1
Ehlanzeni TVET College
2017
DATABASE REGISTRATION FORM 2017
REF NO: ETVETC/2016/2/1–CORPORATE CENTRE
NAME OF SERVICE PROVIDER:
COMPANY NAMEFOR OFFICIAL PURPOSE
SUPPLIER NUMBER
APPLICATION ACCEPTED / APPLICATION REJECTEDREASON IF REJECTED
Captured By:
Signature:
Date:
Ehlanzeni TVET College
2017
SUPPLIER/SERVICE PROVIDER APPLICATION FORM
IMPORTANT NOTES
Please read carefully
To be completed by all applicant seeking registration as an approved supplier;
The questionnaire must be completed in full and be signed;failure to do so will result in the application being declined.
A company profile may accompany the registration form but will not be accepted as substitute for the application form – all fields on application form MUST be completed by the applicant;
Applicants will be contacted via fax and email and must therefore submit an operating fax number and email address: failure to comply will result in excluding the suppliers from the data base;
It should be noted that Ehlanzeni TVET College reserves the right to accept or reject any application without being obligated to give any reasons in this respect;
A maximum of THREE (3)commoditiesmust be reflected on the application form. Reflecting more that three commodities will nullify the application.
Supplier must comply with all the registration – criteria for registration to be finalised – failure to do so will result in the application being declined; and
A company registration certificate MUST be included in the application package.
Only ORIGINALapplication forms will be processed. Any document that has been retyped or redrafted will be disregarded and returned to the applicant.
Only documents with an ORIGINAL signatures must be submitted. All signatures to the document must be commissioned by an authorized Commissioner of Oath. Failure to do so will result in the applicant not qualifying for registration
A Proof of disability provided by a recognised related institution in the case of handicapped persons must be supplied
SuppliersInformation:
Company / Supplier Name:Company / Close Corporation Registration No.
Income Tax Reference (SARS) Number
VAT Registration Number (if applicable)
Web Address
Email Address
Telephone Address / Code:
Fax Number (compulsory) / Code:
CSD Supplier Number
Number of full-time employees
Ehlanzeni TVET College 2017
Postal Address(compulsory) Physical Address (compulsory)
Postal Code: / Street Code:Main contact person in your company
Name of contact personCompany Position
Cell Phone Number / Code:
Fax Number / Code:
Email Address
Previous Experience (IF Applicable)If insufficient space, kindly attach a separate copy of the previous experience signed by the same person who signs on behalf of the business
Company Name / Contact Person / Tel. Number / Contract Value in Rand / Completed SuccessfullyYes / No / Year
Company / Supplier Classification: (Please tick the relevant box or boxes)
ISOListed / Importer / Services / Manufacturer / Repairer / Distributor / Exporter / Sales
(Please tick the relevant box)
Tax Clearence Certificate Attached / Yes / NoExpiry date:
Supplier Grouping Details: Type of Firm. Please tick the relevant box
1 / Public Company (Ltd) / 8 / Sole Proprietor2 / Private Company (Pty) (Ltd) / 9 / Foreign entity
3 / Close Corporation (cc) / 10 / Partnership
4 / Co-operative / 11 / Trust
5 / Joint Venture / 12 / Consortium
6 / Section 21 Company / 13 / Other (specify)
7 / Government / Parastatal
Ehlanzeni TVET College
2017
List all persons who are OWNERS in the business /trust, and indicate their involvement in the management /operations of the business /trust SMME status of your enterprise:
Please use this table to determine the SMME status of your enterprise
Please tick the relevant box in each column
- Sector
- Full time paid employees
- Annual Turnover (millions)
- 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
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
Catering / 100 / 50 / 10 / 5 / 10 / 5 / 1 / 0.15 / 2 / 1 / 0.2 / 0.1
Accommodation / 100 / 50 / 10 / 5 / 10 / 5 / 1 / 0.15 / 2 / 1 / 0.2 / 0.1
Transport / 100 / 50 / 10 / 5 / 20 / 10 / 2 / 0.15 / 5 / 2.5 / 0.5 / 0.1
Finance & 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 / 20 / 5 / 1 / 0.15 / 2 / 1 / 0.2 / 0.1
SMME status of your enterprise: (Please tick the relevant box)
(According to SMME table) (Compulsory)
MicroVery Small
Small
Medium
Large
Ehlanzeni TVET College
2017
Points awarded for B-BBEE Status Level of Contribution
In terms of Regulation 5 (2) and 6 (2) of the Preferential Procurement Regulations, preferencepoints must be awarded to a bidder for attaining the B-BBEE status level of contribution inaccordance with the table below:
B-BBEE Status Level ofContributor (Attach Proof) / 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
Bidders who qualify as EMEs in terms of the B-BBEE Act must submit a certificate issued by an
Accounting Officer as contemplated in the CCA or a Verification Agency accredited by SANAS or aRegistered Auditor. Registered auditors do not need to meet the prerequisite for IRBA’s approvalfor the purpose of conducting verification and issuing EMEs with B-BBEE Status Level
Certificates.
