DannhauserMunicipality kzn254
8 Church Street Telephone : 034 621 2666
Private Bag X1011 Facsimile :034 621 3114
DANNHAUSERemail :
3080 email :
Service Provider Database
Original application must be completed and
Submitted to:
Enquiries:
Mr. Yusuf Nabee
Tel:034 621 2666
Fax: 034 621 2342 / 086 6900 882
Email :
No / Details / Service Provider Details1. / Business Name
2. / Type Of Business (Soletrader, Cc, Co)
3. / Registration No (Co & Cc or Co-operative)
4. / Date of Registration
5. / Vat Registration No
6. / Physical Address
7. / Postal Address
8. / Telephone No
9. / Fax No
10. / Email Address
11. / Website Address
12. / Tax Clearance Certificate
(Attach copy)
13. / Proof Of Rates & Service Changes been paid (Attach Copy)
14. / Satisfactory proof of Skills & Resources to execute the service to be rendered or supply of goods… (References/brochures etc. Company Profile to be attached)
Type of Business*
Please tick the appropriate block
Public Company LtdPrivate Company (Pty) Ltd
Close Corporation CC
Sole Proprietor
Partnership
Trust
Co-operative
Kindly attached signed letter of Authority by all members
Voluntary Associations
Previous Database Registration Number (if applicable)
*Please ensure to attach a certified copy of the document dependent on type,
e.g. Public Co, to attach certified copy of Incorporation.
Previous Business Information
Did your business exist under a previous name?
If “Yes”, what was the previous business Name:
Reasons for Name Change:
Previous Names of Owners, Partners, Members or Shareholders:
Name / TitleBusiness Information
*Please indicate you appropriate Sector
AgricultureMining & Quarrying
Manufacturing
Electricity, Gas & Water
Construction
Retail, Motor Trade & Repair
Wholesale Trade, Commercial
Catering, Accommodation, Other
Transport & Storage
Finance & Business Services
Community, Social and Personal
Proprietors / Shareholders / Partners / Sole Proprietors / Trustees / Owners
Please list all owners (as listed above) and where applicable, provide proof of disability by a recognised related institution. If insufficient space, kindly attach a copy of this page signed by the person who signs on behalf of the business.
NAME / ID NO / DISABILITY INSTITUTION / SHAREHOLDING
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Full Name / ID No / SA CitizenYes / No / SA Citizen before 27.04.1994 / Capacity (Member, Partner etc) / % ownership/ Partner ship/trust/ interest / Male/ female / Handi
capped
Y/N / HDI
Yes/
No / Race
(W/ B/
I / C/
Other) / % of time
Devoted to
firm
Employee Details: (Make a copy and attach if more space is required)
Full Name / ID No / SA CitizenYes / No / SA Citizen before 27.04.1994 / Designation (Member, Partner etc) / % ownership/ Partner ship/trust/ interest / Male/ female / Handi
capped
Y/N / HDI
Yes/
No / Race
(W/ B/
I / C/
Other) / % of time
Devoted to
firm
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Annexure 1 (PLEASE ENSURE THAT YOU LIST 1 MAIN CATEGORY)
Dannhauser municipality kzn 254
Supply chain management database category list
Construction
Air conditioning systemsElectrical Contractors
Alarm/Security systems/Access controlEvacuation systems
AutodavosFencing
Automatic hanger doorsGeneral Building Work
Automatic Sliding DoorsGlazing
Automatic Sprinkle Fire Protection SystemsHauling/Heavy Equipment/Transport
Brickwork/ MasonryHot water Installations
Cabinet/Furniture MakingIncinerators
Carpeting/Tiling/Floor coveringLandscaping/Earthworks
Ceilings, partitioning & ShopfittingLift & Escalator Equipment
Cladding contractsMechanical Contracts
Cooking & related systemsMetalwork & Burglar Bars
Compressed Air installationsPainting
Concrete worksPaving
DemolitionPlastering
Plumbing
Precast concrete Manufacture
Pumping Installations
Road marking & signage
Roadworks & Cleaning
Roofing & Waterproofing
Sewage Installation/Reticulations
Steam Installations & Ancillary Equipment
Steel fabrication & Erection
Storm-water draining
Water installations/reticulations
Other (specify) ______
Services
AccommodationHorticultural Services
Advertising/Public RelationsHV Fault finding, Joining, Terminations
Auto Repairs & ServicesInsurance/Employee benefits
Auto Electrical & Hydraulic RepairsInterior/Industrial Design
BookkeepersIT Maintenance
Carpet CleaningIT Management
Catering/Vending/Food SupplyIT Networking
Cleaning ServicesIT Programming
Computer Supplies/ServicesLaundry service/Dry Cleaning
Corporate Gifts/ClothingLocksmith services
CopywritingMedia Liaison
Courier ServicesMailing/Courier Services
Cleaning Equipment/MaterialsMedical/Ambulance/Health Care
Diesel & Petrol EnginesMunicipal Services
Debt CollectionMedical Equipment/Instruments
DistributionOffice Maintance
Digging of GravesPersonnel Service
Educational ServicesPest Removal Service
EntertainmentPerformance Management
Fire extinguishers & refillsPrinting/Photography/Graphic Design
Fire HydrantsPromotional Materials
Food & BeveragePublishing
Funeral ServicesReal Estate
