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SUPPLIER REGISTRATION APPLICATION FORM - …

Joburg Market Heidelberg Road City Deep Johannesburg 2049 PO Box 86007 City Deep, Johannesburg South Africa 2049 Tel +27(0) 11 992 8000 Fax +27(0) 11 613 7381 E-mail: Non-Executive Directors Mr. Khehla Shubane (Chairperson), Mr. Bongani Nkosi, Mr. Samuel Mafadza, Mr. Terry Tselane, Bishop Nchime Tsekedi, Ms. Shelley Childs, Mr. Caesar Molebatsi, Mr. Sandile Ndlungwane, Mr. Sakhile Masango, Chief Executive Officer (Acting) Mr. Josiah Mazibuko Chief Financial Officer (Acting) Ms. Benvinda Rocha Auditors Auditor General REGISTRATION Number: 2000/023383/07 SUPPLIER REGISTRATION APPLICATION form For Enquiries Contact: SUPPLY CHAIN MANAGEMENT UNIT Tel: 011 992 8000 Email Address: The forms must be submitted at: Joburg Market building, 4 fortune road, Joburg Market Deep Fourth Floor: SCM Office Page 2 of 10 The Joburg Market hereby invites current and prospective suppliers to apply to be accredited and registered on its SUPPLIER Database as required by the Municipal Finance Management Act of 2003 and its Regulations.

Page 3 of 10 Cancelled cheque or stamped bank confirmation letter not older than a year. CHECK LIST FOR THE NEW DATABASE REGISTRATION FORMS FOR OFFICE USE ONLY SUPPLIER NAME:

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