ga-segonyna local municipality grading status please use this table to determine for which programe...
TRANSCRIPT
* To be completed by all sub-contractors seeking registration as an approved sub-contractor;
* The form must be completed in full and be signed;
for the application form - all fields on application form must be completed by the applicant;
* It should be noted that Ga-Segonyana Local Municipality reserves the right to accept or reject
any application without being obliged to give any reasons in this respect
* Sub- contractors will not be notified whether appplication was accepted or not, but will be advises of the
outcome if telephonically requested
* Sub-contractors must comply with all the registration-criteria for registration to be finalised - failure to do
so may result in the application being declined.
* Please ensure to attach the following amongst other documents: CK1, CoR 14.3, Valid Tax Clearance Certificate,
Business Profile, Proof of Bank Account, Certified ID Copies of Equity Holders.
Sub- Contractor Details:
E-Mail Address:
Postal Address: Physical Address:
INVITATION TO LOCAL SUBCONTRACTORS TO REGISTER ON THE MUNICIPAL
SUPPLIER DATABASE FOR THE DIFFERENT INFRASTRUCTURE
PROJETCS/PROGRAM
Company / Closed Corporation Registration Number
Trading Name
Income tax reference number:
NOTICE NO 01/2017-18
GA-SEGONYNA LOCAL MUNICIPALITY
Telephone Number
Fax Number
Cellphone Number
(Please √ the relevant box)
YES NO
Y Y Y Y M M D D
Regional Levies Registration No:
YES NO
Supplier Group Detail: Type of Firm: (Please √ the relevant box)
Main Contact Person in Your Company:
Company Position
City
Code
E-mail Addres
TEL E-MAIL POSTPrefereed method Of Correspondence
Expiry Date:
VAT Registration No:
02
03
City
Code
Cell Phone Number
Fax Number
Municipal Services Account (latest) Attached
01
12
04
05
06
07
09
10
11
Name
Government / Parastatals
Tax Clearance Certificate Attached
Other ( Specify)
Public Compny (Ltd)
Private Company ( Pty) Ltd
Closed Corporation (CC)
Joint Venture
Consortium
08
Sole Proprieter
Foreign Company
Partnership
Trust
Section 21 Company
Other/ Alternative Contact Person in your Company:
Cell Phone Number
Name
Company Position
Fax Number
E-mail Addres
CIDB GRADING STATUS
Please use this table to determine for which programe you regsitering for.
Please √ only ONE COMMODITY
List all members of the Entity
Expiry Date
Rural Roads
Programme
Contractor Grade (i.e. 1CE PE/
4GB) CRS Number
Please √List of Returnable Documents
Original Valid Tax Clearence Certificate
Certified copies of the Identity Documents of Direcors and/ equity holders
B-BBEE Status Level Certificate (Original/ Certified)
Workman's Compesation Fund Certificate (Good Standing)
NHBRC Certificate
CIDB Grading Certificate
Company Profile
Vat Registration Form (where applicable)
UIF Registration Form (where applicable)
Company Registration (i.e.CK1, CoR 14.3)
Partnership Agreement (where applicable)
Joint Venture Agreement (where applicable)
Central Supplier Database For Government (CSD)
Name
Position Occupied in the
Enterprise Citizenship ID Number
Rural Water
Rural Sanitation
Declaration of any Conflict of Interest (compulsory)
I/We the undersigned acknowledge(s) that:
* The information Furnished is true and correct.
* Any conflict of interest will be declared in the comment space below
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
Comments / Notes:
* To be completed by all sub-contractors seeking registration as an approved sub-contractor;
* The form must be completed in full and be signed;
for the application form - all fields on application form must be completed by the applicant;
* It should be noted that Ga-Segonyana Local Municipality reserves the right to accept or reject
any application without being obliged to give any reasons in this respect
* Sub- contractors will not be notified whether appplication was accepted or not, but will be advises of the
outcome if telephonically requested
* Sub-contractors must comply with all the registration-criteria for registration to be finalised - failure to do
so may result in the application being declined.
* Please ensure to attach the following amongst other documents: CK1, CoR 14.3, Valid Tax Clearance Certificate,
Business Profile, Proof of Bank Account, Certified ID Copies of Equity Holders.
