application form to register on the … form.pdfapplication form to register on the service provider...
TRANSCRIPT
THE FOLLOWING DOCUMENTS/ INFO MUST BE ATTACHED (REQUIREMENTS)
Operating contact and fax numbers including email address.
Company profile with company letterhead must be attached.
Certified copies of ID (shareholders/ members).
CK1.
Proof of registration for any services/ consultancy that requires registration
with professional bodies.e.g. CIBD for construction services, PSIRA for security
services and etc.
Valid and original tax clearance certificate.
Valid BEE certicate.
Signed declaration of Interest.
For purposes of section 256 of the Tax Administration Act of 2011 (the TAAct), the
contractor / service provider authorises the South African Revenue Service to disclose
‘taxpayer information’ as contemplated under the provisions of Chapter 6 of the TAAct in
relation to the compliance status of tax registration, tax debt and filing requirements.
Name of other party here Signature Date
SECTION ONE: CONDITIONS
1.1 Please note that all information will be treated confidentially.
1.2 Forms that are incomplete or which are not accompanied by the required
documents will be disqualified.
1.3 Completed f o rm s should be posted to or hand delivered to no1 Dr Lategan Road,
Groenkloof, for the attention of Khuliswa Mazizi by 20 January 2015.
1.4 THE SABS’s Service Provider Database will be used mainly for the purposes of
identifying entities that can be approached when price quotations for goods and services
are to be invited. The fact that an entity is registered as a supplier does not constitute
any contractual relationship between that business and THE SABS.
1.5 For procurement above the financial limit applicable to price quotations, as determined
from time to time by National Treasury, The SABS will normally invite competitive Bids
by means of advertisements. The onus is on entities to ensure that they obtain copies
of the Bidding documents that are available at THE SABS when Bids are advertised.
1.6 It is the responsibility of a Registered Entity to inform the SABS immediately in
writing of any changes in the particulars as stated in the application, especially
changes in respect of the BBBEE status of the entity. Should a contract be awarded
to an entity as a result of incorrect particulars on the status of an entity, THE SABS
shall have the right to, in addition to any other remedy that it may have in terms of the
Preferential Procurement Regulation, cancel the contract and to claim for damages.
1.7 THE SABS reserves the right to cancel the registration of an entity if the entity has provided
incorrect or false information in the application form or any correspondence relating to the
application:
Failed to inform the SABS of any changes of the particulars as furnished in the
application
Failed to comply with the conditions of any contract that might have been
awarded to the entity
Failed to respond on requests for price quotations
The entity being blacklisted by National Treasury
If the entity has acted in an improper, fraudulent or corrupt manner
SECTION TWO: SUPPLIER INFORMATION
2.1 Supplier Details
Registered Name Trading Name Holding Name Company Registration Number Income Tax Registration Number Vat Registration Number Telephone Number Fax Number Cell Phone Number E-Mail Address
2.2 Company Addresses
Postal Address Town Region Code
Physical Address Town Region Code
2.3 Company Type
(Mark with an X in the applicable column)
Public Company Private Company Close Corporation Section 21 Company Trust Partnership Sole Proprietor Parastatal Non-Governmental Organisation Other
If selected other, please specify: _
_ _ _
2.4 Contact Person Details
Contact Person Full Name Position in Company Telephone Number Fax Number E-Mail Address Telephone Number Cell Phone Number
2.5 Contact Person Addresses
Postal Address Town Region Code
Physical Address Town Region Code
2.6 Supply Region and Town
Please indicate which province you will be capable of delivering goods or services, and indicate the town
names within the region. Goods Service Providers must supply proof of satellite office existence should
they wish to link themselves to a region where their main offices are not based or attach proof of Goods
delivered previously around the area on other projects.
Regions Mark Towns
e.g. Region Town A, Town B
Eastern Cape Free State Gauteng Limpopo Kwa-Zulu Natal Mpumalanga Northern Cape Western Cape Northwest
2.7 Ownership of Company
Full Name Position in Company Identity Number Telephone Number Fax Number E-Mail Address Telephone Number Cell Phone Number Percentage Owned
Please indicate ownership on other Companies with percentage owned.
