APPLICATION FOR REGISTRATION ON THE …

1 APPLICATION FOR REGISTRATION ON THE supplier DATABASE OF SANRAL SOUTHERN REGION supplier Database THE SOUTH AFRICAN NATIONAL ROADS AGENCY LIMITED SOC (SANRAL) APPLICATION FOR REGISTRATION ON THE supplier DATABASE OF SANRAL SOUTHERN REGION DESCRIPTION: APPLICATION TO BE REGISTERED ON THE supplier DATABASE / LIST OF PROSPECTIVE SERVICE PROVIDERS THIS DOCUMENT COMPILED BY: THE SOUTH AFRICAN NATIONAL ROADS AGENCY SOC LTD BLOCK C, SOUTHERN LIFE GARDENS 70 2nd AVENUE NEWTON PARK PORT ELIZABETH 6001 Tel No.

2 : (041) 398 3200 E-mail: APPLICATION FOR REGISTRATION ON THE supplier DATABASE OF SANRAL SOUTHERN REGION supplier Database 1. INTRODUCTION AND GUIDELINES The purpose of this database is to give all prospective suppliers an equal opportunity to submit quotations to SANRAL Southern Region in order to comply with the procedures set out in the Public Finance Management Act 1 of 1999 (PFMA), the Preferential Procurement Policy Framework Act 5 of 2000 (PPPFA), and Supply Chain Management Regulations issued by the National Treasury.

3 Preference will be given to registered suppliers but it does not necessarily follow that suppliers who are not yet registered will be totally excluded from quoting for the supply of goods or service to SANRAL Southern Region Office. APPLICATION FOR REGISTRATION ON SANRAL S SUPPLIERS DATABASE THESE FORMS MUST BE COMPLETED AND SUBMITTED TO: SANRAL SOUTHERN REGION BLOCK C, SOUTHERN LIFE GARDENS 70 2nd AVENUE NEWTON PARK PORT ELIZABETH 6001 OR POSTED TO: PO BOX 27230 GREENACRES 6057 ENQUIRIES: TEL NO.

4 : (041) 398 3200 FOR OFFICIAL USE ONLY NAME OF supplier REGISTRATION NUMBER / VENDOR NUMBER DATE APPROVED APPLICATION FOR REGISTRATION ON THE supplier DATABASE OF SANRAL SOUTHERN REGION supplier Database APPLICATION FORM 1 IMPORTANT NOTES To be completed by all vendors seeking REGISTRATION as an approved supplier ; The questionnaire must be completed in full and be signed; 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 applicant; Applicants will be contacted via email and must therefore submit an operating email address.

5 Failure to comply will result in excluding the supplier from the data base; It should be noted that SANRAL reserves the right to accept or reject any APPLICATION without being obliged to give any reasons in this respect; Suppliers will be notified whether APPLICATION was accepted; supplier must comply with all the REGISTRATION criteria for REGISTRATION to be finalized - failure to do so may result in the APPLICATION being declined; Failure to submit all required documents will lead to supplier not being registered on the database.

6 CHECKLIST OF DOCUMENTS REQUIRED NO DOCUMENT REQUIRED RECEIVED YES/NO 1. Completed, Signed & Commissioned supplier Database Form 2. Completed and Signed SBD 4: Declaration of Interests 3. Completed and Signed SBD : Preference Points Claim Form 4. Completed and Signed SBD 8: Bidder s Past SCM Practices 5. Completed and Signed SBD 9: Certificate Of Independent Bid Determination 6. Valid & Original Tax Clearance Certificate 7. Valid BBBEE Verification Certificate 8. Certified Proof of Company REGISTRATION 9.

7 Company Profile 10. Vendor APPLICATION Form APPLICATION FOR REGISTRATION ON THE supplier DATABASE OF SANRAL SOUTHERN REGION supplier Database 1. BUSINESS PARTICULARS Name Of Business As Registered With The Registrar Of Companies/Close Corporations Business REGISTRATION number: NB: Attach copy of business REGISTRATION certificate Service provider s core business (what is the principle business) VAT REGISTRATION number: NB: Attach Original Tax Clearance Certificate Tax Clearance Certificate Expiry Date Income Tax Reference Number.

8 Postal Address: Physical Address: Postal Code Postal Code Telephone No: Fax No: Cell. No. E-Mail Address: Contact Person: APPLICATION FOR REGISTRATION ON THE supplier DATABASE OF SANRAL SOUTHERN REGION supplier Database Name of person authorised for signing: Capacity under which the APPLICATION is signed: Date signed: Signature: 2.

9 Please indicate (X) the geographical areas where your business has offices. Please provide addresses, telephone numbers and contact person for different offices (add separate sheet, if necessary) Regions Mark ( X ) Gauteng Kwazulu Natal Western Cape Eastern Cape 3. supplier Group Detail: Type of Firm (Please tick the relevant box) 1 Public Company (Ltd) 2 Private Company ((Pty) Ltd) 3 Closed Corporation (CC) 4 Other (Specify) 5 Joint Venture 6 Sole Proprietor 7 Partnership 8 Trust 9 Section 21 Company 10 Government / Parastatals 4.

10 Range of services offered in relation to the principal business of the enterprise 5. Are you registered with a professional body for the services that you provide? YES NO APPLICATION FOR REGISTRATION ON THE supplier DATABASE OF SANRAL SOUTHERN REGION supplier Database If so, please state particulars: Name of Organisation Contact Person Telephone number Membership number Date of membership 6. BEE INFORMATION % Of BEE Ownership Provide BEE verification certificate( (from ABVA accredited verification agencies) NB: Attach BEE certificate 7.)