Bidders other than EMEs must submit their original and valid B-BBEE status level verification certificateor a certified copy thereof, substantiating their B-BBEE rating issued by a Registered Auditor approved byIRBA or a Verification Agency accredited by SANAS.
Ehlanzeni TVET College
2017
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 anunincorporated entity, provided that the entity submits their consolidated B-BBEE scorecard as if theywere a group structure and that such a consolidated B-BBEE scorecard is prepared for every separatebid.
Tertiary institutions and public entities will be required to submit their B-BBEE status level certificates interms 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 thatsuch a bidder intends sub-contracting more than 25% of the value of the contract to any other enterprisethat does not qualify for at least the points that such a bidder qualifies for, unless the intended subcontractoris 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 anyother 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 thesub-contract.
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 PARAGRAPHS TABLEABOVE
7.1 B-BBEE Status Level of Contribution: …………. = ……………(maximum of 20points)(Points claimed in respect of paragraph 7.1 must be in accordance with the tablereflected in paragraph below 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 theCCA).
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)
Ehlanzeni TVET College
2017
Broad-Based Black Economic Empowerment B-BBEE Status: Please read notes belowvery carefully before completing.
Instructions and Definitions:
Legislation:
In terms of Section 38 of the PFMA the accounting officer of a department must ensure that
the department has and maintains an appropriate procurement and provisioning systemwhich is fair, equitable, transparent, competitive and cost-effective.
Terminology:
Commodities: The commodities the company wishes to be registered for as a supplier tothe department.
Trade Names: The trade names that the company owns or distributes, which you wish tobe registered for as a supplier to the department.
Owned:Having all the customary elements of ownership, including the right of decision makingand sharing all the risks and profits commensurate with the degree of ownershipinterests as demonstrated by an examination rather than the form of ownershiparrangements.
B-BBEE Status Level of Contribution: means broad-based black economic empowermentas defined in section 1 of the Broad-Based Black Economic Empowerment Act
B-BBEE Status Level of Contribution: means the B-BBEE status received by a measuredentity based on its overall performance using the relevant scorecard contained in the Codesof Good Practice on Black Economic Empowerment, issued in terms of section 9(1) of theBroad-Based Black Economic Empowerment Act;
EME: means any enterprise with annual total revenue of R5 million or less.
Ehlanzeni TVET College
2017
Documents to be attachedThe following documents must be attached to each application:
- Completed National Treasury Central Supplier Database (CSD) Registration Report (Form)
- Business registration including details of directorship and membership;
- Bank account holder information; Cancelled cheque/ 3 months certified bank statement;
- Proof of registration / accreditation/ affiliation to relevant professional institutions or
- Brief Company Profile, organogram and brochures;
- Certificate of incorporation from the Registrar of Companies (CIPRO);
- Tax compliance status e.g. Original Tax clearance certificate;
- Certified copies of ID document of company member(s) (ownership);
- BBBEE status level;
- Tender defaulting and restriction status;
- Certified Copy of Public Drivers Permit (PDP);
- VAT Registration
- BEE Rating Certificate and any other supporting documents
Ehlanzeni TVET College
Central Office
29 Bell Street
Supply Chain Section
Private Bag X 11297,
NELSPRUIT
1200
PLEASE NOTE: No double application forms will be allowed. Only one application form will be issued to a Supplier /Service Provider.
VERIFICATION OF INFORMATION SUPPLIED TO PREFERENCES THAT THE APPLICANT (BUSINESS) MAY APPLY FOR
Ehlanzeni TVET College
2017
I/we the undersigned who warrants that he / she is duly authorized to do so on behalf of the supplier, certifies that the information supplied in terms of this document including the annexure/s with additional information, is correct and accurate and acknowledge(s) that:1.The supplier will be required to furnish documentary proof of the information relating to preferences if requested to do so.
2.If the information supplied is found to be incorrect then the college may, in addition to any remedies it may have:
2.1disqualify the supplier / contractor for a particular tender/contract/project it may be considered for, or which had been awarded to the supplier / contractor
2.2recover from the supplier / contractor all costs, losses or damages incurred or sustained by the College as a result of breach of the contract
2.3cancel the contract and claim any damages which the College may suffer by having to make less favorable arrangements after such cancellation; and/or
2.4De-register the supplier registered on the Supplier Database.
