2)
  • Legal compliance consultants (HR3)
  • Salary benchmarks and surveys (HR4)
  • Dispute resolution experts, qualified mediators and arbitrators (HR5)
  • Business processes specialists (HR6)
  • Organisational development HR 7)
  • Labour Broking Services (HR 8)
  • Other related services (HR8)
/ c) Marketing and Public Relations:
  • Advertising (MPR1)
  • Corporate gifts (MPR2)
  • Corporate Clothing (MPR3)
  • Special events/functions (MPR4)
  • Event management (MPR5)
  • Media services (MPR6)
  • Design and layout (MPR7)
  • Video and related services (MPR8)
  • Editorial services (MPR9)
  • Sound and Music System / Equipment hire (MPR 10)
  • Embroidery (MPR 11)
  • Promotional items (MPR 12
  • Photographic Services (MPR 13)
  • Printing and Binding (MRP 14)
  • Other related services (MPR15)

d) Information Technology:
  • Telephone/PABX maintenance (IT1)
  • IT software & hardware suppliers (IT2)
  • IT maintenance (IT3)
  • Data warehousing (IT4)
  • Website development and maintenance (IT5)
  • Computer cable installation and maintenance (IT6)
  • Computer Network installation and maintenance (IT7)
  • Data Management Services (IT8)
  • Information retrieval systems (IT9)
  • Internet Services (IT10)
  • Management Information System (IT11)
  • Uninterrupted Power Supply (UPS) supply, maintenance and service (IT12)
  • Other related services (IT13)
/ e) Research & Analysis:
  • Economic and social research (RA1)
  • Labour Market analysis (RA2)
  • Monitoring and evaluation (RA3)
  • Sector specific research (RA4)
  • Other related services (RA5)
/ f) Training Provision:
  • Learnership Development Providers (TP1)
  • Resource and Materials Developers (TP2)
  • Curriculum and Learning Programme Designers (TP3)
  • Assessors and moderators (TP4)
  • Training providers in all SETA sectors across existing qualifications and scarce skills identified in the FP&M Sector (TP5)
  • Financial Management (PFMA & Supply Chain Management) (TP6)
  • Other related services (TP7)

Choose a maximum of two categories of goods and/or services you want to be listed under, you may list categories of goods/services that are not listed in the database registration form

Provide at least three references related to your business (if applicable)

Client / Contact Person / Contact Number / e-mail address / Contract Value

I,…………………………………………….…. (Print name) hereby certify that the information, facts and representatives are correct and that I am duly authorised to sign on behalf of the company.

______

Signature Date

Please attach the following documents:

Tick with X /
  • Valid original Tax Clearance Certificate

  • Company registration document

  • Broad-Based Black Economic Empowerment Certificate certified as true copy of the original (if applicable)

  • SETA Registration Information (if applicable)

  • Company Profile

  • Copy of ID(s) of owners or Directors

  • SBD 4

  • SBD 8

  • SBD 9

  1. SUPPLIER GROUPING DETAIL: TYPE OF FIRM: (Please  the relevant box)

1 Public Company (Ltd)
2 Private Company (Pty) Ltd
3 Close Corporation (cc)
4 Other (specify)
5 Joint Venture
6 Consortium
7 Sole Proprietor
8 Foreign Company
9 Partnership
10 Trust
11 Section 21 Company
12 Government / Parastatal
  1. SMME STATUS OF YOUR ENTERPRISE:

Please use this table to determine the SMME status of your enterprise

Please the relevant box in each column

A. Sector / B. Full time paid employees / C. Annual Turnover (millions) / D. Total Gross asset value
(property excluded) (millions)
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 and Quarrying / 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 and 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 and Business Services / 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
Other Trade / 100 / 50 / 10 / 5 / 10 / 5 / 1 / 0.15 / 2 / 1 / 0.2 / 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
Personal Services / 100 / 50 / 10 / 5 / 10 / 5 / 1 / 0.15 / 5 / 2.5 / 0.5 / 0.1

SMME status of your enterprise: (Please the relevant box)

(According to SMME table) (Compulsory)

Micro
Very small
Small
Medium
Large

BID DECLARATION

Bidders who claim points in respect of B-BBEE Status Level of Contribution must complete the following:

B-BBEE STATUS LEVEL OF CONTRIBUTION CLAIMED IN TERMS OF TABLEABOVE

B-BBEE Status Level of Contribution: …………. = ……………(maximum of 20 points)

(Points claimedmust be in accordance with the tablereflected above and must be substantiated by means of a B-BBEEcertificate issued by a Verification Agency accredited by SANAS or a RegisteredAuditor approved by IRBA or an Accounting Officer as contemplated in the CCA).

  1. SUB-CONTRACTING

Will any portion of the contract be sub-contracted? YES / NO (delete which is notapplicable)If yes, indicate:

(i) What percentage of the contract will be subcontracted?...... ……………….…%

(ii) The name of the sub-contractor?…………………………………………………………..