Name of Company Company Registration Nr Percentage Ownership
2.8 Commodities
Please indicate on Annexure A (attached), the goods and/or services, in terms of your Core Business you
can offer the SABS.
Service Providers are limited to five (5) Commodities NB: (Please note that the highlighted areas in
BOLD are commodities and sub-commodities are listed below, therefore you may select all sub-
commodities under one commodity.)
ANNEXURE A
List of Goods Commodities
ELECTRO-TECHNICAL ENGINEERING LABORATORIES Tick
(A) Electronics Laboratory
Lab equipment
Lab instrument
Testing instrument
Consumables
Maintenance and repairs
Calibration
Other (Please specify)
(B) Appliances Laboratory
Lab equipment
Lab instrument
Testing instrument
Consumables
Maintenance and repairs
Calibration
Other Please specify
(C) Metrology Laboratory
Lab equipment
Lab instrument
Testing instrument
Consumables
Maintenance and repairs
Calibration
Other (Please specify)
(D) NETFA: Short Circuit Laboratory
Lab equipment
Lab instrument
Testing instrument
Consumables
Maintenance and repairs
Calibration
Other (Please Specify)
(E) NETFA: High Voltage
Lab equipment
Lab instrument
Testing instrument
Consumables
Maintenance and repairs
Calibration
Other (please specify)
56](G) NETFA: Materials & Installations Lab
Lab equipment
Lab instrument
Testing instrument
Consumables
Maintenance and repairs
Calibration
Other (Please specify)
(H) Explosion Prevention Technology & Rotation Machines
Lab equipment
Lab instrument
Testing instrument
Consumables
Maintenance and repairs
Calibration
Other, (Please Specify)
MINING & MINERALS LABORATORIES
Lab equipment
Lab instrument
Testing instrument
Consumables
Maintenance and repairs
Calibration
Other, (Please specify)
AUTOMOTIVE & MECHANICAL LABORATORIES
Lab equipment
Lab instrument
Testing instrument
Consumables
Maintenance and repairs
Calibration
Control Valves
Other (Please Specify)
CHEMICALS/BIO & MATERIALS LABORATORIES
(A) Materials Technology Laboratories
Lab equipment
Lab instrument
Testing Facilities
Scientific Instrument
Consumables
Maintenance and repairs
Calibration
Chemicals supplies
Gas supplies
Other, (Please specify)
(B) Rubber Plastics Paints Sealants Laboratories
Lab equipment
Lab instrument
Testing instrument
Consumables
Maintenance and repairs
Calibration
Other, (Please specify)
(C) Radiation Protection Services Laboratories
Lab equipment
Lab instrument
Testing instrument
Consumables
Maintenance and repairs
Calibration
Other, (Please specify)
(D) Radiation Protection Services Laboratories
Lab equipment
Lab instrument
Scientific Instrument
Consumables
Maintenance and repairs
Calibration
Chemicals supplies
Gas supplies
Other, (Please specify)
(E) Condom Test Lab Laboratories
Lab equipment
Lab instrument
Scientific Instrument
Consumables
Maintenance and repairs
Calibration
Chemicals supplies
Gas supplies
Other, (Please specify)
(F) Fibre & Polymers Laboratories
Lab equipment
Lab instrument
Scientific Instrument
Consumables
Maintenance and repairs
Calibration
Chemicals supplies
Gas supplies
Other, (Please specify)
(G) Bio Technology
Lab equipment
Analytical instrument
Scientific Instrument
Consumables
Maintenance and repairs
Calibration
Chemicals supplies
Glassware
Other, (Please specify)
(H) Pharmaceutical Microbiology
Lab equipment
Analytical instrument
Scientific Instrument
Consumables
Maintenance and repairs
Calibration
Chemicals supplies
Gas supplies
Glassware
Other (Please Specify)
(I) Food Microbiology
Lab equipment
Analytical instrument
Scientific Instrument
Consumables
Maintenance and repairs
Calibration
Chemicals supplies
Gas supplies
Glassware
Other (Please specify)
(J) Chemicals Technology
Lab equipment
Analytical instrument
Scientific Instrument
Consumables
Maintenance and repairs
Calibration
Chemicals supplies
Gas supplies
Glassware
Other, (please specify)
Facilities
Air Conditioner
Carpentry, Dry walling and Partitioning
Painting
Cleaning and Waste removal
Cleaning Materials
Electrical supplies
Electrical contractor
Glass fitting and Blinds
Landscaping and Horticulture
Renovations and Refurbishments