FloristRadio Publicity / TV Publicity
Garden ServicesRoad Maintance
Handy manRecruitment Agencies
Safety & Security servicesSafety & Security Access control
Servicing HV & LV switchgear/TransformersSite Cleaning
Solid Waste DisposalTelephone & Data Line Maintance
Training & Development
Other (Specify)______
______
______
Professional Services
Accountants/Financial Advisory ServicesOHS Consultants
ArchitectsOrganisational Development Consultants
Attorneys/Legal ServicesPharmacies
Archival Services ConsultantsPre-employments Assess. Consultants
Business Information ManagementProject Managers
Consulting Engineers (Geotechnial)Quantity Surveyors
Consulting Engineering (civil/structure)Statisticians
Consulting Engineers (Electrical)Teachers
Consulting Engineers (Mechanical)Town Planners
Consulting Engineers (Multidisciplinary)Training Providers
ContractorsTranslation Services
EDMS ConsultantsEAP Consultants
EconomistsMedical Practioners
Industrial Relations ConsultansJob Description Consultants
Legal Compliance ConsultantsLand Surveyors
Other (Specify) ______
______
______
wholesalers / Traders
Automotive partsFire Extinguisher
Air Pollution Measuring EquipmentFire Protection & Detection
BooksFloor Coverings
Building Materials & HardwareFood Supplies
BatteriesFertilisers
CleaningSupplies/Chemicals/PesticidesFuel Supplies
ClothingFurniture
Computer Equipment & SoftwareFencing
CurtainsFood for game animals
ConsumablesGenerating sets
Domestic Appliances & GroceriesHealth Safety & Environmental Supply
Electrical Supplies & EquipmentIT Hardware & Software
Industrial Catering EquipmentLinen, Pillows & Blankets
Laundry EquipmentMedical Supplies & Equipment
MedicinesNGO’s / NBO’s
Office ConsumablesOffice Equipment
Paint SuppliesPaper & Stationery
Recreational SuppliesRefrigeration & Air Conditioning
Refuse Bulk ContainersProtective Clothing / Uniforms
Radio / Radio EqipmentSupply plants, flowers & Seeds
Toilet paper wrapped / UnwrappedTraffic Signs/Materials
VehicleWorkshop Equipment
Vehicles, Equipment, trailers & tractors
Other (Specify)______
______
______
Annexure 2 – Certified Banking Details Form
This form needs to be completed and certified by the appropriate Banking Institute and attached to the registration Form.
Name of Banking Institute:______
Branch Name______
Branch Code______
Town/City______
Bank Account Number______
Name of Account Holder______
Name under which the account is operated, this needs to be same as business name
Type of account e.g. cheque______
BANK STAMP
Received & Stamped By ______
(Name in Block letters)
Signature ______
Date ______
Annexure 3 – Required Documentation check list
Please ensure that all listed documentation below is attached (where applicable) to the registration form
ALL documentation to be provided in its original format
DOCUMENT NAME / ATTACHEDOriginal Tax Clearance Certificate
Company Registration Certificate
Company Resolution of Signatories
Original / Certified copy of “Letter of Good Standing” from Workmen’s Compensation Commissioner or its Agent
Most recent municipal accounts for your business location or your personal residence account i.e. rates, water, refuse, electricity (if applicable) levy confirmation registration letter.
Financial Documentation
Staff Listing
OWNER / OWNERS DETAILS
SURNAME:______
FIRST NAME/S:______
ID NO:______
PHYSICAL ADDRESS:______
______
POSTAL ADDRESS:______
______
TEL NO:______
CELL NO:______
FAX NO:______
EMAIL ADDRESS:______
OWNERS BANKING DETAILS:
1.Correct Account Name:______
2.Name of Bank:______
3.Branch Code:______
4.Account Number:______
5.Type of Account:______
e.g. cheque, current, savings
Verification of information supplied relating to references that the Applicants / Business may apply for.
I/We, the undersigned, who warrants that I/we are duly authorised to do so on behalf of the supplier, certifies that the information supplied in terms of this documentation including the Annexure(s) with additional information, is correct and accurate and acknowledges that:-
- The supplier will be required to furnish documentary proof of the information relating to preferences, if required to do so.
- If the information supplied is found to be incorrect, then DannhauserMunicipality may, in addition to any other remedies it may have:
- Disqualify the supplier/contractor for a particular bid/contract/project it may be considered for, or which had been awarded to the supplier/contractor;
- Recover from the supplier/contractor for all costs, losses or damages incurred or sustained by DannhauserMunicipality as a result of breach of contract;
- Cancel the contract and claim any damages which DannhauserMunicipality may suffer by favourable arrangements after such cancellation and / or;
- De-register the supplier registered on the Supplier Database
SIGNED ON THIS ______DAY OF ______20______
AT: ______
______
Name of RepresentativeSignature of Authorised Representative
______
Suppliers Name
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