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TO ALL SUPPLIERS SEEKING REGISTRATION AS AN …

Enquiries: Ms P Ndlovu, Tel: 012 312 5511, ALL SUPPLIERS SEEKING REGISTRATION AS AN APPROVED SUPPLIER ON THE DATABASE OFTHE DEPARTMENTAll SUPPLIERS are herewith invited to register as an approved supplier on the database of the (AOPP),as referred to in the Public Finance Management Act, 1999 (Act 1 of 1999)(PFMA), the Departmentdeveloped a supplier database to be used by the procurement the registered will be totally exempted from quoting for the supplying of goods or services to the is envisaged however, that this database will contribute to efficient administration and compliance with please find an official REGISTRATION form to assist us in updating our database according to following important notes should be read carefully before the completion of this form to be completed by all businesses SEEKING to conduct with the profile / BEE profilewillnot be acceptedas replacement for the application form must be completed in full and signed by the owner(s)

Website Address: Email Address: Telkom area code: e.g. 012,011 ect. Telephone No. Fax No: Toll free No Postal Address: City / Town: Postal Code: Physical Address: City / Town Postal Code: Classification of Business: Please all the relevant boxes ISO Listed Importer Services Manufacturer Repairer Black owned Distributor Exporter Sales page 1

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Transcription of TO ALL SUPPLIERS SEEKING REGISTRATION AS AN …

1 Enquiries: Ms P Ndlovu, Tel: 012 312 5511, ALL SUPPLIERS SEEKING REGISTRATION AS AN APPROVED SUPPLIER ON THE DATABASE OFTHE DEPARTMENTAll SUPPLIERS are herewith invited to register as an approved supplier on the database of the (AOPP),as referred to in the Public Finance Management Act, 1999 (Act 1 of 1999)(PFMA), the Departmentdeveloped a supplier database to be used by the procurement the registered will be totally exempted from quoting for the supplying of goods or services to the is envisaged however, that this database will contribute to efficient administration and compliance with please find an official REGISTRATION form to assist us in updating our database according to following important notes should be read carefully before the completion of this form to be completed by all businesses SEEKING to conduct with the profile / BEE profilewillnot be acceptedas replacement for the application form must be completed in full and signed by the owner(s)

2 Or manager or administration signature is required when alterations are made in this the information required is not applicable to your business, clearly insert N/A in the appropriate the appropriate square with an 'X' where it is applicable to fields on application formMUSTbe completed by applicant; if the space provided is left blank, it willbe regarded as information that is still outstanding and you will not be front page of the form must be clearly marked "DATABASE" and be posted to the above postaladdress or hand delivered to the note that no unsigned faxed or e-mailed forms will be business registered on the database must notify the Department within 14 (Fourteen) days of anychanges to information provided in the application form. Failure to comply may result in such abusiness being removed and/or blacklisted from the providing information intentionally incorrectly or fraudulently will be who have been declared insolvent and wish to do business with the Department must havebeen rehabilitated and provide the necessary proof blacklisted by any organs of state* must first be removed or cleared from blacklist copies of the following documents must be attached to application form:a)A concise company profile (max 2 pages);b)Company Certificate or Shareholder(s) register;c)Tax Clearance Certificate:d)Income Tax Certificate;e)VAT REGISTRATION certificate (for VAT vendors only).

3 F)ID for all members/ to submit all the above documents will result in * will result in a business being Department has the right to visit the business premises to verify the information provided in / directors / partners / owners in service with any organ of state* management; must declareany conflict of interest. Failure to do so may lead to disqualification or is only a REGISTRATION form for our database and does not guarantee any award of bid / is only a REGISTRATION form for our database and does not guarantee any award of bid / will be given to registered SUPPLIERS but it does not necessarily follow that SUPPLIERS , who arenot yet registered, will be totally excluded from quoting for the supply of goods or database will be updated on quarterly basis. A summary of the supplier s info on the database willbe posted for verifying. Changes can be made on the summary and faxed back to the on receipt of a signed changed summary, updates will be added to the Department reserves the right to reject any application, which in its opinion failed to comply withthe REGISTRATION requirements or applicants will be notified as such.

