Upload
buibao
View
219
Download
0
Embed Size (px)
Citation preview
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
Certification Application Form The goal of the SASDC is to facilitate sustainable business linkages between bona-fide, capable black enterprises and South
African Private Sector Corporations, State-owned Enterprises and Universities from its membership base.
A rigorous certification process to deter “front companies” has been created to verify Black ownership, control, management and transaction readiness.
T: +27 11 544 6000
NAME OF APPLICANT: _______________________________________________
DATE OF APPLICATION: __________________________
Certify & Connect [SOUTH AFRICAN SUPPLIER DIVERSITY COUNCIL]
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
Pag
e2
I n t roduc t ion The South African Supplier Diversity Council (SASDC) is a member-directed, not-for-profit organisation. It is the first of its kind in South Africa, and is affiliated with a global network of five supplier diversity councils. Members are like-minded private sector corporations, state-owned enterprises and universities that are committed to supplier diversity.
The SASDC seeks to be the leading corporate council in South Africa dedicated to promoting sustainable supplier diversity value-add, through targeted procurement and black supplier development. The Council enables members to practice supplier diversity as a strategic business objective, by:
establishing and maintaining a database of certified bona fide black suppliers for members to access,
sharing knowledge, experience and best practice in supplier diversity, and supporting member commitments in growing procurement and development opportunities for
black-owned suppliers.
The goal of the SASDC is to facilitate business to business linkages between its corporate members and bona-fide Black Owned Business Enterprises geared towards becoming long-term, qualified entities capable of competing in the national and international economic mainstream. The SASDC implements a rigorous black supplier certification process and maintains a database that is approved by the Council’s members as a collectively endorsed methodology and standard for assessing and certifying black suppliers with whom they would be prepared to transact. Applicant businesses that are successfully certified are loaded onto the SASDC Black Supplier Information System (BSISYS) database that:
Is owned, managed and maintained by the Council. Only contains bona-fide black suppliers that have been certified as “transaction-ready” to do business
with Council members. Is aligned with the supplier assessment and vetting processes that Council members would normally
undertake with all their new suppliers. Is aimed at reducing the cost and time that would be expended independently by each of the Council
members in the absence of such a database.
This application form is the first step that you need to take towards achieving SASDC certification as a bona-fide Black Supplier. Please ensure that you familiarize yourself with its content and understand what is expected from all applicants initiating certification requests.
What is a Bona-fide Black Owned Supplier?
For the purposes of certification as a bona fide black supplier by the SASDC, an applicant must meet the following
requirements:
OWNERSHIP: Not less than 51% of unfettered black shareholding (per related gazetted legislation).
CONTROL: Black owners enjoy control commensurate with their shareholding (per Companies Act and
principles of non-dilution and undue limitation of the rights of majority owners).
MANAGEMENT: Black managers are involved in running the business and demonstrate control/ authority that
is commensurate with their level (junior, middle, senior, top) and their functional responsibility. Where the
black owners are not directly involved in daily management, they must demonstrate control over the business
and the managers.
ESTABLISHED: Demonstrate that they have an established business capable of providing goods or services that
member corporations would be willing to buy.
Black Supplier Certification Application Form
_______________________________________________________________________________________
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
Strictly Confidential ©2010 SASDC. All rights reserved
Pag
e 3
Kindly note of the following in relation to this application form:
Mandatory Fields: Certain fields and documents are mandatory to certain business types only. Please
ensure that all fields relevant to your business type, which is marked “Mandatory Field”, have been
completed, and if a field is not applicable to your business, clearly mark it as N/A (Not applicable).
Required documents: Please ensure that all mandatory, requested documents are certified and
attached to your application form.
Completion of questions: All questions must be answered clearly with YES, NO, or N/A. Do not
leave any fields open. Please respond to all questions in the application form as incomplete forms will not be
processed.
Certified Documents: Please ensure that a Commissioner of Oaths has certified your Company
Registration Document, Proof of Shareholding Certificates, ID documents or other documents relevant to
your business type. The stamp of certification should be on the front of the document.
Copies of documents: Please keep copies of this application form and all supporting documentation
submitted, for your own records and to ensure that all data is maintained and up to date on a continuous
basis.
