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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.: (041) 398 3200
E-mail: [email protected]
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.
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 SANRALS 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.: (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.
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.
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 6.1: Preference Points Claim Form 4. Completed and Signed SBD 8: Bidders 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. Company Profile
10. Vendor Application Form
APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN
REGION
Supplier Database
1. BUSINESS PARTICULARS
1.1. Name Of Business As Registered With The Registrar Of Companies/Close Corporations
Business registration number:
NB: Attach copy of business registration certificate
1.2. Service providers core business (what is the principle business)
1.3. VAT registration number:
NB: Attach Original Tax Clearance Certificate Tax Clearance Certificate Expiry Date
Income Tax Reference Number:
1.4. Postal Address: Physical Address:
Postal Code Postal Code
1.5. Telephone No: Fax No:
1.6. Cell. No.
1.7. E-Mail Address:
1.8. Contact Person:
APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN
REGION
Supplier Database
1.9 Name of person authorised for signing:
Capacity under which the application is signed:
Date signed:
Signature:
2. 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. 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. PREVIOUS EXPERRIENCE / TRACK RECORD
List the most important contracts/assignments completed by your firm in the last three years. Service providers Relevant Experience minimum 3 years public sector experience.
WORK PERFORMED
FOR WHOM
CONTACT PERSON AND TELEPHONE NUMBERS
8. SUPPLIERS OF THE FOLLOWING PRODUCTS/SERVICES ARE REQUIRED TO REGISTER ON THE DATABASE.
PLEASE MARK THE MAIN SERVICES YOUR COMPANY SUPPLIES:
TYPE
SERVICES / GOODS TICK RELEVANT BOX
SUPPLIERS
Office Stationery Office Furniture Office Equipment Office Groceries Other Office Supplies (crockery, cutlery, etc.)
SERVICES Catering Services Printing & Binding Shuttle Services Florists
HEALTH AND SAFETY
Fire Extinguishers First Aid Supplies
OTHER SERVICES General Repairs (Handyman) Cleaning products
APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN
REGION
Supplier Database
9. TEAM STRUCTURE Personnel Complement (Add separate sheet to list all personnel)
No
First Name
Surname
Male/Female
Position
Accreditation
Relevant Experience(years)
Geographical Location where service is available
APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN
REGION
Supplier Database
APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN
REGION
Supplier Database
SBD 4 DECLARATION OF INTEREST
1. Any legal person, including persons employed by the state, or persons having a kinship with
persons employed by the state, including a blood relationship, may make an offer or offers in terms of this invitation to bid (includes a price quotation, advertised competitive bid, limited bid or proposal). In view of possible allegations of favouritism, should the resulting bid, or part thereof, be awarded to persons employed by the state, or to persons connected with or related to them, it is required that the bidder or his/her authorised representative declare his/her position in relation to the evaluating/adjudicating authority where-
- the bidder is employed by the state; and/or - the legal person on whose behalf the bidding document is signed, has a relationship
with persons/a person who are/is involved in the evaluation and or adjudication of the bid(s), or where it is known that such a relationship exists between the person or persons for or on whose behalf the declarant acts and persons who are involved with the evaluation and or adjudication of the bid.
2. In order to give effect to the above, the following questionnaire must be completed and
submitted with the bid. 2.1 Full Name of bidder or his or her representative: . 2.2 Identity Number: 2.3 Position occupied in the Company (director, trustee, shareholder): .. 2.4 Company Registration Number: ... 2.5 Tax Reference Number: . 2.6 VAT Registration Number: ....
2.6.1 The names of all directors / trustees / shareholders / members, their individual identity
numbers, tax reference numbers and, if applicable, employee / persal numbers must be indicated in paragraph 3 below.
State means (a) any national or provincial department, national or provincial public entity or constitutional
institution within the meaning of the Public Finance Management Act, 1999 (Act No. 1 of 1999); (b) any municipality or municipal entity; (c) provincial legislature; (d) national Assembly or the national Council of provinces; or (e) Parliament. Shareholder means a person who owns shares in the compa