Form No. SCM-FO-001

ITHALA DEVELOPMENT FINANCE CORPORATION LIMITED

MAKING IT HAPPEN TOGETHER

SUPPLIER DATABASE REGISTRATION

INVITATION TO PROSPECTIVE SUPPLIERS AND SERVICE PROVIDERS TO APPLY FOR REGISTRATION ON THE ITHALA SUPPLIER DATABASE AND UPDATING OF SUPPLIER

DETAILS

In terms of the Supply Chain Management Policy of Ithala, Ithala may only procure goods and services from suppliers that are listed on Ithala‟s accredited list of suppliers. Ithala Development Finance Corporation Limited invites prospective suppliers and service providers to be listed on their Supplier Database. The purpose is to give all prospective suppliers and service providers an equal opportunity to submit quotations to supply goods and services to Ithala‟s respective offices and branches. The preferred suppliers and service providers database will be updated annually. Suppliers and service providers are urged to update their details as and when necessary to comply with Legislative Requirements. Application forms for service providers to be enlisted on Ithala‟s accredited list of suppliers are obtainable from the following addresses : Corporate Services Centre 17 Isilo Drive, V Section, Umlazi Ithala Limited 15th Floor, Old Mutual Building, 303 Dr Prixley Kaseme Street, Durban Or any of the branches in KwaZulu Natal and the Ithala website www.ithala.co.za The categories and special submission requirements per category are listed on the prescribed forms. Submission Requirements

Only the 5 CORE business must be stated

All applications must be on the standard template.

Detail submission requirements are contained in the application document.

No e-mailed or faxed submissions will be accepted.

Suppliers and service providers who have previously submitted profiles and completed registration forms must submit their updated information only – e.g. current BBBEE and Tax Clearance Certificate.

Only submissions that comply with all the requirements and submitted by the closing date and time will be listed on our database.

Queries in respect of this registration should be addressed to Suesheila Singh in writing on e-mail ssingh@ithala.co.za.

No briefing sessions will be held and Ithala reserves the right to conduct site visits where deemed necessary. Application forms must be returned to Ithala Corporate Services Centre Offices, 17 Isilo Drive, V Section, Umlazi,.

ITHALA DEVELOPMENT FINANCE CORPORATION LIMITED

TO ALL SUPPLIERS AND SERVICE PROVIDERS SEEKING REGISTRATION AS AN APPROVED SUPPLIER OR SERVICE PROVIDER ON THE DATABASE OF ITHALA DEVELOPMENT FINANCE CORPORATION LIMITED. New suppliers are herewith invited to register as an approved supplier on the database of Ithala. Existing suppliers may obtain their vendor numbers and provide updated documents e.g. Tax Clearance and Broad Based Black Economic Empowerment (BBBEE) Certificates. In order to comply with the procedures set out in the Accounting Officers Procurement Procedures (AOPP), as referred to in the Public Finance Management Act, 1999 (Act 1 of 1999), Ithala‟s Supply Chain Management (SCM) department has developed a database to be used by the SCM office. The purpose of the supplier database is to select preferred suppliers and service providers Preference for quotations will be given to those suppliers and service providers registered on the database. Attached, please find an official registration form to assist us with updating our database according to legislative requirements. NOTES:

1. To those that are already registered please forward a Valid Tax Clearance and Broad Based Black Economic Empowerment (BBBEE) Certificate and any other information that may have changed.

2. Ithala will only do business with suppliers who have a valid BBBEE and Tax Clearance Certificate.

APPLICATION TO REGISTER ON

ITHALA’S DATABASE

APPLICATION TO REGISTER ON ITHALA’S DATABASE This application form must be completed by suppliers and service providers in order to register on the Ithala vendor management system. In order for your application to be processed, the following documentation MUST accompany this form, failing which, your application will not be considered. Please DO NOT submit CDs or video tapes with this form.