3.The B-BBEE claimed is in accordance with the new Preferential Procurement Policy Framework Act 2000 (PPPFA).
4.Any conflict of interest will be declared in the comment space below.
Declaration of any conflict of interest:
____
____
____
SIGNED ON THIS ______DAY OF ______2016AT ______
BEFORE THE COMMISSIONER OF OATHS
______
SIGNATURE OF OWNER OR NAME & SURNAME OF OWNER OR
AUTHORISED REPRESENTATIVE AUTHORISED REPRESENTATIVE
(NAME IN BLOCK LETTERS)
SUPPLIER’S NAME:______
Ehlanzeni TVET College
2017
Signed and affirmed to, before me at ______on this _____ day of ______year ______, by the deponent who has acknowledge that he/she knows and understands, the contents of this document and he/she has acknowledged that he/she has no obligation to affirming that he/she regards the affirmation to be binding on his /her conscience.______
COMMISSIONER OF OATHS
______
FULL NAME OF COMMISSIONER
BUSINESS ADDRESS
______
CAPACITY : ______
AREA: ______
STAMP
Ehlanzeni TVET College
2017
Applications are invited from potential suppliers/service providers for the following services / commodities:LIST OF COMMODITIES -MAXIMUM THREE
(Mark with X)
DESCRIPTION / X / DESCRIPTION / X
Access Control / Consulting: Performance Management
Accountants/ Financial Advisory Services/Auditing / Consulting: Training & Development
Accommodation / Consulting : Accountants
Accredited Service Providers / Consulting: Auditors
Advertisement / Corporate Gifts/Clothing
Agricultural Services and equipment / Courier Services
Animal feed: Cattle, Chickens, Sheep, pigs and goats (Lucerne, bales etc.) / Crockery & Cutlery
Architects / Cabling
Annual reports: Concept, Design and Layouts / Data Projectors
Assessors / Decoder Machines
Auctioneers / Dictaphone Machine
Audio visual system / Digital Cameras
Aqua cooler / DJ Services/ Entertainment
Borehole and Pump Maintenance / Electrical Services / Maintenance
Building Contractors / Engraving & Trophies
Building and Maintenance Equipment / Event managementFunctions
Building Renovations / Facilitation services
Building Material and Hardware / Fire Extinguisher
Blinds, Curtaining, Rails & Accessories / Furniture and Office Equipment
Catering / Furniture removal
Car Rental / Furniture repairs
Cartridges / Gardening Services
Cellular telephones and repairs / Hygiene Services
Cleaning Material / IT Maintenance/ IT Software and Hardware/ IT Programming / IT Networking
Cleaning Services and equipment / Insurance Companies
Computers / Internet Service Provider
Consulting: engineers ( Civil, Electrical, Structural and Mechanical / Installation of security equipment
Consulting: Facilitators / Installation and repairs/ servicing of air conditioners, refrigerators and cold rooms etc.
Consulting: Legal / Legal Services
Consulting: Organizational Development / Land Surveyor
Motor Vehicle / Landscaping
Motivational Speaker / Locksmith Services
Paper & Stationery / Office Equipment
Paving and Fencing / Office furniture
Pest Control / PA Systems
Photocopying Machine / Partitioning
Photocopying Machine: Repairs and Services / Plumbing material/ Contractors
Plumbing / Risk Management
Printers / Security Services
Printer repairs and services / Sound & Recording Systems
Printing / Photography/ Graphic Design / Supply of Textbooks
Printing: Brochure/ Business cards/ newsletter/ pamphlets / Telecommunication Services
Printing & supply of promotional material / Telephone Equipment
Project Manager / Television Repairs
Promotional Gifts / Transport services
Protective Clothing and uniform (PPE) / Training and Development
Provision for Residence / Travelling Agency
Public Relations / Marketing / Communication / Valuators (re-valuation of sites)
Quantity Surveyor / Vehicle Towing
Refurbishment of Buildings / Water Bottles
Renovations Services / Web design/ Maintenance
Office / Building Maintenance / Window / Glass Installation & Repairs
Management Consultancy / Window / Glass Repairs
Students Transport / Workshop: Material
Students Accommodation / Workshop: Equipment
Embroidery services / Workshop: Consumables
Occupational Health & Safety Training / Construction Project Management
Day-to-day Infrastructure Development & Maintenance / Leadership and Management Training
Event Management / Communication Strategy Development
Policy & Institutional Development / Knowledge Management Strategy
Rev 2...striving towards excellence