Protective Clothing
Industrial supplies and Tools
Cranes supplies
Transformer supplies and services
Cold & Freezer room Installation, Maintenance and repair
Other, (Please specify)
Computer Hardware and Software
Computer Monitor
Computer Drives and Writers
Computer Accessories
Printers
Printer Accessories
Printer Toner and Cartridges
Memory Devices
Modems and Motherboard
Network, Port, Hub and Accessories
Software
Licenses
Servers and Accessories
Other, (Please specify)
Application Support and Maintenance
Hardware Support
IT Consulting
Other (Please Specify)
Cleaning Equipment and Supplies
Cleaning Equipment
Cleaning Supplies
Hygiene Supplies
Protective Gear
Other, (Please specify)
Fire Equipment
Fire Beater
Fire Trailer Water Pump
Vent Fire Knap Sack Spray
Wooden Handle Fire Beater
Other (Please Specify)
Office Machines and Equipment and Supplies
Office Machine
Office Equipment
Office Supplies
Other, (Please specify)
Medical Equipment and Supplies
Medical Equipment
Medical Supplies
Other, (Please specify)
Office Furniture and Furnishings
Desks
Chairs
Cupboard and Bookcase
Drawers
Cabinets and Filing Cabinet
Bulk Filing Unit
Steel Factory Lockers
Boardroom Tables
Office Furnishings
Tables and Counter Tops
TV Screen
Wall Units
Other, (Please specify)
Photographic, Printing and Presentation Equipment and Supplies
Printing and Publishing Equipment
Audio and Visual Presentation and Composing Equipment
Photographic or Filming or Video Equipment
Photographic and Recording Media
Other, (Please specify)
Promotional Items and Gifts
Corporate Gifts
Promotional Items
Displays and Stands
Other, (Please specify)
Published Products
Printed Media
Electronic Reference Material
Signage and Accessories
Other, (Please specify)
Safety and Security Equipment and Accessories
Safety Equipment
Security Accessories
Alarm and Security Systems
Locks and Handles
Fire Extinguisher
Security Gates and Bugler doors
Smoke Sensor
X-ray Equipment
Other, (Please specify)
Tools and General Equipment
Hand Tools
Electrical Tools
General Equipment
Garden Equipment
Grinding, Cutting and Sharpening Equipment
Scaffolding and Ladders
Sliding Gates
Swing Gates
Barricades
Gate Automation
Artwork Equipment
Audio Visual Equipment (Screen and Sounds)
Other, (Please specify)
Maintenance Supplies and Accessories
Electrical Supplies
Plumbing Supplies
General Maintenance Supplies and Accessories
Other, (Please specify)
Petroleum
Diesel
Petrol
Transmission oil, Hydraulic oil, Brake fluid
Other (Please Specify)
List of Services Commodities
Cleaning Services (Certification Required)
General Building Cleaning Services Interior
General Building Cleaning Services Exterior
Hygiene Services
Carpet Cleaning Services
Garden and Plant Maintenance Services
Vehicle Cleaning Services
Waste Management Services
Other, (Please specify)
Construction Services (CIDB Certification Required)
Building – Including Material
Civil – Roads, Road Markings, Bridges
Mechanical - Engineers
Fencing – Including Material and Installation, Steel Security Fencing Concrete- SQ
Structural Renovation
Paving and Drive Ways
Fabricators, structural Steelwork Fabrication
Roofing
Tilling
Car Ports
Other, (Please specify)
General Building Maintenance and Repair Services (Certification Required)
Locksmith Services
Partitioning Services
Window Services
Fumigation Services
Pest Control Services
Electrical Services
Plumbing Services
Welding Services
Other, (Please specify)
Health Services
Wellness Services
Occupational Health & Safety
Other, (Please specify)
Information Technology Services
Installation Services
Specialized IT Services
Hardware Repairs and Maintenance Services
Data Management and Backup Services
Upgrades and Maintenance
Database Development and Design
Other, (Please specify)
Licenses
Computer Hardware
Other, (Please specify)
Logistical Services
Catering Services
Exhibition Centre and Meeting Facilities
Event Management Services
Bed and Breakfast
Flight Reservations
Accommodation and Hotels
Seminars/ Workshops/ Conferences
Other, (Please specify)
Clearing Agent