DOCUMENT REQUIRED CATEGORY OF SUPPLIER TICK THE RELEVANT BOX INDICATING SUBMISSION OF THE REQUIRED DOCUMENTS

Stamped Banking details form by the bank, verifying the banking details of your business

All suppliers

Certified copy of your business registration documents if you are incorporated as a partnership, close corporation or a company

All suppliers

Certified copies of the ID documents of directors and shareholders / partners / members / sole proprietor

All suppliers

A valid and original tax clearance certificate

All suppliers

Proof of registration with the UIF (i.e. reference number issued by the UIF)

All suppliers who are employers in terms of the Unemployment Insurance Act 63 of 2001 as amended

Proof of registration with the Compensation Fund for Workers‟ Compensation

All suppliers who are employers in terms of the Compensation for Occupational Injuries and Diseases Act 130 of 1993 as amended (COIDA)

A copy of the CIDB (Construction Industry Development Board) certificate NB: You can contact the CIDB on +27 12 482 7200 or +27 086 100 CIDB, or visit www.cidb.org.za for information and registration. You are also required to obtain the document entitled “Code of Conduct for all parties engaged in construction procurement” from the CIDB.

All suppliers whose services constitute construction, electrical and /or engineering works in terms of the Construction Industry Development Board Act 38 of 2000 and its Procurement Regulations

Proof of professional registration or a copy of any other registration certificate pertaining to your relevant industry, e.g. ECB (Electrical Contractors Board)

All suppliers, where applicable

A valid BBBEE verification certificate obtained from a Verification Agency accredited by the South African Accreditation System (SANAS) or a Registered Auditor approved by the Independent Regulatory Board of Auditors (IRBA) or an Accounting Officer as contemplated in the Close Corporation Act (CCA) (only in the absence of accredited verification agencies)

All suppliers.

Supporting documentation confirming the points scored regarding each element of the applicable scorecard, as used by the relevant verification agency

All suppliers submitting a valid verification certificate in terms of the B-BBEE Codes of Good Practice

Shareholder certificates or the shareholder‟s agreement (for companies); OR

association agreements (for close corporations); OR

partnership agreements (for partnerships and

All suppliers

joint ventures), confirming the percentage of Black ownership and Black management within the business

SECTION A: GENERAL „Trading as‟ name of business: ____________________________________________ (Contracts/orders will be placed on this name and invoices must reflect this) Registered name of business: __________________________________________ Title (Prof. / Dr / Mr / Mrs / Ms/) and Surname/s : ____________________________________ (If trading as a sole-proprietor or a partnership) Physical address of business: Building / complex name: ____________________________________________________ Street name and number : ___________________________________________________ Suburb :______________________City :______________________________________ Code: _____________ Country: ___________________________________________ Postal address of business: Postnet address: __________________________________________________________ P O Box / Private Bag :___________City/Town: _______________________ Code:_______ Telephone numbers of business: Code: __________Number:__________________ Alternative number of business: Code: __________Number:__________________ Sales representative fax number: Code: __________Number:__________________ (Used by Ithala for electronic faxing of Request for Quotations, Contracts and Purchase orders) Accounting Clerk‟s fax number: Code: __________Number:__________________ (Used by Ithala for electronic faxing of the APS remittance advices) Business e-mail : ___________________________________________________________ (This is the address to which an Invitation to bid / enquiry and orders / contracts will be sent to) Your own business contact person/sales representative name and telephone number:___________________________________Tel:____________________________ Is your business owned or partly-owned by government? __________(Y/N) Business Registration number (if applicable) ______________________________________ (In the case of a sole proprietor or partnership, please furnish identity numbers plus copies of the identity documents of the owners)

Tax number of business: ______________________________________ VAT registration number: (if applicable) ____________________________________

SECTION B: CONFIRMATION OF B-BBEE STATUS NB: It must be noted that Ithala will recognise only the following categories of persons as “Black” for purposes of B-BBEE, as defined in the Codes of Good Practice:

African, Coloured or Indian persons who are natural persons and:

are citizens of the Republic of South Africa by birth or descent; or

are citizens of the Republic of South Africa by naturalization before the commencement date of the Constitution of the Republic of South Africa Act of 1993; or

became citizens of the Republic of South Africa after the commencement date of the Constitution of the Republic of South Africa Act of 1993, but who, or the Apartheid policy that had been in place prior to that date, would have been entitled to acquire citizenship by naturalization, prior to that date.