Sub- Contractor Details:
E-Mail Address:
Postal Address: Physical Address:
INVITATION TO LOCAL SUBCONTRACTORS TO REGISTER ON THE MUNICIPAL
SUPPLIER DATABASE FOR THE DIFFERENT INFRASTRUCTURE
PROJETCS/PROGRAM
Company / Closed Corporation Registration Number
Trading Name
Income tax reference number:
NOTICE NO 01/2017-18
GA-SEGONYNA LOCAL MUNICIPALITY
Telephone Number
Fax Number
Cellphone Number
(Please √ the relevant box)
YES NO
Y Y Y Y M M D D
Regional Levies Registration No:
YES NO
Supplier Group Detail: Type of Firm: (Please √ the relevant box)
Main Contact Person in Your Company:
Company Position
City
Code
E-mail Addres
TEL E-MAIL POSTPrefereed method Of Correspondence
Expiry Date:
VAT Registration No:
02
03
City
Code
Cell Phone Number
Fax Number
Municipal Services Account (latest) Attached
01
12
04
05
06
07
09
10
11
Name
Government / Parastatals
Tax Clearance Certificate Attached
Other ( Specify)
Public Compny (Ltd)
Private Company ( Pty) Ltd
Closed Corporation (CC)
Joint Venture
Consortium
08
Sole Proprieter
Foreign Company
Partnership
Trust
Section 21 Company
Other/ Alternative Contact Person in your Company:
Cell Phone Number
Name
Company Position
Fax Number
E-mail Addres
CIDB GRADING STATUS
Please use this table to determine for which programe you regsitering for.
Please √ only ONE COMMODITY
List all members of the Entity
Expiry Date
Rural Roads
Programme
Contractor Grade (i.e. 1CE PE/
4GB) CRS Number
Please √List of Returnable Documents
Original Valid Tax Clearence Certificate
Certified copies of the Identity Documents of Direcors and/ equity holders
B-BBEE Status Level Certificate (Original/ Certified)
Workman's Compesation Fund Certificate (Good Standing)
NHBRC Certificate
CIDB Grading Certificate
Company Profile
Vat Registration Form (where applicable)
UIF Registration Form (where applicable)
Company Registration (i.e.CK1, CoR 14.3)
Partnership Agreement (where applicable)
Joint Venture Agreement (where applicable)
Central Supplier Database For Government (CSD)
Name
Position Occupied in the
Enterprise Citizenship ID Number
Rural Water
Rural Sanitation
Declaration of any Conflict of Interest (compulsory)
I/We the undersigned acknowledge(s) that:
* The information Furnished is true and correct.
* Any conflict of interest will be declared in the comment space below
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
Comments / Notes:
* To be completed by all sub-contractors seeking registration as an approved sub-contractor;
* The form must be completed in full and be signed;
for the application form - all fields on application form must be completed by the applicant;
* It should be noted that Ga-Segonyana Local Municipality reserves the right to accept or reject
any application without being obliged to give any reasons in this respect
* Sub- contractors will not be notified whether appplication was accepted or not, but will be advises of the
outcome if telephonically requested
* Sub-contractors must comply with all the registration-criteria for registration to be finalised - failure to do
so may result in the application being declined.
* Please ensure to attach the following amongst other documents: CK1, CoR 14.3, Valid Tax Clearance Certificate,
Business Profile, Proof of Bank Account, Certified ID Copies of Equity Holders.
Sub- Contractor Details:
E-Mail Address:
Postal Address: Physical Address:
INVITATION TO LOCAL SUBCONTRACTORS TO REGISTER ON THE MUNICIPAL
SUPPLIER DATABASE FOR THE DIFFERENT INFRASTRUCTURE
PROJETCS/PROGRAM
Company / Closed Corporation Registration Number
Trading Name
Income tax reference number:
NOTICE NO 01/2017-18
GA-SEGONYNA LOCAL MUNICIPALITY
Telephone Number
Fax Number
Cellphone Number
(Please √ the relevant box)
YES NO
Y Y Y Y M M D D
Regional Levies Registration No:
YES NO
Supplier Group Detail: Type of Firm: (Please √ the relevant box)
Main Contact Person in Your Company:
Company Position
City
Code
E-mail Addres
TEL E-MAIL POSTPrefereed method Of Correspondence
Expiry Date:
VAT Registration No:
02
03
City
Code
Cell Phone Number
Fax Number
Municipal Services Account (latest) Attached
01
12
04
05
06
07
09
10
11
Name
Government / Parastatals
Tax Clearance Certificate Attached
Other ( Specify)
Public Compny (Ltd)
Private Company ( Pty) Ltd
Closed Corporation (CC)
Joint Venture
Consortium
08
Sole Proprieter
Foreign Company
Partnership
Trust
Section 21 Company
Other/ Alternative Contact Person in your Company:
Cell Phone Number
Name
Company Position
Fax Number
E-mail Addres
CIDB GRADING STATUS
Please use this table to determine for which programe you regsitering for.