Management and Business Professionals and Administrative Services
(Certification Required)
Management Advisory Services
Subscriptions Services
Marketing and Distribution Services
Policy Development and Management Services
Document and Information Management Services
Business Administration Services
Policy Expert : Green and White Paper
Other (Please Specify)
Human Resources Services
Affirmative Management
Change Management
Discipline, Grievances and Dispute Resolutions
Personnel Placement (Recruitment) Agencies
In House Training
Competency Skills
Facilitation
Data Captures
Conflict Management
Performance Management
Skills Audit
Competency Test
Psychometric Test
Human Resources Development Services
Human Resources Management Services
Other, (Please specify)
Legal Services (Certification Required)
Legal Advisor
Legal Entities Specialist
Discipline, Grievance and Dispute Resolutions
Labour Law Specialist
Commercial Law
Arbitrators
Other, (Please specify)
Auditing Services (Certification Required)
Financial and operational Audit
Forensic and Investigation Audit
Information Technology Forensic Audit
Information technology Audit
Legal Compliance Audit
Performance Management Audit
Other, (Please specify)
Financial Services (Certification Required)
Business and Financial Advisory Services
Finance Systems Designing Services
Charted Accounts Services
Other, (Please specify)
Publications, Communication and Information Services
Advertising on newspapers
Publications
Books
Marketing
Video Coverage
Multi-Media
Writing and Translations Services
Printing and Reproduction Services
Photographic Services
Graphic Design Services
Other, (Please specify)
Solar Installation and Services
Solar Installation and Repairs
Other, (Please specify)
Relocation, Removals and Storage, Transportation and Mail Services
Courier Services (Mail and Cargo Transport)
Bus and Public Transport
Office Furniture and Household Relocation, Removal and Storage
Distribution and Delivery Services
Chauffer and Shuttle Services
Security and Safety Services (Certification Required)
Security and Personal Safety
Security Surveying Services
Hardware and Software : Installation, Replacement and Labour
CCTV Camera
Other, (Please specify)
Telecommunication Services
Telecommunication Installation
Telecommunication Maintenance and Repairs
Cables and Cabling services
Other, (Please specify)
Services and Repairs
Service and Repairs of Office Machine
Service and Repairs of Furniture
Service and Repairs of Equipment
Engine services (Car service)
Repair and Installation of Glasses
Other, (Please specify)
Water Provision (Certification Required)
Water Provision Contractors / Consultants
Borehole Construction
Water Tanks
Pump Stations
Reservoir
Water Reticulation
Sewerage Systems
NB: Entities are free to supply details of any other products or services they render which are not included
on the above lists.
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2.9 References
Please list contracts/assignments completed by your company in the last three (3) years in relation to the
commodities you linked your company to.
Work Performed Client Contact Person and Telephone Number
SECTION THREE: BBBEE DECLARATION
3.1 Equity Ownership
Please indicate in %, shares owned by the following groups: (Compulsory)
Group Male Female Disabled
African Coloured Indian White
3.2 BEE
Please indicate the Management structure in % of the total percentage owned.
Group Percentage Owned
African Coloured Indian White
3.3 BBBEE
Has your company been assessed for BBBEE? (Yes/No) Which assessment company has provided your company with
your BBBEE rating?
What is your BBBEE rating? Please attach copy of Certificate (Is Certificate attached?)
3.4 SMME Status
(Mark with an X in the applicable column)
Micro Small Medium Large
4. DECLARATION
I/We the undersigned declare that:
1. The information furnished is true and correct
2. The BBBEE Claimed is in accordance with the General Conditions.
3. Any conflict of interest was declared.
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Signature of Owner or Authorized Date
Representative