4 On receipt of any outstanding documents /information, the declined supplier may be re-evaluated for will be contacted via fax andmusttherefore submit anoperating fax number; failureto comply will result in excluding the supplier from the data in the application being completed this questionnaire, please hand deliver to:123 Schoeman StreetPRETORIAFor Attention: The Supplier Database AdministratorProcurement OfficePrivate Bag X174 PRETORIA0001 For attention: The Supplier Database AdministratorProcurement OfficeSERVICE PROVIDER REGISTRATION FORMC ompany REGISTRATION detailsCompany Name:Trading :Vat No. 2004/140566/23 Income Tax No.:Number of full time employees:Accreditation / Certification*Cidb *Contractor 5CE PEPE StatusYesNo**SAACE Reg. other prof. reg. no.*Note: Cidb info. for contractors only**Note: SAACE No. for professionals onlyCompany DetailsWebsite Address:Email Address: telkom area 012,011 No:Toll free NoPostal Address:City / Town:Postal Code:Physical Address:City / TownPostal Code:Classification of Business:Please all the relevant boxesISO ListedImporterServicesManufacturerRepair erBlack ownedDistributorExporterSalespage 1 All sections to be completed inblack ink, submitted with anoriginal signaturecommissioned by an authorizedCommissioner of OathsSupplier Grouping detail: (type of firm)Please the relevant box Joint Venture Consortium Contact Person DetailsContact Person:-Title:First Name:Surname:ID No.

5 :Cell No.:Work No.:Fax No.:Position:E-mail:Please complete Annexure 5: List of Owners / Proprietors / Partners / Sole Proprietors / Trustees (page 10)HDI Ownership Status:Skills EmpowermentHuman ResourcesUpliftment of CommunitiesLocality ProvinceNo Yes If "Yes" please define:Locality RegionNo Yes If "Yes" please define:No Yes If "Yes" please define:Locality Rural AreaNo Yes If "Yes" please define:page 2% of ownership% of turnoverForeign CompanyPartnershipPrivate Company (Pty) LtdClosed Corporation (cc)% of ownershipSole ProprietorDisabled Individuals (DA)SBD Goals Information:% of turnover% of turnoverLocality Municipal AreaGovernment/Parastatels/Organ of StateHistorically Disadvantage Individuals (HDI)Women Equity (WE)Public Company (Ltd)TrustSection 21 Company% of ownershipSMME Status* Please use the table per Annexure 1 (page 5) to determine the SMME status of your enterprise* Please the relevant boxMicro Very Small Small Medium Large Business InformationPlease indicate your appropriate sector with Agriculture Wholesale Trade, Commercial Mining and Quarrying Catering, Accommodation, Other Manufacturing Transport and Storage Electricity, Gas and Water Finance and Business Services Construction Community, Social and Personal Retail, Motor Trade and Repair Declaration of any Conflict of InterestAre you currently working as an employee in any organ of state?

6 Yes No If "Yes", give details:Have you worked in any organ of state for the past 12 months?Yes No If "Yes", give details:Do you have any relative working for an organ of state?Yes No If "Yes", give details:Do you have any close relationship with any official working in our establishment?Yes No If "Yes", give details:Is there any other relevant information that you would like to disclose?Yes No If "Yes", give details:Are you currently servicing on any structures of our establishment?Yes No If "Yes", give details:Is there any other relevant information that you would like to disclose?Yes No If "Yes", give details:page 3 DeclarationVerification of information supplied, including information relating to preferences that the Applicant orBusiness may apply for:I/we, the undersigned, who warrants that I/we are duly authorised to do so onbehalf of the supplier, certifies that the information supplied in terms of thisdocument including the Annexure(s) with additional information, is correct andaccurate and acknowledges that:1.

7 The supplier will be required to furnish documentary proof of the information relatingto preferences, if requested to do If the information supplied is found to be incorrect, then the Department of Higher Education and Trainingmay, in addition to any remedies it may have:(i) Disqualify the supplier/contractor for a particular bid/contract/project it may beconsidered for, or which had been awarded to the supplier/contractor;(ii Recover from the supplier/contractor for all costs, losses or damages incurred orsustained by the Department of Higher Education and Trainingas a result of breach of contract;(iii Cancel the contract and claim any damages whichthe Department of Higher Education and Training may suffer by favourable arrangements after such cancellation and/or; (iv De-register the supplier registered on the Supplier Database3. A registered supplier MUST notify Supply Chain Management Office of any changes to informationsupplied on this form.)))