Please √ only ONE COMMODITY
List all members of the Entity
Expiry Date
Rural Roads
Programme
Contractor Grade (i.e. 1CE PE/
4GB) CRS Number
Please √List of Returnable Documents
Original Valid Tax Clearence Certificate
Certified copies of the Identity Documents of Direcors and/ equity holders
B-BBEE Status Level Certificate (Original/ Certified)
Workman's Compesation Fund Certificate (Good Standing)
NHBRC Certificate
CIDB Grading Certificate
Company Profile
Vat Registration Form (where applicable)
UIF Registration Form (where applicable)
Company Registration (i.e.CK1, CoR 14.3)
Partnership Agreement (where applicable)
Joint Venture Agreement (where applicable)
Central Supplier Database For Government (CSD)
Name
Position Occupied in the
Enterprise Citizenship ID Number
Rural Water
Rural Sanitation
Declaration of any Conflict of Interest (compulsory)
I/We the undersigned acknowledge(s) that:
* The information Furnished is true and correct.
* Any conflict of interest will be declared in the comment space below
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
Comments / Notes:
* To be completed by all sub-contractors seeking registration as an approved sub-contractor;
* The form must be completed in full and be signed;
for the application form - all fields on application form must be completed by the applicant;
* It should be noted that Ga-Segonyana Local Municipality reserves the right to accept or reject
any application without being obliged to give any reasons in this respect
* Sub- contractors will not be notified whether appplication was accepted or not, but will be advises of the
outcome if telephonically requested
* Sub-contractors must comply with all the registration-criteria for registration to be finalised - failure to do
so may result in the application being declined.
* Please ensure to attach the following amongst other documents: CK1, CoR 14.3, Valid Tax Clearance Certificate,
Business Profile, Proof of Bank Account, Certified ID Copies of Equity Holders.
Sub- Contractor Details:
E-Mail Address:
Postal Address: Physical Address:
INVITATION TO LOCAL SUBCONTRACTORS TO REGISTER ON THE MUNICIPAL
SUPPLIER DATABASE FOR THE DIFFERENT INFRASTRUCTURE
PROJETCS/PROGRAM
Company / Closed Corporation Registration Number
Trading Name
Income tax reference number:
NOTICE NO 01/2017-18
GA-SEGONYNA LOCAL MUNICIPALITY
Telephone Number
Fax Number
Cellphone Number
(Please √ the relevant box)
YES NO
Y Y Y Y M M D D
Regional Levies Registration No:
YES NO
Supplier Group Detail: Type of Firm: (Please √ the relevant box)
Main Contact Person in Your Company:
Company Position
City
Code
E-mail Addres
TEL E-MAIL POSTPrefereed method Of Correspondence
Expiry Date:
VAT Registration No:
02
03
City
Code
Cell Phone Number
Fax Number
Municipal Services Account (latest) Attached
01
12
04
05
06
07
09
10
11
Name
Government / Parastatals
Tax Clearance Certificate Attached
Other ( Specify)
Public Compny (Ltd)
Private Company ( Pty) Ltd
Closed Corporation (CC)
Joint Venture
Consortium
08
Sole Proprieter
Foreign Company
Partnership
Trust
Section 21 Company
Other/ Alternative Contact Person in your Company:
Cell Phone Number
Name
Company Position
Fax Number
E-mail Addres
CIDB GRADING STATUS
Please use this table to determine for which programe you regsitering for.