Previous name(s) of business (if applicable)

_________________________________________________________________________________

If operating as an Exempted Micro Enterprise (EME) (turnover less than R5 million per annum), do you operate independently or are you related (common ownership and resources) to other operating EMEs? Y/N ___

If yes, then elaborate on your relationship with other EMEs?

_________________________________________________________________________________

_________________________________________________________________________________

___________________________________________________________________________

Is your EME operating as a continuation of a currently or previously existing business? Y/N ____

If yes, then elaborate on your relationship with this business.

_________________________________________________________________________________

_________________________________________________________________________________

__________________________________________________________________________

Is your business:

An agent ____ Manufacturer____ Distributor____ Consultant _____Contractor _____ Professional Services _____ Other (specify)_________________________________________________________

Governed by a Sector Code? Y/N ___ If yes, specify _______________________________________________________________________

A Multinational based in South Africa with overseas headquarters, operating as a “Global Practice” which restricts the alienation of equity or the sale of businesses in its regional

operations? Y/N ___ (If yes, please provide documentation confirming operation as a Global Practice).

[If your business operates as a Multinational subject to a Global Practice, are you currently a participant in an Equity Equivalent Programme (EEP)? Y/N ___ (If yes, please submit documentary proof that the EEP has been approved by the Minister of Trade and Industry OR forms part of a Sector Code)].

Owned or partly owned by a Trust (Y/N) _____ Private Equity Fund (Y/N) _____ Broad-Based Ownership Scheme (Y/N) _____ Employee Ownership Scheme (Y/N) ______

SECTION C: SUPPLIER PROFILE In order for Ithala to build up a profile of its suppliers, we would like you to complete the following:

Commercial Name 3 commercial references/referees of previous projects / contracts and provide their name(s) and telephone number(s): COMPULSORY ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

Financial Has your business ever been declared insolvent or had a judicial management order granted against it? (Y/N)_____If yes, please elaborate: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

Technical Is your business a permit holder under the South African National Standards (SANS)? (Y/N) ______ If yes, indicate product(s) for which permits are held, including permit numbers ____________________________________________________________________ ____________________________________________________________________

List all your products / services your business can manufacture and/ or supply to Ithala (Please tick a box or boxes in Annexure A attached)

Are you working to accredited National or International Standards? (Y/N)_____If yes, indicate products and to which standards:_____________________________________________________________

Quality

Does your business operate a Quality Management System which includes:

Quality policy and objectives (Y/N) ______

Document and record control system (e.g. proof of competence, minutes of meetings and references) (Y/N) ______

Procedure for non-conforming products / services (Y/N) _____

Procedure for corrective and preventative action (Y/N) _____ Has your Quality Management System been assessed and certified by any Nationally or Internationally recognised accreditation body? (Y/N)_____ If yes, please provide a copy of the certificate.

Safety Does your business have an Occupational Health and Safety Policy complying with the Occupational Health and Safety Act (Act 85 of 1993) (OHS Act) that clearly states overall health and safety objectives and commitment to improving health and safety performance? (Y/N)______ If yes, attach a copy of this policy. Are you registered with the Compensation Fund in terms of the Compensation for Occupational Injuries and Diseases Act (COIDA)? (Y/N) ______ Registration number _________________________

Has your business experienced any incident that resulted in a fatality or serious injury? (Y/N)______ If yes, provide details thereof.

__________________________________________________________________________________ __________________________________________________________________________________

Has any non-conformances or prohibition notices been issued by the Department of Labour to your business on previous projects? (Y/N)______ If yes, provide details thereof.

__________________________________________________________________________________ __________________________________________________________________________________ _______________________________________________________________________________

Do you maintain the integrity and safety of all health and safety related equipment and do you have an effective maintenance schedule? (Y/N)______ If no, provide reasons?