Owners, shareholders and Partners: Ensure that the percentage of ownership amounts to 100% and
that every field is fully completed for each of the business owners.
Certificate of correctness: Kindly ensure that the Certificate of Correctness is signed and dated once
all the required documents and information is ready to be submitted. Please also ensure that all pages have
been initialled by the applicant representative and signatory witnesses.
Submission Point: Completed registration forms and supporting documentation can be delivered to
the address as stated on the Applicant Instructions section of this application form.
Processing of registration: Your fully completed application will be processed, and once verified, will be approved and you will be issued with a Supplier Database Vendor Code to be used in all future communication with all of the role players. This letter of verification will be dispatched to the correspondence details supplied on the application form. Please note that this administration process will take a minimum of 5 days, once your registration has been included on the SASDC Vendor Database, your details will be accessible to the procurement department to all our corporate SA members. Please take careful note that submission of the application form does not guarantee certification. Successful certification is dependent on the complete application form and thereafter the compulsory site visit.
Business Opportunities: Kindly note that qualifying as a vendor does not in any way guarantee any persons, company, service provider vendor, etc. any business from the SASDC.
Amendments: Please notify SASDC of any changes to the verified information submitted.
Queries: Should you have any queries or need assistance in completion of the application forms,
kindly contact the Head: Relationship Services on 086 107 2732 or (011) 100 1025.
The main objective of this process is to enhance transparency and equality on the part of SASDC and to
facilitate effective communication with its members
SASDC Reserves the right to perform an audit to confirm or verify any of the answers supplied in the applications form.
Certify & Connect [SOUTH AFRICAN SUPPLIER DIVERSITY COUNCIL]
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
Pag
e4
App l i can t Ins t ruc t i ons
Please read this section carefully before completing the application form. Failure to complete it properly and to submit all essential information may result in processing delays or your application being rejected
A non refundable processing fee of R 1140.00 Inc of VAT is payable. Certification will be valid for period of 1(one) calendar year from the date of issue. Annual re-certification is compulsory, for a non-refundable re-certification fee of R500, The application fee must be paid into the following bank account:
o Account Name: South African Supplier Diversity Council (SASDC) o Name of Bank: ABSA o Branch Name & Code: 632005 o Current Account number: 9272300940 o Reference: Please use your company registration number as a reference
Answer all questions as completely as possible. If some questions do not apply to your business, please mark as N/A in the space provided. It is a condition of the certification process that an applicant’s taxes must be in order, or satisfactory
arrangements must have been made with the Receiver of Revenue to meet tax obligations. All copies of original documents must be stamped and signed by a bank or Commissioner of Oath. Construction companies must be registered with the CIDB and provide a copy of their certificates If the space provided for some answers are not adequate, use additional paper and cross-reference
accordingly. Ensure that the check list document that is attached at the end of the document is ticked off accordingly
Please complete the form in full in print, using black ink to ensure that all information is legible. Forms that are not readable or incomplete will be rejected.
Should you require any assistance with regard to completing this form please contact the Council on
08610 72732 or (011) 100 1025
The application form must be completed in full and returned in a sealed envelope, clearly marked as follows:
For Attention: The Certification Committee South Africa Supplier Diversity Council
Ground Floor, Block C Riverworld Park
53 Autumn Rd. (North Entrance) or 42 Homestead Rd. (South Entrance), Johannesburg, Rivonia
2128 ________________________________________________________________________________________
For Office Use:
Applicant Name: ...........................................................................................................................................................................
Received by: ................................................................................. Date Received: ....................................................................
Mode of Submission: By Hand By Courier Service By Registered Mail
Delivery Receipt No. / Waybill No. / Registered Mail Tracking No.: ..............................................................................................
Proof of Payment Provided: Deposit Slip EFT Download Reference No.: ....................................................................
Application CRM Reference Number: ___________________________________________
Finance Payment Confirmation: Invoice No.: .............................................. Receipt No.: .........................................................
Responsible Certification Officer: ................................................................................... Date Allocated: ...............................................................