(iii) The B-BBEE status level of the sub-contractor? ……………..

(iv) Whether the sub-contractor is an EME? YES / NO (delete which is notapplicable)

  1. Declaration of applicants past Supply Chain Management practices

SBD 4

DECLARATION OF INTEREST

1.Any legal person, including persons employed by the state¹, or persons having a kinship with persons employed by the state, including a blood relationship, may make an offer or offers in terms of this invitation to bid (includes a price quotation, advertised competitive bid, limited bid or proposal). In view of possible allegations of favouritism, should the resulting bid, or part thereof, be awarded to persons employed by the state, or to persons connected with or related to them, it is required that the bidder or his/her authorised representative declare his/her positionin relation to the evaluating/adjudicating authority where-

-the bidder is employed by the state; and/or

-the legal person on whose behalf the bidding document is signed, has a relationship with persons/a person who are/is involved in the evaluation and or adjudication of the bid(s), or where it is known that such a relationship exists between the person or persons for or on whose behalf the declarant acts and persons who are involved with the evaluation and or adjudication of the bid.

2.In order to give effect to the above, the following questionnaire must be completed and submitted with the bid.

2.1Full Name of bidder or his or her representative: …………………………………………………….

2.2Identity Number: …………………………………………………………………………………………

2.3Position occupied in the Company (director, trustee, shareholder²): ……………………………..

2.4Company Registration Number: ………………………………………………………………..…….

2.5Tax Reference Number: ……………………………………………………………………….………

2.6VAT Registration Number: …………………………………………………………………………....

2.6.1The names of all directors / trustees / shareholders / members, their individual identity numbers, tax reference numbers and, if applicable, employee / persal numbers must be indicated in paragraph 3 below.

¹“State” means –

(a)any national or provincial department, national or provincial public entity or constitutional institution within the meaning of the Public Finance Management Act, 1999 (Act No. 1 of 1999);

(b)any municipality or municipal entity;

(c)provincial legislature;

(d)national Assembly or the national Council of provinces; or

(e)Parliament.

²”Shareholder” means a person who owns shares in the company and is actively involved in the management of the enterprise or business and exercises control over the enterprise.

2.7 Are you or any person connected with the bidder YES / NO

presently employed by the state?

2.7.1If so, furnish the following particulars:

Name of person / director / trustee / shareholder/ member: ……....………………………………

Name of state institution at which you or the person

connected to the bidder is employed : ………………………………………

Position occupied in the state institution: ………………………………………

Any other particulars:

………………………………………………………………

………………………………………………………………

………………………………………………………………

2.7.2If you are presently employed by the state, did you obtainYES / NO

the appropriate authority to undertake remunerative

work outside employment in the public sector?

2.7.2.1If yes, did you attached proof of such authority to the bidYES / NO

document?

(Note: Failure to submit proof of such authority, where

applicable, may result in the disqualification of the bid.

2.7.2.2If no, furnish reasons for non-submission of such proof:

…………………………………………………………………….

…………………………………………………………………….

…………………………………………………………………….

2.8Did you or your spouse, or any of the company’s directors / YES / NO

trustees / shareholders / members or their spouses conduct

business with the state in the previous twelve months?

2.8.1If so, furnish particulars:

…………………………………………………………………..

…………………………………………………………………..

…………………………………………………………………...

2.9Do you, or any person connected with the bidder, haveYES / NO

any relationship (family, friend, other) with a person

employed by thestate and who may be involved with

the evaluation and or adjudication of this bid?

2.9.1If so, furnish particulars.

……………………………………………………………...

…………………………………………………………..….

………………………………………………………………

2.10 Are you, or any person connected with the bidder,YES/NO

aware of any relationship (family, friend, other) between

any other bidder and any person employed by the state

who may be involved with the evaluation and or adjudication

of this bid?

2.10.1If so, furnish particulars.

………………………………………………………………

………………………………………………………………

………………………………………………………………

2.11Do you or any of the directors / trustees / shareholders / members YES/NO

of the company have any interest in any other related companies

whether or not they are bidding for this contract?

2.11.1If so, furnish particulars:

…………………………………………………………………………….

…………………………………………………………………………….

…………………………………………………………………………….

3Full details of directors / trustees / members / shareholders.

Full Name / Identity Number / Personal Tax Reference Number / State Employee Number / Persal Number

4DECLARATION

I, THE UNDERSIGNED (NAME)………………………………………………………………………

CERTIFY THAT THE INFORMATION FURNISHED IN PARAGRAPHS 2 and 3 ABOVE IS CORRECT.

I ACCEPT THAT THE STATE MAY REJECT THE BID OR ACT AGAINST ME IN TERMS OF PARAGRAPH 23 OF THE GENERAL CONDITIONS OF CONTRACT SHOULD THIS DECLARATION PROVE TO BE FALSE.

………………………………….. ..……………………………………………

Signature Date

………………………………….………………………………………………

Position Name of bidder

SBD 8

DECLARATION OF BIDDER’S PAST SUPPLY CHAIN MANAGEMENT PRACTICES

1This Standard Bidding Document must form part of all bids invited.