__________________________________________________________________________________ ______________________________________________________________________________

Environmental Do you have an Environmental Management System in place? (Y/N) ______ Does your facility routinely work with any hazardous substances? (Y/N)______ Has your Environmental Management System been assessed and certified by any Nationally or Internationally recognised accreditation body? (Y/N)_____ If yes, please provide a copy of the certificate.

Energy Efficiency

What is the total energy used to produce your products? (kWh or MJ) ______ [If you are a service provider, derive your total embedded energy from the use of energy to deliver your services (e.g., driving, use of computers, flights, etc)]. Does your business have energy usage reduction targets (in kWh/product or MJ/product)? (Y/N)____________If yes, fill in the target: ___________ Have you taken any measures to improve on energy efficiency of your products / your facilities in the last 5 years? (Y/N)_________If yes, please provide details of such improvements benchmarked against standard practices or product, including kWh reduction or reduction in electricity bill(s): __________________________________________________________________________________ __________________________________________________________________________ What is your business‟s carbon footprint, i.e. a measure of how much carbon dioxide, methane and other “greenhouse gases” that your business is responsible for creating? (in kg CO2/employee/annual) _____________ What would you estimate as your business‟s contribution towards the energy usage reduction percentage targets as set out by Department of Minerals and Energy in The Energy Efficiency Strategy? __________________________________________________________________________________ __________________________________________________________________________________

Human Resources

How many full-time employees do you currently have? ______________________________ How many part-time employees do you have? _____________________________________ Please provide an organogram of your overall business structure indicating all human resources within your business.

Facilities, Plant & Equipment Please provide a summary of your plant and facilities:_____________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Please attach a list detailing tools and equipment held by your business.

SECTION D: DECLARATION OF INTERESTS

Are you or any other person who holds an interest in your business (i.e. a shareholder, a director, or a member or partner, a line manager, or a fellow employee), employed by Ithala or serves as a director at Ithala, or was previously employed by Ithala or served as a director at Ithala? Y/N ___ If yes, state particulars. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Are you, or any other person who holds an interest in your business, a close family member (i.e. related by birth, marriage, domestic partnership, adoption, guardianship or the like) to or an associate (i.e. a friend, rival, business partner, neighbour, etc) of an Ithala employee and/or director? Y/N ___ If yes, state particulars. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Have you, or any other person who holds an interest in your business, given a business courtesy to or received a business courtesy from an Ithala employee and/or director over the last 12 (twelve) months? Y/N ___ If yes, state particulars. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Have you, or any other person who holds an interest in your business undergone an Ithala supplier disciplinary process and / or has been suspended from the Ithala supplier database over the last 5 (five) years? Y/N ___ If yes, state particulars. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________

Is your business currently engaged in defending any legal proceedings which have been instituted against it (including against any of its directors / members / partners), or has your business (including any directors / members / partners) either been charged with or been convicted of any criminal act, or has any judgment or decision been made against it by any administrative or regulatory body? Y/N ___ If yes, state particulars. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ DECLARATION:

I, the undersigned [insert full name of signatory] ____________________________, duly authorised to complete this application form in my capacity as [insert capacity, i.e., member, director, partner, etc] __________________________ on behalf of the applicant [insert full name of the business entity] __________________________ certify that, to the best of my knowledge, the information furnished herein is true and correct. I accept that Ithala reserves its right to act against the applicant or me personally in terms hereof, should this declaration prove to be false.

Name ______________________________

Signature___________________________

Designation __________________________

Date _______________________________

NOTE TO ALL SUPPLIERS AND SERVICE PROVIDERS: Ithala Development Finance Corporation Limited (Ithala) reserves the right to verify and confirm any of the information provided on this application form. Ithala may request additional information during its bid evaluation process. Ithala reserves the right to conduct site visits where deemed necessary. Incomplete submissions will not be processed. An incomplete submission will include failure to provide any supporting documentation required to be submitted with this form. If there are any changes to the information provided on this form, please inform Suesheila Singh on ssingh@ithala.co.za at Ithala’s Supply Chain Management department within 7 (seven) working days of such change. Outdated information could lead to your business not being invited to bid or not receiving correct payment!