Black Supplier Certification Application Form
_______________________________________________________________________________________
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
Strictly Confidential ©2010 SASDC. All rights reserved
Pag
e 5
Where did you hear about the South African Supplier Diversity Council?
Advertisement Internet (e.g. Google) Our website Public presentation Word of mouth Industry body
Other: Please elaborate: ____________________________________________________________________
Referred by: ________________ASTUTE ADVISORY______________________________________________
1. General Business Information:
1.1 (a) Company Registered Name: ______________________________________________________________
(b) Company Trading Name: _________________________________________________________________
1.2 Date Business Was Formed: ____________________________________________ _________________
1.3 Please tick only what applies to your business (a) Type of Business: (b) Legal Structure:
Manufacturer Sole Proprietor Construction Contractor Partnership Distributor Close Corporation Manufactures Rep Pty (Ltd) Consultancy/Professionals Trust Services Other
(c) Geographic Presence:
Gauteng Western Cape KwaZulu-Natal Northern Cape North West Province Limpopo Eastern Cape Free State Mpumalanga
1.4 Registration Number of Business: ____________________________________________ __ ______________
1.5 Physical Address: Street Name & Number: ________________________________ ______________________
Suburb & City: _______________________________ ____ Postal Code: __________ _____
1.6 Postal Address: P O Box: ___________________________________________ ______________________
Suburb & City: ___________________________________ Postal Code: ________________
1.7 Tel No: ______ ________________________
1.9 Fax No: ______________________________
1.8 E-mail: ____________ __________________
1.10 Website: _____________________________
1.11 Key Contact Person:
Name: __________________ ______ Title: ________________________________________
Cell: __________________________________ E-mail: _______________________________________
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
2. Ownership and Management Information
2.1 Provide the following information about the Proprietor, Partners, Members, Shareholders or Trust Beneficiaries:
Name ID Number Gender (M/F) 1Race (A,C,I,W) Date of Ownership % Shareholding or Ownership
Equity Contribution (Value)
% or no. of votes
2.2 List the management team responsible for executive and strategic Business decisions?
Name ID Number Gender (Male/Female)
Race (A,C,I,W) Designation in the Business Date of Appointment Into Position
2.5 Is Your Business BBBEE Certified: Yes No
Please Supply Your B-BBEE Level of Contribution: ____________________________ _ Copy of your certificate attached: Yes No
2.6 Declaration of other Business Interests by the Owner, Management Team or any other Employee from your business Yes No (If yes, please provide details on the agreements that you have with them regarding this declaration. Attach separately)
1 A – African C – Coloured I – Indian W – White (For certification qualification and additional statistical purposes)
Certify & Connect [SOUTH AFRICAN SUPPLIER DIVERSITY COUNCIL]
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
Pag
e7
3. Company Profile
3.1 Please provide a Brief Background of Your Company. Kindly provide this as a separate Annexure and Cross- Reference to this section. Please indicate in what format this has been provided
Company Profile Brochure Business Plan Typed Summary
3.2 Please indicate how the business originated:
Started New Business Franchise Bought Existing Business Long-standing Family-owned Business Other Merger or Consolidation Multinational Subsidiary
3.3 Please indicate Date when your business started trading: _____________________________________
3.4 Has Your Company Ever Been Blacklisted On Any Database? Yes No
If Yes Please Indicate By Whom: _______________________________________________________
3.5 Does Your Company Have Any Pending Lawsuits? Yes No
If Yes Please Indicate By Whom: _______________________________________________________
3.6 Has Your Company Ever Been Denied Any Form of Certification Yes No
If Yes Please Indicate By Whom: _______________________________________________________
3.7 Is you business registered with any Industry Body or Business Association? Yes No
If Yes please list and attach proof (e.g. Master Builders Association Certificate, etc):
________________________ ________________________________________________________
_____________________________________________________________________________________
3.8 Do you require a License/Permit to distribute certain products or conduct certain service?
If Yes, please provide the following and attach copy of current license/permit
Name of License/Permit Holder Type of License / Permit License / Permit No. Tick if Attached
