SUPPLIER REGISTRATION FORM

IMPORTANT NOTES

Please read carefully before completion of registration form

  • To be completed by all vendors seeking registration as an approved supplier.
  • The supplier registration form must be completed in full, and signed. Failure to complete the * mandatory fields, will lead to the application not being processed.
  • Please note that Registration on the Sentech Supplier Database does not guarantee business for your company. All procurement will be subjected to the procurement policy of Sentech.
  • Successful applicants will be contacted via fax and /or email, it is therefore imperative to submit an operating fax number and/or email address. Failure to comply with this requirement will result in your application not approved for registration in the database,
  • Only successful suppliers will be notified in writing if their application has been accepted.
  • No faxed or e-mailed application forms will be accepted.
  • Business blacklisted by any organs of state* must first be removed or cleared from blacklist before registration.
  • Copies of the following documents must be attached to this application form:
  • Original Valid Tax Clearance Certificate
  • Income Company Certificate or Shareholder(s) Register
  • Proof of Company Registration – CIPC
  • VAT Registration Certificate (for VAT vendor only)
  • ID Copy/ies for all company members/ partners/ directors
  • BEE Certificate or Letter from a registered Accountant
  • CIDB Number – applicable to construction related services
  • PSIRA Certificate – applicable to security related services
  • Proof of SETA AND OR SAQA accreditation – applicable to training related services
  • If members/ directors/ owners are employed by the state, proof that they are allowed to conduct business outside remunerative work should be attached

Completed registration forms and supporting documentation must be handed at Sentech Head Office, Radiokop Ext 3,Octave Street, Radiokop 2040 or post to Sentech SOC, Private bag X06, Honeydew, 2040
FOR OFFICE ONLY
Captured by
Date captured
Authorised by
Date Authorised

1. *SUPPLIER DETAILS:

SUPPLIER REGISTERED NAME
SUPPLIER TRADING NAME (if different from Registered Name)
COMPANY REGISTRATION NUMBER
COMPANY or FIRM INCOME TAX REFERENCE
VAT REGISTRATION NUMBER
TELEPHONE DATE
FACSIMILE NUMBER
PHYSICAL ADDRESS
POSTAL ADDRESS
POSTAL CODE

1.1Please confirm the attachment of the following mandatory documents.

YES / NO
*SARS – BUSINESS ENTITY TAX CLEARANCE CERTIFICATE
*COMPANY REGISTRATION CERTIFICATE

2. *CONTACT PERSON DETAILS:

Contact Name
Position
Telephone Number
Cellular Number
Facsimile Number
E-mail Address
Notification (E-mail or SMS)

3. *TYPE OF COMPANY/FIRM (Tick applicable box):

Individual /Sole Trader/Proprietor
Partnership / Consortium
Close corporation registered in terms of the SA Close Corporations Act
Public / Private company registered in terms of the SA Companies Act
Non Profit company registered in terms of the SA Companies Act
Trust as defined in the Income Tax Act
Cooperative Society as defined in the Co – Operatives Act
Government / State Owned Enterprise / Constitutional Entity
Other : (Specify)

4. *BANK DETAILS: (No Personal Account information)

Name Bank
Name of Branch
Branch Code
Name of Account Holder
Account Number
Cheque / Savings / Transmission / Bond
DATE STAMP OF BANK
CERTIFIED AS CORRECT
NB.Please ensure that your bank details have been verified by the bank, and also attach a cancelled Cheque or Bank acknowledgement letter.

Please have this page stamped at the bank

5. TO BE COMPLETED ONLY IF COMPANY/ FIRM IS A REGISTERED BUSINESS ENTERPRISE (Tick applicable box and complete relevant percentages)

Black Owned (At least 50.1%) / %
Black Enterprise (At least 25.1%) / %
Black Owned Women (At least 25.1%) / %
Other Women / %
Disabled Persons / %
SMME / %
Total / 100%

Note: Where owners are themselves a company or partners, owners of the holding firm must be identified. Certified ID copies of partners, members, shareholders or owners must be attached.

6. BBBEE CONTRIBUTION LEVEL

Please attach Scorecard. Exempted Enterprises please submit letter from Auditor confirming Exemption

B-BBEE Status / B-BBEE Recognition Level % / Mark with an (X)
Level 1 Contributor / 135%
Level 2 Contributor / 125%
Level 3 Contributor / 110%
Level 4 Contributor / 100%
Level 5 Contributor / 80%
Level 6 Contributor / 60%
Level 7 Contributor / 50%
Level 8 Contributor / 10%
Non – Compliant Contributor / 0%
Exempted Micro – Enterprise (EME)
Any enterprise with an annual total Revenue of R5million or less qualifies as an Exempted Micro Enterprise (EME).A start-up enterprise must be measured as an Exempted Micro-Enterprise for the first year following its formation or incorporation. Please submit confirmation letter from your Auditors/Accountant

6.1 SMME Status of your Enterprise: (Please tick the relevant box)

Micro
Very Small
Small
Medium
Large

7. *DIRECTORS / OWNERS DETAILS: (Complete table for each Director/Owner)

Director Name / ID Number / Position / Tel Number / Citizenship

8. *LIST A MAXIMUM OF FIVE (5) CONTRACTS, WHICH YOUR COMPANY HAS BEEN ENGAGED IN

CONTRACT DESCRIPTION / LOCATION / CLIENT / CONTRACT AMOUNT / COMPLETION DATE

9. COMMODITY CATEGORIES :( Please Select / Specify a maximum of Three (4) Commodity Categories (Mandatory) that you can supply from ANNEXURE A).