NB: Bank information: In all instances payment will be made via EFT directly into your bank account as per the banking details provided on this application form. Should you change your banking details, you will once again be required to submit an original cancelled cheque or stamped letter from the bank, verifying these banking details. Should you have two companies with separate names operating with one bank account, payment will be rejected by the Accounting system that Ithala utilizes.

All information provided by suppliers will be treated as strictly confidential Section E continued…..(only to be completed by professional building and engineering

consultants to be on Ithala’s panel)

3.1.8 Permanent Staff Compliment: LIST DETAILS OF ALL FULL TIME EMPLOYED PROFESSIONAL AND TECHNICAL STAFF ON THIS SCHEDULE

Names Present Position

Qualifications Specialisation No. years of Experience

HDI Status Refer to point B5

Where Based

Full Time/ Part Time

African/Coloured/ Indian/White or Other

Male/ Female

Disabled *see note 1

* Note 1: If Disabled – clearly state the nature of the disability : ……………………………………………………………

# Enter each member of staff once only a. Describe other: ........................................................................................................................................... Number of non-registered principals........................................................................................................... Number of administrative staff...................................................................................................................

ANNEXURE A Please tick your core business only : (maximum of five)

Advertising, Marketing and Promotions

Billboards Marketing Brand Design

Print Media Corporate Gifts Promotional Material

Electronic Media Communications Public Relations

Exhibition design/build up Website Design Publications

Air-conditioning and Refrigeration

Sales and Installations

Maintenance

Arms and Ammunition

Fire Arms Gun Smithing

Karlgarding Bullet Proof Vests

Building & Maintenance

General Building Thatching Electrical

Renovations / Painting Building Material Carpentry

Tiling Plastering Glazing

Maintenance Gutter Specialists Paving

Plumbing with Trade Cert. Sewer Roller Shutter Doors

Roofing Specialists Ceilings Partitioning

Shop fitting Construction Road Works

Catering

Catering Services Catering Supply Catering Hire

Chemicals

Water Treatment Herbicides Pesticides

Cleaning

Cleaning Services Detergents Sanitary Ware

Chemicals Refuse Removal

Communication

Telecommunication Electronic

Computers

Hardware Software Accessories

Computer Cabling

Delivery Services

Removal Courier

Event & Functions

Event Management Video Filming Entertainment

Sound Hire Floral arrangements Marquee/equipment hire

Portable toilets Speakers Master of Ceremonies

Gift Bags, boxes, specialized paper, frames and accessories

Financial Services

Cash Management / In Transit

Banking Services Insurance

Fencing

Fencing Services Fencing Material (Electrical)

Fencing Material (Non Electrical)

Fuel & Lubricants

Fuel and Lubricants Gas Installations – Fuel and Lubricants

Furniture & Equipment

Office Furniture Outdoor/Camp Furniture Household Appliances

Household Furniture

Gardening

Gardening Services Alien Plant Evasion Tree Felling

Tools & Equipments Service of Pot Plants

Goods for resale

Curios Fire Wood Groceries

Media

Health & Safety

Health & Safety Consulting

First Aid Kits Protective Clothing / gear

Fire Equipment Fire Equipment Maintenance and Service

Language Services

Language Interpretation Document Editing Document Translation

Transcribing

Livestock & Feed

Livestock Supply Livestock Feed Livestock Drugsw

Mobile Units

Park Homes Containers Porta Loos‟

Office Automation

Office Hardware Office Maintenance Audio Visual Equipment

Packaging

Packaging Services Packaging Material

Pest Control

Pesticides Insecticides Fumigation

Plant Hire

Civil Borehole Equipment Hire

Printing & Publication

Face Value Stock Printing Services Document Solutions

Book Publishing

Professional Services

Land Surveyors Quantity Surveyors HR Development

Brokerages Aviation Interior Designers

Graphic Designers Legal Architects

Auditors / Accountants Environmental Consultants

Project Management

Business Solutions (Information Technology)