3.9 If you are a Distributor, please provide the average value of stock held: R_____________________
3.10 If you are a Manufacturer, please list the Basic Equipment and indicate for each whether it is Leased or Owned.
Basic Equipment
_________________________________________________________ Owned Leased
_________________________________________________________ Owned Leased
_________________________________________________________ Owned Leased
Certify & Connect [SOUTH AFRICAN SUPPLIER DIVERSITY COUNCIL]
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
Pag
e8
_________________________________________________________ Owned Leased
_________________________________________________________ Owned Leased
3.11 If you Company Manufactures and Distributes Finished Goods, please indicate the value on hand at any given time.
Value: R _________________________________
3.12 In the space below, please give a concise description of company’s product(s), service(s). If your company offers more than one product/service, list primary product or service first. Use additional paper, if necessary, and attach to this form. The description below will be placed in our database and online directory.
3.13 From the list of products and services coded under Schedule A of this form, by order of preference, rank your offering by listing the applicable commodity reference code (e.g. “R102” to represent “Refrigeration”) in the table below:
Order of Preference
Commodity Code Order of
Preference Commodity Code
Order of Preference
Commodity Code
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
3.14 (a) Is you business premises Owned (attach proof of ownership, e.g. Bank Bond statement), or
Leased (attach copy of lease or rental agreement)
(b) Description of Premises:
Size of Land m2
Buildings:
Floor space for Administration m2
+ Floor space for Stock m2
+ Floor space for Business trading m2
= Total Floor Space m2
3.15 Please provide the following operational staff information:
Number of Managers: ____________________
Number of Supervisors: ____________________
Black Supplier Certification Application Form
_______________________________________________________________________________________
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
Strictly Confidential ©2010 SASDC. All rights reserved
Pag
e 9
Number of frontline and support staff: ____________________
Total Staff complement: ____________________
3.16 Please provide the following information, if applicable:
Vehicle Type (LDV, Truck, Sedan, etc) Load Capacity (Tonnes, passengers)
Owned or leased Age in Years How many?
3.17 Financial Accounts:
(a) Debtors Self-Operated Outsourced
If self operated please state software package used _______________________________________
If outsourced please state details thereof _______________________________________________
(b) Creditors Self-Operated Outsourced
If self operated please state package used _____________________________________________
If outsourced please state details thereof _____________________________________________
3.18 Management Information System:
(a) Inventory Management Manually Managed Software Driven
If manually managed please provide full details thereof ____________________________________
_________________________________________________________________________________
_________________________________________________________________________________
If software driven please provide full details thereof ______________________________________
(b) Orders (Inv/Receipts etc) Manually Managed Software Driven
If manually managed please provide full details thereof ____________________________________
_________________________________________________________________________________
_________________________________________________________________________________
If software driven please provide full details thereof _______________________________________
3.19 Please list the licenses/certifications (ISO 9000, ISO 14000, OSHAC,QMS etc) that you currently have for the
products that you either distribute or manufacture. These need to be valid.
_ _______________________________________
Certify & Connect [SOUTH AFRICAN SUPPLIER DIVERSITY COUNCIL]
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
Pag
e1
0
_______________________________________
_ _______________________________________
3.20 Does Your Company Share Any Resources With Any Other Firm Or Individual? Yes No
If Yes, Please provide ad explanation for this.
_____________________________________________________________________________________
_____________________________________________________________________________________
3.21 Identify Key Owners And Managers Responsible And Accountable For Policy, Decision Making, Performance
in the Following Functions
Operation/choice/logic?? Name Job Title Race (A,C,I,W)
Financial Decisions
Signatories On Major Documents
Personnel Management
Sales / Marketing
Payroll
Estimating/costing
Purchases Of Major Items
Supervision Of Ops
Type Of Jobs Company Will Undertake
3.22 In the space below, please give a brief overview of how and why you see your business growing in the next 3 to 5 years. If available, please attach a copy of your current business plan or strategic plan. This could be in an Excel or either Word document. If a budget has been prepared please provide evidence thereof, by attaching this.
Black Supplier Certification Application Form
_______________________________________________________________________________________
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
Strictly Confidential ©2010 SASDC. All rights reserved
Pag
e 1
1
4. Financial Information
4.1 (a) Please provide the following information on your company’s bank accounts and complete Annexure A for
each account listed.