Please √ only ONE COMMODITY
List all members of the Entity
Expiry Date
Rural Roads
Programme
Contractor Grade (i.e. 1CE PE/
4GB) CRS Number
Please √List of Returnable Documents
Original Valid Tax Clearence Certificate
Certified copies of the Identity Documents of Direcors and/ equity holders
B-BBEE Status Level Certificate (Original/ Certified)
Workman's Compesation Fund Certificate (Good Standing)
NHBRC Certificate
CIDB Grading Certificate
Company Profile
Vat Registration Form (where applicable)
UIF Registration Form (where applicable)
Company Registration (i.e.CK1, CoR 14.3)
Partnership Agreement (where applicable)
Joint Venture Agreement (where applicable)
Central Supplier Database For Government (CSD)
Name
Position Occupied in the
Enterprise Citizenship ID Number
Rural Water
Rural Sanitation
Declaration of any Conflict of Interest (compulsory)
I/We the undersigned acknowledge(s) that:
* The information Furnished is true and correct.
* Any conflict of interest will be declared in the comment space below
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
Comments / Notes:
* To be completed by all sub-contractors seeking registration as an approved sub-contractor;
* The form must be completed in full and be signed;
for the application form - all fields on application form must be completed by the applicant;
* It should be noted that Ga-Segonyana Local Municipality reserves the right to accept or reject
any application without being obliged to give any reasons in this respect
* Sub- contractors will not be notified whether appplication was accepted or not, but will be advises of the
outcome if telephonically requested
* Sub-contractors must comply with all the registration-criteria for registration to be finalised - failure to do
so may result in the application being declined.
* Please ensure to attach the following amongst other documents: CK1, CoR 14.3, Valid Tax Clearance Certificate,
Business Profile, Proof of Bank Account, Certified ID Copies of Equity Holders.
Sub- Contractor Details:
E-Mail Address:
Postal Address: Physical Address:
INVITATION TO LOCAL SUBCONTRACTORS TO REGISTER ON THE MUNICIPAL
SUPPLIER DATABASE FOR THE DIFFERENT INFRASTRUCTURE
PROJETCS/PROGRAM
Company / Closed Corporation Registration Number
Trading Name
Income tax reference number:
NOTICE NO 01/2017-18
GA-SEGONYNA LOCAL MUNICIPALITY
Telephone Number
Fax Number
Cellphone Number
(Please √ the relevant box)
YES NO
Y Y Y Y M M D D
Regional Levies Registration No:
YES NO
Supplier Group Detail: Type of Firm: (Please √ the relevant box)
Main Contact Person in Your Company:
Company Position
City
Code
E-mail Addres
TEL E-MAIL POSTPrefereed method Of Correspondence
Expiry Date:
VAT Registration No:
02
03
City
Code
Cell Phone Number
Fax Number
Municipal Services Account (latest) Attached
01
12
04
05
06
07
09
10
11
Name
Government / Parastatals
Tax Clearance Certificate Attached
Other ( Specify)
Public Compny (Ltd)
Private Company ( Pty) Ltd
Closed Corporation (CC)
Joint Venture
Consortium
08
Sole Proprieter
Foreign Company
Partnership
Trust
Section 21 Company
Other/ Alternative Contact Person in your Company:
Cell Phone Number
Name
Company Position
Fax Number
E-mail Addres
CIDB GRADING STATUS
Please use this table to determine for which programe you regsitering for.
Please √ only ONE COMMODITY
List all members of the Entity
Expiry Date
Rural Roads
Programme
Contractor Grade (i.e. 1CE PE/
4GB) CRS Number
Please √List of Returnable Documents
Original Valid Tax Clearence Certificate
Certified copies of the Identity Documents of Direcors and/ equity holders
B-BBEE Status Level Certificate (Original/ Certified)
Workman's Compesation Fund Certificate (Good Standing)
NHBRC Certificate
CIDB Grading Certificate
Company Profile
Vat Registration Form (where applicable)
UIF Registration Form (where applicable)
Company Registration (i.e.CK1, CoR 14.3)
Partnership Agreement (where applicable)
Joint Venture Agreement (where applicable)
Central Supplier Database For Government (CSD)
Name
Position Occupied in the
Enterprise Citizenship ID Number
Rural Water
Rural Sanitation
Declaration of any Conflict of Interest (compulsory)
I/We the undersigned acknowledge(s) that:
* The information Furnished is true and correct.