10. *INDICATE WETHER THE following mandatory documents are attached /submitted: (Mandatory)

General / Y/N
1. / Company Registration Documents
2. / Tax Clearance Certificate
3. / BBBEE Certificate
4. / Detailed Banking information
5. / Certified ID copies of all owners / shareholders

The undersigned warrants that he / she is duly authorised to do so on behalf of the Company, confirms that the contents of the application are within my personal knowledge and are to the best of my believe both true and correct.

11. DECLARATION:

Any legal person, including persons employed by Sentech, or persons having kinship with persons employed by Sentech including a blood relationship, may apply to register and or to submit a tender. However full disclosure of the particulars of the relationship is required in the interest of fairness and transparency, as indicated in this declaration of interest form.

11.1 Are you or any person connected with your organization employed by Sentech? YES/NO

If so, furnish particulars

……………………………………………………………………………………………

……………………………………………………………………………………………

11.2 Have you or any person in your organization been employed by Sentech over the past twelve months?

YES/NO

If so, furnish particulars.

……………………………………………………………………………………………..

……………………………………………………………………………………………..

11.3 Do you have any relationship (family, friend, partner or other) with persons employed by Sentech?

YES/NO

If so furnish particulars

……………………………………………………………………………………………

…………………………………………………………………………………………….

11.4 Are any of your company’s directors, managers, shareholders or stakeholders in service of the Sentech? YES/NO

If so, furnish particulars

…………………………………………………………………………………………….

…………………………………………………………………………………………….

11.5 Are any spouses, children or parents of the company’s directors, managers, shareholders or stakeholders in service of Sentech? YES/NO?

If so, furnish particulars

……………………………………………………………………………………………

By completing this application form, the firm declares that:

  • It agrees to conform to the requirements of the Supplier Register as set out in this document.
  • The firm agrees to abide by the Procurement Policy of Sentech
  • All the information supplied in this application is true and correct.
  • The firm will submit itself to procedures instituted by Sentech, without protest
  • The firm will supply further information and documentary evidence for scrutiny, if requested to do so.

Duly authorized to sign on behalf of:

Signature / Name / Capacity / Date

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12. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED

EASTERN AREA (NATAL)
Umhlanga Durban North (Head Office) / Mount Ayliff
Mooirivier / Straalhoek
Estcourt / Port Shepstone
Greytown / Matatiele
Radio Kwezi Link / Kokstad
Eshowe / Donnybrook
Empangeni / Durban(Alverst)
Richards Bay / Durban North
Glencoe / Pietermaritzburg
Newcastle / Overport
Ladysmith / Bluff
Loskop / Verulam
Vryheid / Dullstroom
Nongoma / Nelspruit
Ubombo / Lydenburg
Pongola / Hectorspruit
Louwsberg / Mbuzini
Nqutu / Sabie
Ulundi / Qudeni
Standerton / Volksrust
Ermelo / Piet Retief
Carolina / Davel
Middleburg / Howick
WESTERN AREA (Western Cape)
Cape Town(Constantia) / Worcester
Bn Table Mountain / Napier
Sea Point / Piketburg
Paarl / Matjiesfontein
Simonstown / Ceres
Franschhoek / Hex River
Hout Bay / Touwsrivier
Stellenbosch / Klipheuwel
Amanda Glen / Prieska
Tygerberg / Upington
Aurora / Douglas
Grabouw / Kuruman Hills
Clifton / Faans Grove
Fish Hoek / Kuruman
Villiersdorp / Montagu
Hermanus / Kleinmond

PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR ENTITY. FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE PROSPECTIVE SUPPLIERS APPLICATION.

SOUTHERN AREA (Eastern Cape)
Kareedouw / Komga
Port Elizabeth / Graaff-Reinet
P.E.City / Cradock
Despatch / Queenstown
Hankey / Elliot
Andrieskraal / Ugie
Patensie / Sterkspruit
Paul Sauer Dam / Victoria West
Parsons Hill / Noupoort
Grahamstown / Colesberg
Somerset East / Aliwal North
Suurberg / Barkley East
Kirkwood / Burgersdorp
Bedford / Elands Height
East London / De Aar
King Williams Town
Bisho
Butterworth
Cala
Umtata
Ngangelizwe
Port St.Johns
Entshatshongo
/ NORTHERN and CENTRAL AREA (TVL)
Welverdiend / Rustenburg
Potchefstroom / Pretoria
Johannesburg / Menlo Park
Heidelburg / Pretoria North
Bez.Valley / Sunnyside
Mondeor / Soshanguve
Mulbarton / Kwamhlanga
Helderkruin / Kwaggafontein
Linmeyer / Pilanesburg
Sentech Park / Garankuwa
Pankop / Grootfontein
Mabopane / Marks Park
Kagiso / Bedfordview
Mogwase / Nylstroom
Thlabane / Thabazimbi
Behanie / Haenertsberg
Maraisburg / Hoedspruit
Ga-Mabula / Tolwe
Potgietersrus / Blouberg
Tzaneen / Louis Trichardt
Punda Maria / Molema
Sibasa / Malamba

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