Name Of Bank Branch
Type Of Account (Bond, Cheque, Credit Card, etc)
Credit Limit (if applicable)
1
2
3
4
5
(b) Please provide the following information on the levels of authority on operating your bank accounts
Name Of Bank
Type Of Account (Bond, Cheque, Credit Card, etc)
Name and ID no. Of Signatory On Cheques
Name and ID No.’s Of Person/s Authorized To Use
Internet Banking
1
2
3
4
5
4.2 Financial Reporting.
(a) Annual Turnover
2010 Actual
2011 Actual
2012 Actual
2013 Budgeted
2014 Forecast
2015 Forecast
R R R R R R
(b) Please specify the largest successful Tender/Order that your business has handled:
R_________________________ When: ______________________
(c) Please Provide The Company’s Financial Statements. Kindly tick the box below that indicates what has
been supplied.
Audited Financial Statements Signed Financials by Accounting Officer Management Accounts
(d) Indicate Whether Your Company Subscribes to the Following Credit Agencies:
TransUnion Experian XDS Other: _________________________________
(e) Complete VAT Registration Number: ________________________________________________
(f) Tax Clearance Certificate Furnished Yes No
Certify & Connect [SOUTH AFRICAN SUPPLIER DIVERSITY COUNCIL]
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
Pag
e1
2
(g) Certificate of Good standing: Compensation Commissioner Yes No
(h) Please provide information as to whether your company assets or debtors book has been ceded to any
financial institution. If yes kindly attach an annexure cross referencing to 4.2 (h) with full details of cession.
Yes No Amount R_______________ Company ___________________
Black Supplier Certification Application Form
_______________________________________________________________________________________
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
Strictly Confidential ©2010 SASDC. All rights reserved
Pag
e 1
3
5. References
5.1 Please provide Two Customer References.
a Business Name Of Customer
Name Of Contact Person
Physical Address
Telephone No
E-Mail Address
Commodity
Years Of Relationship
b Business Name Of Customer
Name Of Contact Person
Physical Address
Telephone No
E-Mail Address
Commodity
Years Of Relationship
5.2 Please provide Two Supplier References
a Business Name Of Customer
Name Of Contact Person
Physical Address
Telephone No
E-Mail Address
Commodity
Years Of Relationship
b Business Name Of Customer
Name Of Contact Person
Physical Address
Telephone No
E-Mail Address
Commodity
Years Of Relationship
Please ensure that the Contact Persons referenced above are aware that we will be calling them for a reference
check.
Certify & Connect [SOUTH AFRICAN SUPPLIER DIVERSITY COUNCIL]
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
Pag
e1
4
6. Declaration
Checklist of Supporting Documents to be Submitted No. Document to be submitted Yes/No/Not applicable
1 Proof of payment (application fee) Yes
2 Tax clearance certificate Yes
3 Company registration documents Yes
3 Financial statements for the years requested Yes No
4 Bank stamp on document Yes
5 Ownership of property details Yes No
6 Lease agreement details Yes No
7 List of vehicles used for delivery and other information required Yes No N/A
8 Example of a current logistic plan/model Yes No N/A
9 Business plan/strategy document Yes No
10 Brief description of the business Yes No
11 Certified copy of B-BBEE certificate & Report Yes No
12 Action plan for industrial disputes Yes No
13 Business organogram Yes No
14 Staff business interest declarations Yes No
15 Other additional Documentation Yes No
16 CIPRO Documentation Yes No
17 Copies of license’s or certification (e.g.) ISO/OHS/QMS etc Yes No
18 Copy of the ID and certificates of the directors/members as listed in
CM29/CK1
Yes No
19 Original cancelled cheque Yes No
20 A tax clearance certificate regarding Income Tax, Pay as you Earn(PAYE),
Unemployment Insurance Fund(UIF), skills Development Levy(SDL) and
Value added Tax(VAT from the Receiver of Revenue(SARS)
Yes No
The undersigned, who warrants that he / she is duly authorized to do so on behalf of the company, confirms that the information
provided in this application is true and correct.
