APPLICATION FOR REGISTRATION (ZNT 31) - Ilembe DISTRICT MUNICIPALITY DATABASE... · 1 application for registration ilembe district municipality database kwazulu-natal these forms

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APPLICATION FOR REGISTRATION

ILEMBE DISTRICT MUNICIPALITY

DATABASE

KwaZulu-Natal

THESE FORMS MUST BE COMPLETED AND SUBMITTED TO:

SUPPLY CHAIN MANANAGEMENT OFFICE GROUND FLOOR

ILEMBE TECHNICAL SERVICES BUILDING

12 HAYSOM ROAD

KWA DUKUZA

4450

OR POSTED TO :

SUPPLY CHAIN MANAGEMENT (DEPARTMENT)

P. O BOX 1788

KWADUKUZA

4450

ENQUIRIES :

Tel: 032-5518753 /032 5518757

FOR OFFICIAL PURPOSES ONLY

NAME OF SUPPLIER: .....................................................................................

REGISTRATION NUMBER: ......................................................................................

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INTRODUCTION AND GUIDELINES

The form was specifically designed to provide for the registration of suppliers on the Ilembe District Municipality

Suppliers Database. In order to ensure that suppliers are considered legitimate tenderers, it is

imperative that the following guidelines are adhered to.

Applicants must complete pages 2 to 8, where applicable. Failure by an applicant to provide ALL

relevant information and documents required will result in non-registration. If the information required is

not applicable to your business; clearly insert the symbols “N/A” in the appropriate space. If the space

provided is left blank, it will be regarded as information that is still outstanding and you WILL NOT be

registered.

Applicants are advised that only ORIGINAL IDM or PHOTOSTAT copies thereof will be processed. Any

Document that has been retyped or redrafted will be disregarded and returned to the applicant.

It is imperative that only documents with an ORIGINAL signature be submitted.

All signatures to the document must be commissioned by an authorized Commissioner of Oaths. Failure

to do so will result in the applicant not qualifying for registration.

A supplier registered on the Suppliers Database MUST notify the Supply Chain Management Office of any

changes to information provided in the initial IDM . Failure to do so may result in such a supplier being

removed from the Suppliers Database and/or the cancellation of contracts awarded to the supplier, on

the basis of misrepresentation.

Suppliers providing information incorrectly or fraudulently in their IDM will be disqualified from tendering

and removed from the Suppliers Database, in addition to any other action the Council may institute

against such a supplier. Further, in the event of the Council being prejudiced financially, it reserves the

right to take legal action against the supplier.

For definitions of terminology used in this document, please refer to the definitions set out in regulation 1

of the Procurement Regulations, 2001, obtainable from the SCM Office or website.

Any alterations made by the tenderer must be initialed. The use of correcting fluid is prohibited and the

use thereof will lead to non-registration of the applicant business.

Electronic forms are available on the website: www.ilembedistrictmunicipalitygov.za

APPLICATION FOR REGISTRATION ON ILEMBE DISTRICT MUNICIPALITY SUPPLIERS DATABASE

(The following information must be filled in by the applicant. Failure to submit ALL the required

information may lead to non-registration of the applicant business)

1. BUSINESS PARTICULARS:

1.1 Name of Business as registered with the Registrar of Companies/Close Corporations

________________________________________________________________________________________________

1.2 Name of business used for TRADING purposes, if different from 1.1 or name of business if business is

not registered with the Registrar

________________________________________________________________________________________________

1.3 Registration Number as registered with the Registrar of companies/close corporations (if

applicable):

____________________________________________

1.4 Postal address

________________________________________________________________________________________________

________________________________________________________________________________________________

Postal Code: _____________________

http://www.ilembedistrictmunicipalitygov.za/

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Physical address

________________________________________________________________________________________________

________________________________________________________________________________________________

Postal Code: ____________________

Telephone no. : (______) _______________________ Fax no.: (______) _________________________________

Cell. no. : ___________________________________

E-mail address (if available): _____________________________________________________________________

Preferred method of Communication: Email Fax Post

1.5 Contact person: ____________________________________________________________________________

1.6 Physical location of Head Office (if applicable) ________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

1.7 Unemployment Insurance Fund no. (if applicable) : ____________________________________________

1.8 Compensation Commissioner registration no. (If applicable): ___________________________________

1.9 Income Tax Reference Number : ______________________________________________________________

N.B. *Insert personal income tax no. if a one person business (Sole Proprietor) and Personal Income

Tax Numbers of all partners in a partnership. If insufficient space kindly attach information with

original signature.