* Any conflict of interest will be declared in the comment space below
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
Comments / Notes:
* To be completed by all sub-contractors seeking registration as an approved sub-contractor;
* The form must be completed in full and be signed;
for the application form - all fields on application form must be completed by the applicant;
* It should be noted that Ga-Segonyana Local Municipality reserves the right to accept or reject
any application without being obliged to give any reasons in this respect
* Sub- contractors will not be notified whether appplication was accepted or not, but will be advises of the
outcome if telephonically requested
* Sub-contractors must comply with all the registration-criteria for registration to be finalised - failure to do
so may result in the application being declined.
* Please ensure to attach the following amongst other documents: CK1, CoR 14.3, Valid Tax Clearance Certificate,
Business Profile, Proof of Bank Account, Certified ID Copies of Equity Holders.
Sub- Contractor Details:
E-Mail Address:
Postal Address: Physical Address:
INVITATION TO LOCAL SUBCONTRACTORS TO REGISTER ON THE MUNICIPAL
SUPPLIER DATABASE FOR THE DIFFERENT INFRASTRUCTURE
PROJETCS/PROGRAM
Company / Closed Corporation Registration Number
Trading Name
Income tax reference number:
NOTICE NO 01/2017-18
GA-SEGONYNA LOCAL MUNICIPALITY
Telephone Number
Fax Number
Cellphone Number
(Please √ the relevant box)
YES NO
Y Y Y Y M M D D
Regional Levies Registration No:
YES NO
Supplier Group Detail: Type of Firm: (Please √ the relevant box)
Main Contact Person in Your Company:
Company Position
City
Code
E-mail Addres
TEL E-MAIL POSTPrefereed method Of Correspondence
Expiry Date:
VAT Registration No:
02
03
City
Code
Cell Phone Number
Fax Number
Municipal Services Account (latest) Attached
01
12
04
05
06
07
09
10
11
Name
Government / Parastatals
Tax Clearance Certificate Attached
Other ( Specify)
Public Compny (Ltd)
Private Company ( Pty) Ltd
Closed Corporation (CC)
Joint Venture
Consortium
08
Sole Proprieter
Foreign Company
Partnership
Trust
Section 21 Company
Other/ Alternative Contact Person in your Company:
Cell Phone Number
Name
Company Position
Fax Number
E-mail Addres
CIDB GRADING STATUS
Please use this table to determine for which programe you regsitering for.
Please √ only ONE COMMODITY
List all members of the Entity
Expiry Date
Rural Roads
Programme
Contractor Grade (i.e. 1CE PE/
4GB) CRS Number
Please √List of Returnable Documents
Original Valid Tax Clearence Certificate
Certified copies of the Identity Documents of Direcors and/ equity holders
B-BBEE Status Level Certificate (Original/ Certified)
Workman's Compesation Fund Certificate (Good Standing)
NHBRC Certificate
CIDB Grading Certificate
Company Profile
Vat Registration Form (where applicable)
UIF Registration Form (where applicable)
Company Registration (i.e.CK1, CoR 14.3)
Partnership Agreement (where applicable)
Joint Venture Agreement (where applicable)
Central Supplier Database For Government (CSD)
Name
Position Occupied in the
Enterprise Citizenship ID Number
Rural Water
Rural Sanitation
Declaration of any Conflict of Interest (compulsory)
I/We the undersigned acknowledge(s) that:
* The information Furnished is true and correct.
* Any conflict of interest will be declared in the comment space below
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
Comments / Notes:
* To be completed by all sub-contractors seeking registration as an approved sub-contractor;
* The form must be completed in full and be signed;
for the application form - all fields on application form must be completed by the applicant;
* It should be noted that Ga-Segonyana Local Municipality reserves the right to accept or reject
any application without being obliged to give any reasons in this respect
* Sub- contractors will not be notified whether appplication was accepted or not, but will be advises of the
outcome if telephonically requested
* Sub-contractors must comply with all the registration-criteria for registration to be finalised - failure to do
so may result in the application being declined.
* Please ensure to attach the following amongst other documents: CK1, CoR 14.3, Valid Tax Clearance Certificate,
Business Profile, Proof of Bank Account, Certified ID Copies of Equity Holders.