I acknowledge, and save where stated otherwise, that the information is to the best of my belief both true and correct.
Full Name & Surname: ________________________________________________________________________
Signature: _________________________________________
Duly authorized to sign on behalf of: _____________________________________________________________
Designation: ________________________________________________________________________________
Cell phone: ______________________________ E-mail: _____________________________________
THUS DONE AND SIGNED AT ………………………………… ON THIS ……………………… DAY OF………………………………………………………………… 20.................
In the presence of the undersigned witnesses:
1. Name of Witness: ___________________________________________ Signature: ……………………………………
2. Name of Witness: ___________________________________________ Signature: ……………………………………
Black Supplier Certification Application Form
_______________________________________________________________________________________
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
Strictly Confidential ©2010 SASDC. All rights reserved
Pag
e 1
5
7. Non Disclosure
I, (print name)................................................................................................ of (company)…………………………………………………………………………………………
Do hereby and herewith 1.0 Acknowledge that I am/we are aware that, for any work undertaken for MEMBER CORPORATES (hereafter referred to as SASDC
MEMBERS and/or its subsidiaries during the course of negotiations, tendering or other pre-contract periods as well as, if applicable, any period of performance, I/We have or shall have confidential information as defined in paragraph 4.0 herein, disclosed to me/us, or that such information shall come to my/our knowledge.
2.0 undertake for and on behalf of myself/ourselves and my/our consultants, partners, members, associates, employees, contractors, sub-contractors, agents and sub-agents (as applicable), whether permanent or temporary, to make every effort to hold in trust and confidence all confidential information received and not to use, pass on, publish, disclose or in any manner make available any such confidential information to anyone without the prior written consent of SASDC.
3.0 undertake, on request by SASDC, to produce to it a Non-disclosure Undertaking in terms similar to this undertaking executed by each of my/our consultants, partners, members, associates, employees, contractors, sub-contractors, agents and sub-agents (as applicable), whether permanent or temporary.
4.0 Agree that “confidential information” shall mean:
4.1 All information disclosed to me/us or which comes to my/our knowledge, directly or indirectly:
4.1.1 as a result of or during my/our participation or assistance in the installation, commissioning, training, testing, setup, programming, repair, maintenance, or the execution of any other service, service of computers, access control equipment, card key codes or any ancillary or related equipment;
4.1.2 as a result of my/our receiving or having received any invitation to tender for any contract or attending or having attended any discussion relative to the installation, commissioning, training, of any other service, service of computers, access control equipment, card key codes or any ancillary or related equipment;
But subject at all times that the aforesaid provisions, shall not include information which:
4.1.2.1 at the time it was disclosed, was already known to me/us or was public knowledge, or thereafter became public knowledge other than through my/our default, or
4.1.2.2 Became known to me/us, without restriction as to its use and disclosure, from a third party with valid title thereto, or
4.1.2.3 was or is developed by or known to me/us and any of my/our consultants, partners, members, associates, employees, contractors, sub-contractors, agents or sub-agents, either before or subsequent to the disclosure of such information to me/us, such consultant, partners, associates, employees, contractors, sub-contractors, agent or sub-agent having no knowledge of the content of such disclosure.
5.0 undertake to disclose such confidential information only to those of my/our consultants, partners, members, associates, employees, contractors, sub-contractors, agents or sub-agents, whether permanent or temporary, who require knowledge of such information to enable the carrying out of any work directly or indirectly connected with the installation, commissioning, programming, repair, maintenance or the execution of any other service, service of computers, access control equipment, card key codes or any ancillary or related equipment.
6.0 undertake to refrain from using commercially, technically or otherwise confidential information without the prior written consent of SASDC.
7.0 undertake to report to SASDC any unauthorised disclosure, actual or threatened, of any confidential information that I/we may become aware of and to co-operate with SASDC in taking such action as may be deemed to be appropriate in the circumstances.