1.10 P.A.Y.E. Number (if applicable) _______________________________________________________________

N.B. COPIES OF REGISTRATION CERTIFICATES FOR 1.7 AND 1.8 MUST BE SUPPLIED

(If you cannot provide these certificates, kindly attach explanation)

2. BANKING DETAILS

2.1 Name of banking institution: _________________________________________________________

2.2 Branch Name: ______________________________________________________________________

2.3 Branch Code: __________________________________________________________________________

2.4 Banking account number: ___________________________________________________________

2.5 Account Holder (Name under which account is operated):

_________________________________________________________________________________________

N. B. A COPY OR ORIGINAL BANK STATEMENT NOT OLDER THAN 60 DAYS MUST BE SUPPLIED.

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3. TYPE OF BUSINESS

3.1 Tick whichever block is applicable to your business or firm and attach the relevant certified copy.

PUBLIC COMPANY LTD CERTIFIED COPY OF CERTIFICATE OF

INCORPORATION (CM 3)

PRIVATE COMPANY (PTY) LTD CERTIFIED COPY OF CERTIFICATE OF

INCORPORATION (CM 3)

CLOSE CORPORATION CC CERTIFIED COPY OF CK 1 DOCUMENT AND CK

2 IF APPLICABLE

SOLE PROPRIETOR CERTIFIED COPY OF I.D. DOCUMENT

PARTNERSHIP CERTIFIED COPY OF PARTNERSHIP AGREEMENT

TRUST CERTIFIED COPY OF TRUST DOCUMENT

CO-OPERATIVE CERTIFIED COPY OF PROOF OF REGISTRATION

WITH

THE DIRECTORATE CO-OPERATIVES

VOLUNTARY ASSOCIATIONS

CERTIFIED COPY OF CONSTITUTION

4. PREVIOUS BUSINESS INFORMATION

4.1 Did your business exist under a previous name? (Answer to be encircled) Yes or No

_________________________

4.2 If “yes” what was the previous business name?

_____________________________________________________________________________________________

4.3 Why was the name changed?

________________________________________________________________________________________________

________________________________________________________________________________________________

4.4 Previous Suppliers Database registration number: _____________________________________________

4.5 Who were the owners, partners, members or shareholders?

NAME TITLE

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5. BUSINESS CLASSIFICATION FOR KWAZULU NATAL SUPPLIER DATABASE (M A N D A T O R Y)

Please tick appropriate classification /type (only ONE)

CODE CLASSIFICATION

D100 Supplier

D200 Main Contractor

D300 Sub-contractor

D400 Labour-only Contractor

D500 Consultant

D600 Manufacturer

D700 Professional Services

D800 Education,Development,Training

5.1 CLASSIFICATION OF BUSSINESS AND CATEGORY*

Please tick the appropriate

COMMODITY CODE COMMODITY DESCRIPTION

D101 Stationery

D102 Printing

D103 Cleaning materials

D104 Cleaning equipment

D105 Vehicle maintenance & repairs

D106 Office maintenance

D107 Office equipment

D108 Catering

D109 Office furniture

D110 Computer hardware, software, development

D111 Network solutions etc

D112 Travel agent, conference facilities

D113 Accommodation and car rental

D114 Courier services

D115 Media/publicity/advertising

D116 Promotional materials

D117 Vehicle purchasing

D118 Office maintenance

D119 Insurance brokers

D120 Computer accessories

D121 Consumables

D122 Entertainment

D123 Publishing

D124 Books

D125 Fuel, oil, tyres and gas

D126 Auctioneers

D127 Security Services

D128 Pest control

D129 Painting

D130 Plumbing

D131 Electrical Repairs

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D132 Renovations

D133 Fumigation

D134 Carpet Cleaning

D135 Car Wash

D201 Training and development

D202 Organisational development

D203 Legal compliance

D204 Job evaluation

D205 Industrial relations training

D301 Health, safety and environment

D302 Health services

D303 Medical Consumables

D304 Medical instruments

D305 Linen, pillows and blankets

D401 Corporate Finance.