Property Development / Evaluations

Business Management Services i.e. Performance Management Review, Policy Development, etc

Market Research Specialists

Property Auctioneers Ironmongery

Marina Management Loss Adjustors / Assessors (fire & Accident

Roofing Specialists

Forensic Investigation (Perils investigation)

Environmental Impact Assessment Consultants

Occupational Health & Safety Consultants

Recruitment

Recruitment Agencies

Reticulation

Water Treatment Pipes & Fittings Maintenance - Reticulation

Security

Security Services Alarms & Safes Surveillances

Tracking Equipments Locksmith Access Control

Door Automation Time Delays

Signage

Billboards Road Marking Information Signs

Artificial Rock Trail / Signs

Soft Furnishing

Linen Decor Carpeting

Blinds & Curtains

Solar Panels

Manufacturing / Supply Installations

Sport & Recreation

Equipment Supply Recreation Facilities

Specialist Engineering Services

Civil Engineering / Consultants (Water & Sanitation)

Chemical Engineering / Consultants

Mechanical Engineering / Consultants

Civil Engineering / Consultants (Roads)

Electrical (Light) Engineering / Consultants

Electrical (Heavy) Engineering/Consultants

Civil Engineering / Consultants (Building)

Structural (Steel & Metal) Engineering/Consultants

Structural (Concrete) Engineering/Consultants

Civil (Geotechnical) Engineering/Consultants

Stationery

Printing Paper Office Stationery Rubber Stamps

Printing

Training

Legislative Compliance Computers / IT Technical Skills

Employee Development Management Development

Leadership Development

Travel

Car / Bus Hire Accommodation Airport Shuttle

Flight Conferencing Tours

Uniform

Foot Wear Corporate Wear Field Wear

Vehicles

Vehicle Maintenance Vehicle Supply Vehicle Spares

Trailers

Veterinary

Veterinary Services Vet Drugs Vet Equipments

Waste Services

Waste Supplies Toxic Waste Non-Toxic Waste

Waste Removal

KINDLY TICK THE AREAS YOU ARE ABLE TO SERVICE:

1 Bulwer South Region

2 Port Shepstone South Region

3 Izingolweni South Region

4 Harding South Region

5 Kokstad South Region

6 Ixopo South Region

7 Umzinto South Region

8 Umlazi South Region

9 Mega City South Region

10 Philani Valley South Region

11 Galleria South Region

12 Moorten South Region

13 Manguzi NorthRegion

14 Ingwavuna NorthRegion

15 Ndumo NorthRegion

16 Mbazwana NorthRegion

17 Jozini NorthRegion

18 Mkuze NorthRegion

19 Pongola NorthRegion

20 Mtubatuba NorthRegion

21 Hluhluwe NorthRegion

22 Madadeni MidlandsRegion

23 Newcastle MidlandsRegion

24 Nqutu MidlandsRegion

25 Vryheid MidlandsRegion

26 Ezakheni/Ladysmith MidlandsRegion

27 Estcourt MidlandsRegion

28 Pietermaritzburg MidlandsRegion

29 Tugela Ferry MidlandsRegion

30 Nkandla MidlandsRegion

31 Greytown MidlandsRegion

32 Bergville MidlandsRegion

33 Dalton MidlandsRegion

34 Ulundi MidlandsRegion

35 Eshowe Eastern Region

36 Mandini Eastern Region

37 Richards Bay Eastern Region

38 Empangeni Eastern Region

39 Nongoma Eastern Region

40 Durban and Surroundings CentralRegion

References

Description of Service Contract Amount

Company Contact Person and

Number Completed Year

Yes No

Yes No

Yes No

Details of Trade Association

Is your enterprise affiliated with any associations or professional bodies ?

If yes, provide details

Yes No