8 Failure to do so may result in such a supplier being removed from the Supplierdatabase and / or the cancellation of contracts awarded to the supplier, on the basis of on this _____day of_____20____at_____Signature of Authorised RepresentativeName in Block LettersCommissioner of OathsBusiness AddressCapacityAreapage 4 Commissioner of Oaths SignatureCommissioner of Oaths Full NameAnnexure 1 - SMME tableValues of following items dependent on most recent Financial StatementItemValueTotal number of full time EmployeesTotal Annual TurnoverTotal Gross Asset ValueThe following table must be completed to establish whether a business can be classified as an SMME in termsof the National Small Business Act 102 of the Sector and tick the appropriate blocks in Column 2, 3 and 4 next to your chosen sectorColumn 1 Column 4 (tick applicable)Sectors in accordance with thestandard Industrial CouncilMediumSmallVery SmallMicroMediumSmallVery SmallMicroMediumSmallVery , Accommodation & , Social and , Gas and and Business and , Motor Trade and , Storage Trade, CommercialAgents, and Allied office use onlySummary of resultsColumn 2 Column 3 Column 4page 5 Total Gross asset value(property exluced) (millions)medium small very small micro Total full time paid employeesTotal Annual turnover (millions)medium small very small micro RRColumn 2 (tick applicable)Column 3 (tick applicable)medium small very small micro SMME Status as per above ( appropriate block)Annexure 2 - Commodity listPlease indicate with Please note.

9 Only commodities will be registeredConstructionAirconditioning SystemsElectrical ContractsPlumbingAlarm/Security/Access ControlEvacuation SystemsPrecast Concrete ManufactureAutoclavosFencingPumping InstallationsAutomatic Hanger DoorsGeneral Building WorkRoad Marking & SignageAutomatic Sliding DoorsGlazingRoadworks & CleaningAuto Sprinkle Fire Protection SystemsHauling/Heavy Equip/TransportRoofing & WaterproofingBrickwork/MasonryHot Water InstallationsSewerage Installations/ReticulationsCabinet/Furni ture MakingIncineratorsSteam Installations & AncilliaryEquipmentCarpeting/Tiling/Floo r coveringLandscaping/EarthworksSteel Fabrication & ErectionCeilings, Partitioning and ShopfittingLift & Escalator EquipmentStormwater DrainingCladding ContractsMechanical ContractsWater installations/reticulationsCooking & Related SystemsMetalwork & Burglar BarsOther (Specify)Compressed Air InstallationsPaintingConcrete worksPavingDemolitionPlasteringServicesA ccommodationFire HydrantsPerformance ManagementAdvertising/Public RelationsFood & BeveragePrinting/Photography/GraphicDesi gnAuto Repairs & ServicesFuneral ServicesPromotional MaterialAuto Electrical and Hydraulic RepairsFloristPublishingBookkeepersGarde n ServicesReal EstateCarpet CleaningHandymanRadio Publicity/TV PublicityCartridgesHorticultural ServicesRoad MaintenanceCatering/Vending/Food SupplyHV Fault Finding.

10 Jointing &TerminationsRecruitment AgenciesCleaning ServicesInsurance/Employee BenefitsSafety & Security ServicesComputer Supplies/ServicesInterior/Industrial DesignSecurity & Access ControlCorporate Gifts/Corporate ClothingIT MaintenanceServices HV&LVSwitchgear/TransformersCopywritingI T ManagementSite CleaningCourier ServicesIT NetworkingSolid Waste DisposalCleaning Equipment/MaterialsTelecommunicationData Backup Services & SoftwareIT ProgrammingTransport Services GoodsData Capturing & Management ServicesLaundry Service/Dry CleaningTransport Services PassengersDiesel & Petrol EnginesLocksmith ServicesTransportation ServicesDebt CollectionMedia LiaisonTravel AgenciesDistributionMailing/Courier ServiceTimber ContractorDigging of GravesMedical/Ambulance/Health CareTelephone& Data Line MaintenanceDocument Binding ServicesMunicipal ServicesTraining & DevelopmentEducational ServicesMedical Equipment/InstrumentsUpholsterersEnterta inmentOffice MaintenanceWeb pages & DesignExhibition CentresPersonnel ServicesWind Socks for the AerodomeFire Extinguishers & RefillsPest Removal ServicesOther (Specify)Higher Education and TrainingSUPPLY CHAIN MANAGEMENT DATABASE COMMODITY LIST page 6 Professional ServicesAccountants/Financial Advisory ServicesEDMS ConsultantsPre-Employment AssessmentConsultantsArchitectsEAP ConsultantsProject ManagersAttorneys/Legal ServicesEconomistsQuantity SurveyorsArchival Services ConsultantsIndustrial Relations ConsultantsStatisticiansBusiness Information ManagementJob Description ConsultantsTeachersConsulting Engineers (Geotechnical)Land SurveyorsTown PlannersConsulting Engineers (Civil/Structure)Legal Compliance ConsultantsTraining ProvidersConsulting Engineers (Electrical)Medical PractitionersTranslation ServicesConsulting Engineers (Mechanical)OHS ConsultantsOther (Specify)


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