D402 Financial Management

D403 Tax Consulting Services

D404 Audit consulting services

D405 Payroll systems consulting

D406 Financial systems consulting

D407 Banking Services

D501 Sockets

D502 Valves

D503 Wire

D504 Tees, couplings, ferrules etc

D505 Tubes

D506 Hose taps

D507 Packings

D508 Water meters

D509 Miscellaneous water equipment

D601 Bolts & nuts

D602 Building material

D603 Nails

D604 Locks

D605 Cement

D606 Tools

D607 Pipes & accessories

D608 Window glass

D609 Corrugated iron

D610 Other specify

D701 Building contractors

D702 Consulting engineers

D703 Electrical engineers

D704 Mechanical engineers

D705 Land surveyors

D706 Architects

D707 Water treatment chemicals

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D708 Telemetry systems& maintenance

D709 Plant hire

D710 Safety equipment

D711 Town & development planning

D712 Environmental

D713 Strategic planning

D714 Economic development

Our core business is: _________________________________________________________________

Products/Services: ___________________________________ ______________________________________

___________________________________ _______________________________________

___________________________________ ________________________________________

___________________________________ ________________________________________

5.2 INDICATE VALUE FOR THE FOLLOWING BASED ON THE LATEST FINANCIAL STATEMENT

5.2.1 Total Fixed Assets @ Book Value (e.g land, buildings, plant, equipment,

vehicles) R _____________

5.2.2 Vehicles @ Book value R _____________

Number of vehicles _____________

5.2.3 Average stock on hand R _____________

5.2.4 Cost of goods produced annually R _____________

Quantity produced annually _____________

Units of measure (e.g. tons, kilolitres) _____________

5.2.5 Total Current assets (e.g. stock, debtors, cash) R _____________

Total Current liabilities (e.g. creditors, bank overdraft) R _____________

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6. BUSINESS INFORMATION

THE FOLLOWING TABLE MUST BE COMPLETED IN ORDER TO ESTABLISH WHETHER A BUSINESS CAN BE CLASSIFIED AS AN SMME IN TERMS OF THE NATIONAL SMALL

BUSINESS ACT 102 OF 1996. SELECT THE SECTOR AND TICK THE APPROPRIATE BLOCKS IN COLUMN 2, 3 AND 4.

COLUMN 1 COLUMN 2 COLUMN 3 COLUMN 4

Sector or sub-sectors in accordance with

the Standard Industrial Council

Total full time equivalent of

paid

employees

TICK WHERE APPLICABLE

Total annual turnover

TICK WHERE APPLICABLE

Total gross asset value (fixed

property

excluded). TICK WHERE APPLICABLE

Agriculture

MORE THAN 100 MORE THAN R 5m MORE THAN R 5m

LESS THAN 100 LESS THAN R 5m LESS THAN R 5m

Mining and Quarrying



Manufacturing


LESS THAN 200 LESS THAN R 51m LESS THAN R19m

Electricity, Gas and Water



Construction



Retail, Motor Trade and Repair Services



Wholesale Trade,Commercial Agents &

Allied Services

MORE THAN 100 MORE THAN R 64m MORE THAN R10m


Catering, Accomodation & Other Trade



Transports, Storage and Communications

MORE THAN 100 MORE THAN R 26 m MORE THAN R 6m


Finance and Business services



Community ,Social & Personal Services

MORE THAN 100 MORE THAN R13m MORE THAN 6m

LESS THAN 100 LESS THAN R13m LESS THAN R 6m

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7. PROPRIETORS /SHAREHOLDERS/PARTNERS/SOLE PROPRIETORS/TRUSTEES/BENEFICIARIES (OWNER)

7.1 List all persons who are OWNERS (as listed above), in the business/trust, and indicate their involvement in the management/operations of the

business/trust.

7.2 PROOF OF DISABILITY PROVIDED BY A RECOGNISED RELATED INSTITUTION, IN THE CASE OF HANDICAPPED PERSONS, MUST BE SUPPLIED.

7.3 If insufficient space, kindly attach a copy/copies of this page to this form, signed by the same person who signs on behalf of the business/trust on

page 6 hereof.

BUSSINESS OWNERSHIP

FULL NAME ID NUMBER SA

CITIZEN

YES /NO

SA

CITEZEN

BEFORE

27 APRIL

1994

YES/NO

CAPACITY:

MEMBER/PARTNER

/ SHAREHOLDERS/

TRUSTEE, etc

% OWNERSHIP/

PARTNERSHIP/

TRUST/ INTEREST

HDI

YES/NO

MALE /

FEMALE

HANDICAPPED YOUTH

OWNED

YES/NO

% OF

TIME

DEVOTED

TO THE

FIRM

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8. PREVIOUS EXPERIENCE (IF APPLICABLE)

List the last 4 contracts awarded to you (the supplier) or other previous experience related to your

core business.

EMPLOYER

/DEPARTMENT

CONTACT PERSON

and TELEPHONE

NO.

