database registration form 2018 ref no: …ehlanzenicollege.co.za/forms/db 2 nelspruit 2018...

Rev 2 ...striving towards excellence

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Ehlanzeni TVET College 2018

DATABASE REGISTRATION FORM 2018 REF NO: ETVETC/2017/1/2- NELSPRUIT

NAME OF SERVICE PROVIDER :

COMPANY NAME

FOR OFFICIAL PURPOSE SUPPLIER NUMBER

APPLICATION ACCEPTED APPLICATION REJECTED

REASON IF REJECTED

Captured By: Signature: Date:


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Ehlanzeni TVET College

2018

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) commodities must 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 ORIGINAL application 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

Suppliers Information:

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


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Postal Address (compulsory) Physical Address (compulsory)

Postal Code: Street Code:

Main contact person in your company

Name of contact person

Company 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 Successfully Yes / No

Year

Company / Supplier Classification: (Please tick the relevant box or boxes)

ISO Listed

Importer Services Manufacturer Repairer Distributor Exporter Sales

(Please tick the relevant box)

Tax Clearence Certificate Attached Yes No

Expiry date:

Supplier Grouping Details: Type of Firm. Please tick the relevant box

1 Public Company (Ltd) 8 Sole Proprietor

2 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


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2018

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

A. Sector B. Full time paid employees

C. Annual Turnover (millions)

D. 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)

Micro

Very Small

Small

Medium

Large


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Points awarded for B-BBEE Status Level of Contribution In terms of Regulation 5 (2) and 6 (2) of the Preferential Procurement Regulations, preference points must be awarded to a bidder for attaining the B-BBEE status level of contribution in accordance with the table below:

B-BBEE Status Level of Contributor (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 a Registered Auditor. Registered auditors do not need to meet the prerequisite for IRBA’s approval for 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 certificate or a certified copy thereof, substantiating their B-BBEE rating issued by a Registered Auditor approved by IRBA or a Verification Agency accredited by SANAS.


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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 an unincorporated entity, provided that the entity submits their consolidated B-BBEE scorecard as if they were a group structure and that such a consolidated B-BBEE scorecard is prepared for every separate bid. Tertiary institutions and public entities will be required to submit their B-BBEE status level certificates in terms 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 that such a bidder intends sub-contracting more than 25% of the value of the contract to any other enterprise that does not qualify for at least the points that such a bidder qualifies for, unless the intended subcontractor is 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 any other 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 the sub-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 TABLE ABOVE

7.1 B-BBEE Status Level of Contribution: …………. = ……………(maximum of 20 points) (Points claimed in respect of paragraph 7.1 must be in accordance with the table reflected in paragraph below and must be substantiated by means of a B-BBEE certificate issued by a Verification Agency accredited by SANAS or a Registered Auditor approved by IRBA or an Accounting Officer as contemplated in the CCA). SUB-CONTRACTING Will any portion of the contract be sub-contracted? YES / NO (delete which is not applicable) 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 not applicable)


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2018 Broad-Based Black Economic Empowerment B-BBEE Status: Please read notes below very 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 system which is fair, equitable, transparent, competitive and cost-effective. Terminology: Commodities: The commodities the company wishes to be registered for as a supplier to the

department.

Trade Names: The trade names that the company owns or distributes, which you wish to be

registered for as a supplier to the department.

Owned: Having all the customary elements of ownership, including the right of decision

making and sharing all the risks and profits commensurate with the degree of ownership

interests as demonstrated by an examination rather than the form of ownership arrangements.

B-BBEE Status Level of Contribution: means broad-based black economic empowerment

as 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 measured

entity based on its overall performance using the relevant scorecard contained in the Codes of

Good Practice on Black Economic Empowerment, issued in terms of section 9(1) of the Broad-

Based Black Economic Empowerment Act;

EME: means any enterprise with annual total revenue of R5 million or less.


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Documents to be attached

The 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

regulatory; councils relevant to the type of services / commodity e.g. CIDB;

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

A complete application must be hand delivered to the postal address mentioned below:

Ehlanzeni TVET College Cnr Koraalboom Ave & Kaapsehoop Private Bag X 11282, 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


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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: 2.1 disqualify the supplier / contractor for a particular tender/contract/project it

may be considered for, or which had been awarded to the supplier / contractor

2.2 recover from the supplier / contractor all costs, losses or damages incurred or sustained by the College as a result of breach of the contract

2.3 cancel the contract and claim any damages which the College may suffer by having to make less favorable arrangements after such cancellation; and/or

2.4 De-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 _______________ 2017 AT _______________________ 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:_____________________________________________________________


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2018

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


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2018

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 management & Functions

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


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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/ Sewerage drainage 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


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Policy & Institutional Development Knowledge Management Strategy

OHS Act Fire Inspection

Compliance Certificate Verification Screening / Security Check