Sub- Contractor Details:
E-Mail Address:
Postal Address: Physical Address:
INVITATION TO LOCAL SUBCONTRACTORS TO REGISTER ON THE MUNICIPAL
SUPPLIER DATABASE FOR THE DIFFERENT INFRASTRUCTURE
PROJETCS/PROGRAM
Company / Closed Corporation Registration Number
Trading Name
Income tax reference number:
NOTICE NO 01/2017-18
GA-SEGONYNA LOCAL MUNICIPALITY
Telephone Number
Fax Number
Cellphone Number
(Please √ the relevant box)
YES NO
Y Y Y Y M M D D
Regional Levies Registration No:
YES NO
Supplier Group Detail: Type of Firm: (Please √ the relevant box)
Main Contact Person in Your Company:
Company Position
City
Code
E-mail Addres
TEL E-MAIL POSTPrefereed method Of Correspondence
Expiry Date:
VAT Registration No:
02
03
City
Code
Cell Phone Number
Fax Number
Municipal Services Account (latest) Attached
01
12
04
05
06
07
09
10
11
Name
Government / Parastatals
Tax Clearance Certificate Attached
Other ( Specify)
Public Compny (Ltd)
Private Company ( Pty) Ltd
Closed Corporation (CC)
Joint Venture
Consortium
08
Sole Proprieter
Foreign Company
Partnership
Trust
Section 21 Company
Other/ Alternative Contact Person in your Company:
Cell Phone Number
Name
Company Position
Fax Number
E-mail Addres
CIDB GRADING STATUS
Please use this table to determine for which programe you regsitering for.
Please √ only ONE COMMODITY
List all members of the Entity
Expiry Date
Rural Roads
Programme
Contractor Grade (i.e. 1CE PE/
4GB) CRS Number
Please √List of Returnable Documents
Original Valid Tax Clearence Certificate
Certified copies of the Identity Documents of Direcors and/ equity holders
B-BBEE Status Level Certificate (Original/ Certified)
Workman's Compesation Fund Certificate (Good Standing)
NHBRC Certificate
CIDB Grading Certificate
Company Profile
Vat Registration Form (where applicable)
UIF Registration Form (where applicable)
Company Registration (i.e.CK1, CoR 14.3)
Partnership Agreement (where applicable)
Joint Venture Agreement (where applicable)
Central Supplier Database For Government (CSD)
Name
Position Occupied in the
Enterprise Citizenship ID Number
Rural Water
Rural Sanitation
Declaration of any Conflict of Interest (compulsory)
I/We the undersigned acknowledge(s) that:
* The information Furnished is true and correct.
* Any conflict of interest will be declared in the comment space below
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
Comments / Notes:
* To be completed by all sub-contractors seeking registration as an approved sub-contractor;
* The form must be completed in full and be signed;
for the application form - all fields on application form must be completed by the applicant;
* It should be noted that Ga-Segonyana Local Municipality reserves the right to accept or reject
any application without being obliged to give any reasons in this respect
* Sub- contractors will not be notified whether appplication was accepted or not, but will be advises of the
outcome if telephonically requested
* Sub-contractors must comply with all the registration-criteria for registration to be finalised - failure to do
so may result in the application being declined.
* Please ensure to attach the following amongst other documents: CK1, CoR 14.3, Valid Tax Clearance Certificate,
Business Profile, Proof of Bank Account, Certified ID Copies of Equity Holders.
Sub- Contractor Details:
E-Mail Address:
Postal Address: Physical Address:
INVITATION TO LOCAL SUBCONTRACTORS TO REGISTER ON THE MUNICIPAL
SUPPLIER DATABASE FOR THE DIFFERENT INFRASTRUCTURE
PROJETCS/PROGRAM
Company / Closed Corporation Registration Number
Trading Name
Income tax reference number:
NOTICE NO 01/2017-18
GA-SEGONYNA LOCAL MUNICIPALITY
Telephone Number
Fax Number
Cellphone Number
(Please √ the relevant box)
YES NO
Y Y Y Y M M D D
Regional Levies Registration No:
YES NO
Supplier Group Detail: Type of Firm: (Please √ the relevant box)
Main Contact Person in Your Company:
Company Position
City
Code
E-mail Addres
TEL E-MAIL POSTPrefereed method Of Correspondence
Expiry Date:
VAT Registration No:
02
03
City
Code
Cell Phone Number
Fax Number
Municipal Services Account (latest) Attached
01
12
04
05
06
07
09
10
11
Name
Government / Parastatals
Tax Clearance Certificate Attached
Other ( Specify)
Public Compny (Ltd)
Private Company ( Pty) Ltd
Closed Corporation (CC)
Joint Venture
Consortium
08
Sole Proprieter
Foreign Company
Partnership
Trust
Section 21 Company
Other/ Alternative Contact Person in your Company:
Cell Phone Number
Name
Company Position
Fax Number
E-mail Addres
CIDB GRADING STATUS
Please use this table to determine for which programe you regsitering for.