8.0 declare that I/we have read and understood the contents and provisions of this undertaking and that any breach of confidentiality by myself/ourselves and/or my/our consultants, partners, members, associates, employees, contractors, sub-contractors, agents or sub-agents, whether permanent or temporary, shall cause irreparable harm and give rise to claim by the injured party and/or SASDC against the offending party which will compensate such injured party for all loss, liability, damages or expenses arising out of or which may be attributable to:-
8.1 Any intentional or negligent disclosure of the confidential information
8.2 Any unauthorised use of confidential information
9.0 undertake not to use any Intellectual Property Rights belonging to the SASDC without written permission
THUS DONE AND SIGNED AT ………………………………… ON THIS ……………………… DAY OF…………………………………………………………………20.................
SIGNATURE: ………………………………………………………………………………………………….
In the presence of the undersigned witnesses.
1. ……………………………………………(Witness) 2. …………………………………………….(Witness)
Certify & Connect [SOUTH AFRICAN SUPPLIER DIVERSITY COUNCIL]
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
Pag
e1
6
ANNEXURE A
PROOF OF BANKING ACCOUNTS DECLARED
Name of Applicant:
Address:
(Hereinafter referred to as “the Applicant”)
The Applicant hereby declares proof and validity of the bank account as indicated below, with an original bank stamp
to verify the information set out below:
Account Number: Original Bank Stamp
Bank:
Branch Code: ____________________________________
Branch Name:
Type of Account:
Signed at on this day of 200
Signed on behalf of “the Applicant”
Full names:
In my capacity as
Please note that this form is to be completed for each of the bank accounts listed under
section 4.1 of this application form.
Black Supplier Certification Application Form
_______________________________________________________________________________________
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
Strictly Confidential ©2010 SASDC. All rights reserved
Pag
e 1
7
SCHEDULE A
Please Tick the Commodity or Service that your business provides
Tick box
Activity Code
Commodity/Service
- A100 - Accounting
- A101 - Air-conditioning
- A102 - Architecture
- A103 - Aviation
- A104 - Advertising
- A105 - Agriculture & Animal Products
- B100 - Bakery & products
- B101 - Banking
- B102 - Beverages
- B103 - Building Materials
- B104 - Buildings
- B105 - Books & training material
- C100 - Canteens & Catering Equipment
- C101 - Carpentry & fittings
- C102 - Cement & cement products
- C103 - Chemicals & Chemical products
- C104 - Civil works
- C105 - Clay & clay products
- C106 - Cleaning (& materials, detergents)
- C107 - Clothing & Textiles (not protective)
- C108 - Computers & Accessories
- C109 - Consultancy
- C110 - Corrosion protection
Tick box
Activity Code
Commodity/Service
- C111 - Concrete structures & products
- C112 - Custom clearance (Sales tax)
- D100 - Dental
- D101 - Design
- D102 - Drilling
- E100 - Earth works
- E101 - Education
- E102 - Electrical ( services)
- E103 - Electrical ( materials & fittings)
- E104 - Electrical ( power )supply
- E105 - Electronics
- E106 - Engineers
- E107 - Engineering
- E108 - Environment
- E109 - Explosives
- E110 - Engines (Gearboxes, Diffs.)