CONTRACT

VALUE IN RAND

COMPLETED

SUCCESSFULLY

YES /NO

YEAR

9. PLEASE INDICATE ANY OWNER WHO HAS A CONTROLLING OWNERSHIP INTEREST IN ANOTHER BUSINESS

NAME OF OWNER NAME AND

ADDRESS OF

OTHER BUSSINESS

POSITION HELD % OF OWNWERSHIP TYPE OF BUSINESS

10. IDENTIFY BY NAME, HDI STATUS AND LENGTH OF SERVICE, THOSE INDIVIDUALS IN THE FIRM

(INCLUDING OWNERS AND NON OWNERS) RESPONSIBLE FOR DAY TO DAY MANAGEMENT AND

BUSINESS DECISIONS.

NAME HDI STATUS

(YES /NO)

LEGTH OF SERVICE

(YEARS)

CHEQUE SIGNING

SIGNING AND CO-SIGNING

FOR LOANS

BUSINESS FINANCE (overdraft,

lease agreements)

SURETIES

APPROVAL MAJOR PUCHASES

OR ACQUISITIONS

SIGNING CONTRACTS

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DECLARATION: CONFLICT OF INTEREST *

Are any members or shareholders of the business:

a) employed by iLembe District Municipality; or b) in the service of the state?

□ Yes □ No

NOTE: “in the service of the state” means –

a) a member of -

i) any municipal council; ii) any provincial legislature; or iii) the National Assembly or the National Council of Provinces;

b) a member of the board of directors of any municipality entity;

c) an official of any municipality or municipal entity;

d) any employee of 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)

e) a member of the accounting authority of any national or provincial public entity; or

f) an employee of Parliament or a provincial legislature.

If “YES” please state the nature of the relationship

Employee Name: ________________________

Salary Number: _______________________

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11. VERIFICATION OF INFORMATION SUPPLIED RELATING TO PREFERENCES THAT THE

APPLICANT(BUSINESS) MAY APPLY FOR

I/WE, THE UNDERSIGNED, WHO WARRANTS THAT HE/SHE IS DULY AUTHORISED TO DO SO ON BEHALF OF

THE SUPPLIER, CERTIFIES THAT THE INFORMATION SUPPLIED IN TERMS OF THIS DOCUMENT (ZNT 31)

INCLUDING THE ANNEXURE/S WITH ADDITIONAL INFORMATION, IS CORRECT AND ACCURATE AND

ACKNOWLEDGES 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 Council may, in addition to any

remedies it may have:

i. Disqualify the supplier/contractor for a particular tender/contract/project it may be

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

ii. Recover from the supplier/contractor all costs, losses or damages incurred or sustained by the

Council as a result of breach of the contract;

iii. Cancel the contract and claim any damages which the Province may suffer by having to

make less favourable arrangements after such cancellation: and/or;

iv. iv. De-register the supplier registered on the Supplier Database

SIGNED ON THIS _________ DAY OF _________________20________ AT _________________________________

BEFORE THE COMMISSIONER OF OATHS

___________________________________________

SIGNATURE OF AUTHORIZED REPRESENTATIVE

____________________________

NAME IN BLOCK LETTERS

SUPPLIER’S NAME: ________________________________________________________________________

Signed and affirmed to, before me at, _____________________________________________ on this

__________day of ___________________ year ___________, by the deponent who has acknowledged that

he/she knows and understands, the contents of this document, and he/she has acknowledged that

he/she has no objection to affirming, that he/she regards the affirmation to be binding on his/her

conscience.

____________________________

COMMISSIONER OF OATHS

FULL NAME:

____________________________________________________________________________________________________

BUSINESS ADDRESS :

____________________________________________________________________________________________________

CAPACITY : ___________________________________________________

AREA : ________________________________________________________

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* MANDATORY INFORMATION

ANNEXURE “A”

Required document checklist

Please ensure that all documentation listed below is attached (where applicable) to the registration

form.

Document Name Attached

Duly completed suppliers database form □

Company Registration Documents □

Certified copies of Identity Documents of directors/owners/members/shareholders □

Banking Details and attach the recent bank statement □

Original Valid Tax Clearance Certificate □

Latest statements or bills on municipal services charges (electricity, water and sanitation,

rates etc). □

Compensation of Occupational Injuries and Diseases (COID)Registration Certificates(if applicable )□

All relevant registration certificate pertaining to your business, incl. but not limited to (if applicable)

NHBRC Registration Certificate □

CIDB Registration Certificate □

SETA Registration □

SAQA pertaining to business sector □

Trade test certificates □

SOB Registration □

Membership certificates for professional services □

FOR OFFICE USE ONLY

RECEIPT NO: _______________________________________

CAPTURED BY: _____________________________________

CHECKED BY: ______________________________________

VERIFIED BY: ______________________________________