2It serves as a declaration to be used by institutions in ensuring that when goods and services are being procured, all reasonable steps are taken to combat the abuse of the supply chain management system.

3The bid of any bidder may be disregarded if that bidder, or any of its directors have-

  1. abused the institution’s supply chain management system;
  2. committed fraud or any other improper conduct in relation to such system; or
  3. failed to perform on any previous contract.

4In order to give effect to the above, the following questionnaire must be completed and submitted with the bid.

Item / Question / Yes / No
4.1 / Is the bidder or any of its directors listed on the National Treasury’s Database of Restricted Suppliers as companies or persons prohibited from doing business with the public sector?
(Companies or persons who are listed on this Database were informed in writing of this restriction by the Accounting Officer/Authority of the institution that imposed the restriction after the audi alteram partem rule was applied).
The Database of Restricted Suppliers now resides on the National Treasury’s website() and can be accessed by clicking on its link at the bottom of the home page. / Yes / No
4.1.1 / If so, furnish particulars:
4.2 / Is the bidder or any of its directors listed on the Register for Tender Defaulters in terms of section 29 of the Prevention and Combating of Corrupt Activities Act (No 12 of 2004)?
TheRegister for Tender Defaulters can be accessed on the National Treasury’s website () by clicking on its link at the bottom of the home page. / Yes / No
4.2.1 / If so, furnish particulars:
4.3 / Was the bidder or any of its directors convicted by a court of law (including a court outside of the Republic of South Africa) for fraud or corruption during the past five years? / Yes / No
4.3.1 / If so, furnish particulars:
4.4 / Was any contract between the bidder and any organ of state terminated during the past five years on account of failure to perform on or comply with the contract? / Yes / No
4.4.1 / If so, furnish particulars:

SBD 8

CERTIFICATION

I, THE UNDERSIGNED (FULL NAME)…………………………………………………

CERTIFY THAT THE INFORMATION FURNISHED ON THIS DECLARATION FORM IS TRUE AND CORRECT.

I ACCEPT THAT, IN ADDITION TO CANCELLATION OF A CONTRACT, ACTION MAY BE TAKEN AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE.

………………………………………...…………………………..

Signature Date

……………………………………….…………………………..

PositionName of Bidder

Js365bW

SBD 9

CERTIFICATE OF INDEPENDENT BID DETERMINATION

1This Standard Bidding Document (SBD) must form part of all bids¹ invited.

2Section 4 (1) (b) (iii) of the Competition Act No. 89 of 1998, as amended, prohibits an agreement between, or concerted practice by, firms, or a decision by an association of firms, if it is between parties in a horizontal relationship and if it involves collusive bidding (or bid rigging).² Collusive bidding is a pe se prohibition meaning that it cannot be justified under any grounds.

3Treasury Regulation 16A9 prescribes that accounting officers and accounting authorities must take all reasonable steps to prevent abuse of the supply chain management system and authorizes accounting officers and accounting authorities to:

a.disregard the bid of any bidder if that bidder, or any of its directors have abused the institution’s supply chain management system and or committed fraud or any other improper conduct in relation to such system.

b.cancel a contract awarded to a supplier of goods and services if the supplier committed any corrupt or fraudulent act during the bidding process or the execution of that contract.

4This SBD serves as a certificate of declaration that would be used by institutions to ensure that, when bids are considered, reasonable steps are taken to prevent any form of bid-rigging.

5In order to give effect to the above, the attached Certificate of Bid Determination (SBD 9) must be completed and submitted with the bid:

¹ Includes price quotations, advertised competitive bids, limited bids and proposals.

² Bid rigging (or collusive bidding) occurs when businesses, that would otherwise be expected to compete, secretly conspire to raise prices or lower the quality of goods and / or services for purchasers who wish to acquire goods and / or services through a bidding process. Bid rigging is, therefore, an agreement between competitors not to compete.

SBD 9

CERTIFICATE OF INDEPENDENT BID DETERMINATION

I, the undersigned, in submitting the accompanying bid:

______

(Bid Number and Description)

in response to the invitation for the bid made by:

______

(Name of Institution)

do hereby make the following statements that I certify to be true and complete in every respect:

I certify, on behalf of:______that:

(Name of Bidder)

  1. I have read and I understand the contents of this Certificate;
  2. I understand that the accompanying bid will be disqualified if this Certificate is found not to be true and complete in every respect;
  3. I am authorized by the bidder to sign this Certificate, and to submit the accompanying bid, on behalf of the bidder;
  4. Each person whose signature appears on the accompanying bid has been authorized by the bidder to determine the terms of, and to sign the bid, on behalf of the bidder;
  5. For the purposes of this Certificate and the accompanying bid, I understand that the word “competitor” shall include any individual or organization, other than the bidder, whether or not affiliated with the bidder, who:

(a) has been requested to submit a bid in response to this bid invitation;