- E111 - Electrical “motor rewinding”
- F100 - Fencing
- F101 - Flooring
- F102 - Food (processed)
- F103 - Food (Fruit & vegetables) (animal products see MEAT)
- F104 - Footwear (non-safety)
- F105 - Fuels & Lubricants
Certify & Connect [SOUTH AFRICAN SUPPLIER DIVERSITY COUNCIL]
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
Pag
e1
8
Tick box
Activity Code
Commodity/Service
- F106 - Furniture & equipment (domestic)
- F107 - Furniture & equipment (office)
- F108 - Filters & Filtration
- F109 - Fire Services & Equipment
- G100 - Garage
- G101 - Gardening & Horticulture
- G102 - Gases ( Industrial & LP )
- G103 - Gases (Medical)
- G104 - Glass & glass products
- G105 - Gaskets, Sealants & Solutions
- H100 - Hardware
- H101 - Herbicide
- H102 - Hotel
- H103 - Hydraulics
- I100 - Instruments
- I101 - Insurance
- L100 - Land Surveying
- L101 - Leather & Leather products
- L102 - Legal
- L103 - Lifting & handling equipment
- M100 - Management & Supervision
- M101 - Machines, Machining & Tooling
- M102 - Meat
- M103 - Meat products
- M104 - Mechanical & Installation & Engineering
Tick box
Activity Code
Commodity/Service
- M105 - Medical
- M106 - Metal (non-steel)
- M107 - Metal fabricated products (non-steel)
- M108 - Mine equipment
- M109 - Mine machinery
- M110 - Mine plant
- O100 - Office equipment & machinery
- O101 - Opticians & Optical products
- O102 - Organisational Intervention
- P100 - Paint & colouring products
- P101 - Painting & decoration
- P102 - Paper and paper products
- P103 - Photographic
- P104 - Piping & piping products
- P105 - Plant (non-mining)
- P106 - Plastic products
- P107 - Plumbing, & Sanitary ware & fittings
- P108 - Printing and publishing
- P109 - Protective clothing & Textiles & Material (Safety)
- P110 - Pumps & Accessories
- P111 - Prefabricated & Mobile Structures
- P112 - Pneumatics
- P113 - Property Management
- P114 - Panel beating
- Q100 - Quarrying
Black Supplier Certification Application Form
_______________________________________________________________________________________
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
Strictly Confidential ©2010 SASDC. All rights reserved
Pag
e 1
9
Tick box
Activity Code
Commodity/Service
- Q101 - Quantity Surveying
- Q102 - Quality control & Material Testing
- R100 - Radio, TV & equipment
- R101 - Railways
- R102 - Refrigeration
- R103 - Restaurant / catering
- R104 - Roads / Parking
- R105 - Rubber & rubber products - (tyres, belts)
- S100 - Sandblasting
- S101 - Security
- S102 - Seed & grain
- S103 - Sewer supply & Equipment
- S104 - Stationery
- S105 - Steel & Iron
- S106 - Steel & Iron fabricated products
- S107 - Steel structures
- S108 - Stone & stone products
- S109 - Sheet metal works
- S110 - Signs
Tick box
Activity Code
Commodity/Service
- S111 - Solar Energy products & Services
- S112 - Safety & Occupational Health
- T100 - Technical (Engineers etc)
- T101 - Tele communication
- T102 - Timber Products (Wood)
- T103 - Timbers (Hard & soft wood)
- T104 - Tools (Electric & Fuel) & Equipment
- T105 - Tools (Hand) & Equipment
- T106 - Training & Manpower
- T107 - Travel
- V100 - Vehicles Loading (Heavy) - Transport, Sales & Spares
- V101 - Vehicles Loading (Light) - Transport, Sales & Spares
- V102 - Vehicles (Passenger) - Transport, Sales & Spares
- V103 - Vehicles Tractors & Loaders - Sales & Spares
- W100 - Water supply and equipment
- W101 - Wet trades - (brickwork, plaster, tiling)
- W102 - Welding
- W103 - Wax & Related Products
- W104 - Warehousing / Storage
Certify & Connect [SOUTH AFRICAN SUPPLIER DIVERSITY COUNCIL]
________________________________________________________________________________________________________________
This document is for the exclusive use of the SASDC. Any unauthorized dissemination or duplication is subject to legal action.
©2010 SASDC. All rights reserved Strictly Confidential
Pag
e2
0
Contac t de ta i l s :
S O U T H A F R I C A N S U P P L I E R D I V E R S I T Y C O U N C I L
G r o u n d F l o o r , B l o c k C
R i v e r w o r l d P a r k
5 3 A u t u m n R d ( N o r t h E n t r a n c e ) o r 4 2 H o m e s t e a d R d ( S o u t h
E n t r a n c e )
R i v o n i a
J o h a n n e s b u r g
2 1 2 8
R e p u b l i c o f S o u t h A f r i c a
T e l : + 2 7 ( 0 ) 8 6 1 0 S A S D C 7 2 7 3 2
E m a i l : [email protected]
W e b s i t e : www.sasdc.org.za
https://twitter.com/sdcsouthafrica
www.facebook.com/pages/SASDC-South-African-Supplier-Diversity-Council
http://za.linkedin.com/in/sasdc
www.sasdc.org.za/index.php?format=feed&type=rss