Please √ only ONE COMMODITY
List all members of the Entity
Expiry Date
Rural Roads
Programme
Contractor Grade (i.e. 1CE PE/
4GB) CRS Number
Please √List of Returnable Documents
Original Valid Tax Clearence Certificate
Certified copies of the Identity Documents of Direcors and/ equity holders
B-BBEE Status Level Certificate (Original/ Certified)
Workman's Compesation Fund Certificate (Good Standing)
NHBRC Certificate
CIDB Grading Certificate
Company Profile
Vat Registration Form (where applicable)
UIF Registration Form (where applicable)
Company Registration (i.e.CK1, CoR 14.3)
Partnership Agreement (where applicable)
Joint Venture Agreement (where applicable)
Central Supplier Database For Government (CSD)
Name
Position Occupied in the
Enterprise Citizenship ID Number
Rural Water
Rural Sanitation
Declaration of any Conflict of Interest (compulsory)
I/We the undersigned acknowledge(s) that:
* The information Furnished is true and correct.
* Any conflict of interest will be declared in the comment space below
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
Comments / Notes:
* To be completed by all sub-contractors seeking registration as an approved sub-contractor;
* The form must be completed in full and be signed;
for the application form - all fields on application form must be completed by the applicant;
* It should be noted that Ga-Segonyana Local Municipality reserves the right to accept or reject
any application without being obliged to give any reasons in this respect
* Sub- contractors will not be notified whether appplication was accepted or not, but will be advises of the
outcome if telephonically requested
* Sub-contractors must comply with all the registration-criteria for registration to be finalised - failure to do
so may result in the application being declined.
* Please ensure to attach the following amongst other documents: CK1, CoR 14.3, Valid Tax Clearance Certificate,
Business Profile, Proof of Bank Account, Certified ID Copies of Equity Holders.
Sub- Contractor Details:
E-Mail Address:
Postal Address: Physical Address:
INVITATION TO LOCAL SUBCONTRACTORS TO REGISTER ON THE MUNICIPAL
SUPPLIER DATABASE FOR THE DIFFERENT INFRASTRUCTURE
PROJETCS/PROGRAM
Company / Closed Corporation Registration Number
Trading Name
Income tax reference number:
NOTICE NO 01/2017-18
GA-SEGONYNA LOCAL MUNICIPALITY
Telephone Number
Fax Number
Cellphone Number
(Please √ the relevant box)
YES NO
Y Y Y Y M M D D
Regional Levies Registration No:
YES NO
Supplier Group Detail: Type of Firm: (Please √ the relevant box)
Main Contact Person in Your Company:
Company Position
City
Code
E-mail Addres
TEL E-MAIL POSTPrefereed method Of Correspondence
Expiry Date:
VAT Registration No:
02
03
City
Code
Cell Phone Number
Fax Number
Municipal Services Account (latest) Attached
01
12
04
05
06
07
09
10
11
Name
Government / Parastatals
Tax Clearance Certificate Attached
Other ( Specify)
Public Compny (Ltd)
Private Company ( Pty) Ltd
Closed Corporation (CC)
Joint Venture
Consortium
08
Sole Proprieter
Foreign Company
Partnership
Trust
Section 21 Company
Other/ Alternative Contact Person in your Company:
Cell Phone Number
Name
Company Position
Fax Number
E-mail Addres
CIDB GRADING STATUS
Please use this table to determine for which programe you regsitering for.
Please √ only ONE COMMODITY
List all members of the Entity
Expiry Date
Rural Roads
Programme
Contractor Grade (i.e. 1CE PE/
4GB) CRS Number
Please √List of Returnable Documents
Original Valid Tax Clearence Certificate
Certified copies of the Identity Documents of Direcors and/ equity holders
B-BBEE Status Level Certificate (Original/ Certified)
Workman's Compesation Fund Certificate (Good Standing)
NHBRC Certificate
CIDB Grading Certificate
Company Profile
Vat Registration Form (where applicable)
UIF Registration Form (where applicable)
Company Registration (i.e.CK1, CoR 14.3)
Partnership Agreement (where applicable)
Joint Venture Agreement (where applicable)
Central Supplier Database For Government (CSD)
Name
Position Occupied in the
Enterprise Citizenship ID Number
Rural Water
Rural Sanitation
Declaration of any Conflict of Interest (compulsory)
I/We the undersigned acknowledge(s) that:
* The information Furnished is true and correct.
* Any conflict of interest will be declared in the comment space below
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
Comments / Notes:
* To be completed by all sub-contractors seeking registration as an approved sub-contractor;
* The form must be completed in full and be signed;
for the application form - all fields on application form must be completed by the applicant;
* It should be noted that Ga-Segonyana Local Municipality reserves the right to accept or reject
any application without being obliged to give any reasons in this respect
* Sub- contractors will not be notified whether appplication was accepted or not, but will be advises of the
outcome if telephonically requested
* Sub-contractors must comply with all the registration-criteria for registration to be finalised - failure to do
so may result in the application being declined.
* Please ensure to attach the following amongst other documents: CK1, CoR 14.3, Valid Tax Clearance Certificate,
Business Profile, Proof of Bank Account, Certified ID Copies of Equity Holders.
Sub- Contractor Details:
E-Mail Address:
Postal Address: Physical Address:
INVITATION TO LOCAL SUBCONTRACTORS TO REGISTER ON THE MUNICIPAL
SUPPLIER DATABASE FOR THE DIFFERENT INFRASTRUCTURE
PROJETCS/PROGRAM
Company / Closed Corporation Registration Number
Trading Name
Income tax reference number:
NOTICE NO 01/2017-18
GA-SEGONYNA LOCAL MUNICIPALITY
Telephone Number
Fax Number
Cellphone Number
(Please √ the relevant box)
YES NO
Y Y Y Y M M D D
Regional Levies Registration No:
YES NO
Supplier Group Detail: Type of Firm: (Please √ the relevant box)
Main Contact Person in Your Company:
Company Position
City
Code
E-mail Addres
TEL E-MAIL POSTPrefereed method Of Correspondence
Expiry Date:
VAT Registration No:
02
03
City
Code
Cell Phone Number
Fax Number
Municipal Services Account (latest) Attached
01
12
04
05
06
07
09
10
11
Name
Government / Parastatals
Tax Clearance Certificate Attached
Other ( Specify)
Public Compny (Ltd)
Private Company ( Pty) Ltd
Closed Corporation (CC)
Joint Venture
Consortium
08
Sole Proprieter
Foreign Company
Partnership
Trust
Section 21 Company
Other/ Alternative Contact Person in your Company:
Cell Phone Number
Name
Company Position
Fax Number
E-mail Addres
CIDB GRADING STATUS
Please use this table to determine for which programe you regsitering for.
Please √ only ONE COMMODITY
List all members of the Entity
Expiry Date
Rural Roads
Programme
Contractor Grade (i.e. 1CE PE/
4GB) CRS Number
Please √List of Returnable Documents
Original Valid Tax Clearence Certificate
Certified copies of the Identity Documents of Direcors and/ equity holders
B-BBEE Status Level Certificate (Original/ Certified)
Workman's Compesation Fund Certificate (Good Standing)
NHBRC Certificate
CIDB Grading Certificate
Company Profile
Vat Registration Form (where applicable)
UIF Registration Form (where applicable)
Company Registration (i.e.CK1, CoR 14.3)
Partnership Agreement (where applicable)
Joint Venture Agreement (where applicable)
Central Supplier Database For Government (CSD)
Name
Position Occupied in the
Enterprise Citizenship ID Number
Rural Water
Rural Sanitation
Declaration of any Conflict of Interest (compulsory)
I/We the undersigned acknowledge(s) that:
* The information Furnished is true and correct.
* Any conflict of interest will be declared in the comment space below
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
SIGNATURE OF OWNER OR DATE
AUTHORISED REPRESENTATIVE
Comments / Notes:
