SUPPLIER DATABASE REGISTRATION · PDF fileSupplier Database Registration Form Page 1 of 30 Supplier‟s Initials SUPPLIER DATABASE REGISTRATION FORMS Private Bag X922, PRETORIA, 0001

CIVILIAN SECRETARIAT FOR POLICE

Supplier Database Registration Form Page 1 of 30 Supplier‟s Initials

SUPPLIER DATABASE REGISTRATION FORMS

Private Bag X922, PRETORIA, 0001 Van Erkom Building, Van Erkom Arcade, 7th Floor, 217 Pretorius Street

PRETORIA, Tel: (012) 393 2500/2/3, Fax (012) 393 2536/8, WEB: www.policesecretariat.gov.za

http://www.policesecretariat.gov.za/



What to do with the completed application form?

Double check that you have correctly filled in all the required information

Use the attached checklist to make sure that you have all the required supporting information. To submit your application:

Make a photocopy of the application to keep for your own records.

Hand Deliver or Mail your application along with all the supporting information to: PRETORIA OFFICE ADDRESS:

Physical Address Postal Address

Civilian Secretariat for Police Supply Chain Management Van Erkom Building, 7

th Floor

217 Pretorius Street Pretoria 0001

Civilian Secretariat for Police Supply Chain Management Private Bag X922 Pretoria 0001

Enquiries can be directed to: Ms LN Mokoena

Contact No. 012 393 1883 [email protected]

CAPE TOWN OFFICE ADDRESS:

Physical Address

Ministry of Police, 120 Plein Street, Cape Town, Room 9-24.

Enquiries can be directed to: Ms S Samuels

Contact No. 021 467 7020 [email protected]



IMPORTANT NOTES

Please read carefully:

This questionnaire must be completed by all vendors seeking registration as an approved supplier on CSP

database and it must be signed by an authorized person in the vendor‟s organization. A company profile

may accompany the registration form, but will not be accepted as a substitute for the application form.

Applicants will in most cases, be contacted via fax and must therefore submit an operating fax number.

It should be noted that CSP reserves the right to accept or reject any application without being obliged to

give any reasons in this respect.

INTRODUCTION

SUPPLIERS SEEKING REGISTRATION AS APPROVED SUPPLIER ON THE DATABASE OF

THECIVILIAN SECRETARIAT FOR POLICE (CSP)

The Civilian Secretariat for Police (CSP) is an institution responsible for conducting civilian oversight over

the police service and to provide the Minister of Police with strategic support. The CSP derives its mandate

from the Constitution of the Republic of South Africa, Act 108 of 1996. The CSP operates directly under the

Minister of Police.

Suppliers are herewith invited to register as approved suppliers on the database of CSP.

In order to comply with the procedures set out in the Supply Chain Management guidelines and the Public

Finance Management Act, 1999 (Act 1 of 1999) (PFMA), the CSP has to develop a supplier database to be

used by the Supply Chain Management Unit for acquisition of goods and services.

Although preference will be given to suppliers on the database, it does not necessarily follow that suppliers

who are not yet on the database will be totally exempted from quoting for the supplying of goods or services

to CSP. It is envisaged however, that this database will contribute to the efficient administration and

compliance with the PFMA.



All the applications for registration as a service provider must be accompanied by the following

documents where applicable

ANNEXURE REQUIRED INFORMATION/ DOCUMENTS YES NO

A* Supplier Database Application Form fully completed and signed. Physical Address and contact details provided

B* Supplier Registration Documents attached (CIPRO/ CIPC)

C* Original valid/ current Tax Clearance Certificate Expiring date:

D Vat registration

E* Copy of Identity Document(s) for the Director(s)/ Shareholder(s)

F Original/ certified copy of the B-BBEE Certificate

G* Company Profile

H SANS / SABS certificate

I Shareholding Agreements

J* List of Commodities – maximum of five (5) selected

K Unemployment Insurance Fund

L COIDA – registration or letter of good standing

M Occupational Health and Safety Certificate

N Patent Certificate (if applicable)

O*

Supplier Maintenance– fully completed and signed, original recent bank letter/ original cancelled cheque, and that the banking details on either bank letter or cancelled cheque correspond with that completed on the form. Banking details form must be stamped.

P* Declaration of interest – Commissioner of Oaths

Q* Declaration of Interest (SBD 4) – fully completed and signed

R* Declaration of bidders interest past SCM practices (SBD 8)

S* Certificate of Independent Bid Determination (SBD 9)

T*

The entity and director(s)/ shareholder(s) are not listed on the National Treasury Database of Restricted Suppliers

U*

The entity and director(s)/ shareholder(s) are not listed on the National Treasury Register for Tender Defaulters

*Compulsory

IMPORTANT NOTE: THE CSP RESERVES THE RIGHT TO SUBJECT ANY SUPPLIER/S WILLING TO

BE REGISTERED ON THE CSP SUPPLIER DATABASE TO STATE SECURITY AGENCY (SSA) FOR

VETTING.

For further clarification please contact: SCP Supply Chain Management

Tell: 012 393 2500/2/3 email [email protected]

SECTION 1: TERMS AND CONDITIONS

1.1 APPLICATION PROCEDURE

Service providers wishing to register may do so by completing the registration form applicable on CSP‟s

website or obtainable from CSP‟s Offices.

1.2 DURATION OF REGISTRATION

Suppliers acceptable to the CSP shall remain on the database for a period of 24 months from the date of

acceptance. CSP reserves the right to either accept or reject any application.



1.3 UPDATING INFORMATION

Suppliers shall be responsible to ensure that information is updated as and when such change occurs.

Information must be submitted to CSP‟s Supply Chain Management Unit.

1.4 MONITORING OF SUPPLIER PERFORMANCE

CSP will monitor suppliers performance on projects awarded. The evaluation will assist the CSP on any

future work that may be awarded.

1.5 PRIVACY

Information supplied will be treated as confidential and will only be for CSP„s use, unless required by law.

1.6 SUBMISSION OF FORMS

Only signed original application forms will be accepted. No alteration on the application form will be

Permitted. Faxed or emailed applications will not be accepted.

SECTION 2: TERMINOLOGY

2.1. Commodities: The goods and services the company wishes to register for as a supplier to CSP.

2.2. Ownership: Having all the customary elements of ownership, including the right of decision-

making and sharing all the risks and profits corresponds with the degree of

ownership interests as demonstrated by an examination rather than the form of

ownership arrangements.

2.3. Trade Names: The trade names that the company owns or distributes, which you wish to

be registered for as a supplier to the department.

2.4. B-BBEE Status Level of Contribution: means broad-based black economic empowerment

as defined in section 1 of the Broad-Based Black Economic Empowerment Act

2.5. B-BBEE Status Level of Contribution: means the B-BBEE status received by a measured

entity based on its overall performance using the relevant scorecard contained in

the Codes of Good Practice on Black Economic Empowerment, issued in terms of

section 9(1) of the Broad-Based Black Economic Empowerment Act;

2.6. EME: means any enterprise with annual total revenue of R 5 million or less.

2.7. CSP: means Civilian Secretariat for Police



SUPPLIER DATABASE REGISTRATION FORM CIVILIAN SECRETARIAT FOR POLICE (CSP)

SECTION 3: SUPPLIER DETAILS:

NAME OF BUSINESS: …………………………………………………………………………………………..

TRADE NAME (If different from above): ……..………………………………………………………………..

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

VAT REGISTRATION NUMBER: …….………………………………………………………………………..

INCOME TAX REGISTRATION NUMBER: …….…………………………………………………………….

PHYSICAL ADDRESS: ……………….………………………………………….…………………………….

…………………………………………………………………………………… CODE.…….…………………

POSTAL ADDRESS: ……………………………………………………………………………………………..

…………………………………………………..………………………………….CODE……..…………………

MAIN CONTACT PERSON: ……………………………………………………………………………………

POSITION HELD: ……………………………………………………………………………………………….

TELEPHONE NUMBER: ……………………………………. CELL NUMBER: .……………………………

FAX NUMBER: ….………………………………………………………………………………………………

E-MAIL ADDRESS: …………………………………………………………………………………………….

SECTION 4: INDICATE WHERE THE ABOVE COMPANY AND BRANCH/S IS/ARE LOCATED:

PROVINCE DISTRICT MUNICIPALITY TOWN/VILLAGE

1.

2.

3.

4.

5.

6.

7.



8.

9.

SECTION 4: TYPE OF COMPANY (INDICATE WITH AN X AND PROVIDE DOCUMENATRY PROOF)

1 Public company (LTD)

2 Private Company(Pty)Ltd

3 Joint Venture

4 Consortium

5 Sole Proprietary

6 Foreign Company

7 Partnership

8 Trust

9 Section 21 Company

10 Government Parastatals

11 Other(Specify)

12 Public company (Ltd)Pty

SECTION 5: Points awarded for B-BBEE Status Level of Contribution In terms of Regulation 5 (2) and 6 (2) of the Preferential Procurement Regulations, preference points must be awarded to a bidder for attaining the B-BBEE status level of contribution in accordance with the table below: B-BBEE Status Level of Contributor Number of points (80/20 or 90/10 system) BBBEE Status Level of Contributor

Number of points (80/20 system)

BBBEE Status Level of Contributor

Number of points (90/10 system)

1

20

1

10

2

18

2

9

3

16

3

8

4

12

4

5

5

8

5

4

6

6

6

3

7

4

7

2

8

2

8

1

Non-Compliant Contributor

0

Non-Compliant Contributor 0



Bidders who qualify as EMEs in terms of the B-BBEE Act must submit a certificate issued by an

Accounting Officer as contemplated in the CCA or a Verification CSP accredited by SANAS or a

Registered Auditor. Registered auditors do not need to meet the prerequisite for IRBA‟s approval

for the purpose of conducting verification and issuing EMEs with B-BBEE Status Level

Certificates.

Bidders other than EMEs must submit their original and valid B-BBEE status level verification certificate

or a certified copy thereof, substantiating their B-BBEE rating issued by a Registered Auditor approved by

IRBA or a Verification CSP accredited by SANAS.

A trust, consortium or joint venture, will qualify for points for their B-BBEE status level as a legal entity,

provided that the entity submits their B-BBEE status level certificate. A trust, consortium or joint venture will

qualify for points for their B-BBEE status level as an unincorporated entity, provided that the entity submits

their consolidated B-BBEE scorecard as if they were a group structure and that such a consolidated B-BBEE

scorecard is prepared for every separate bid.

Tertiary institutions and public entities will be required to submit their B-BBEE status level certificates in

terms of the specialized scorecard contained in the B-BBEE Codes of Good Practice.

A person will not be awarded points for B-BBEE status level if it is indicated in the bid documents that

such a bidder intends sub-contracting more than 25% of the value of the contract to any other enterprise

that does not qualify for at least the points that such a bidder qualifies for, unless the intended

subcontractors an EME that has the capability and ability to execute the sub-contract.

A person awarded a contract may not sub-contract more than 25% of the value of the contract to any

other enterprise that does not have an equal or higher B-BBEE status level than the person concerned,

unless the contract is sub-contracted to an EME that has the capability and ability to execute the

Sub-contract.



LIST OF DIRECTORS AND SHAREHOLDERS (Please attach certified ID copies/s)

Initial & Surname Date Position

occupied in Company

ID Number Citizenship

SECTION 6: BID DECLARATION

Bidders who claim points in respect of B-BBEE Status Level of Contribution must complete the following:

B-BBEE STATUS LEVEL OF CONTRIBUTION CLAIMED IN TERMS OF PARAGRAPHS TABLE

ABOVE

7.1 B-BBEE Status Level of Contribution: …..……………(maximum of 20 points)

(Points claimed in respect of paragraph 7.1 must be in accordance with the table

reflected in paragraph below and must be substantiated by means of a B-BBEE

certificate issued by a Verification CSP accredited by SANAS or a Registered

Auditor approved by IRBA or an Accounting Officer as contemplated in the CCA).

SUB-CONTRACTING

Will any portion of the contract be sub-contracted? YES / NO (delete which is not

applicable)

If yes, indicate:

(i) what percentage of the contract will be subcontracted?

............……………….…%

(ii) the name of the sub-contractor?

…………………………………………………………..

(iii) the B-BBEE status level of the sub-contractor? ……………..

(iv) whether the sub-contractor is an EME? YES / NO (delete which is not applicable)



SECTION 8: LIST OF COMMODITIES TO BE PROVIDED (MAXIMUM OF FIVE)

Please indicate the type of goods/ service and sign in the appropriate box. Should the service provider mark

more than five items, CSP will consider only the first five items and ignore the remaining items.

NB: PLEASE NOTE THAT THE HIGHLIGHTED AREAS IN BOLD ARE COMMODITIES AND SUB-COMMODITIES ARE LISTED BELOW, THEREFORE YOU MAY SELECT ALL SUB-COMMODITIES UNDER ONE COMMODITY.

List of Goods Commodities Air conditioning, circulating and Heating Equipment Mark with x Signature

Air conditioner and air conditioner regulator

Air circulation ventilator

Fans

Heaters

Books, Maps, and other publications

Books and pamphlets

Newspapers and Periodicals

Communication Equipment and accessories

Communication devices

Communication equipment

Microphones

Cases and bags

Laptop carry bags

Laptop trolley bags

Equipment cases

Cleaning Equipment and supplies

Cleaning Equipment

Cleaning supplies

Hygiene supplies

Cleaning Protective gear

Groceries

Beverages

Food supplies

Kitchen and Electrical Appliances and supplies

Kitchen Appliances

Crockery and cutlery

Kitchen Supplies

Office Machines and Equipment and supplies

Office machines

Office Equipment

Office Supplies

Office Furniture and Furnishings

Desks



Chairs

Credenzas

Cupboard and Filing Cabinet

Drawers

Cabinets and Filing Cabinet

Bulk Filing Unit

Boardroom Tables

Office Furnishings

Tables and counter tops

Wall units

Photographic, Presentation Equipment and Supplies

Printing and publishing Equipment

Audio and Visual Presentation and Composing Equipment

Photographic or Filming or Video Equipment

Photographic and Recording Media

TV Screen

Camera

Projectors

Promotional Items

Corporate Gifts

Printing and Embroidery services

Displays and stands

Printing Services

Printed media

Electronic Reference Material

Signage and Accessories

Engravers

Safety and Security Equipment

Safety Equipment

Security gates and Bugler doors

Alarm and Security Systems

Locks and Handles

Fire extinguisher

Biometrics reader

Smoke sensor

Luggage X-ray Equipment

Stationery

Book, Pads and legal

Boards and flip Charts

Boards and flip charts consumables

Correction fluids and Tape

Desktop Stationery

Envelopes and Packaging

Filing and storage

File Dividers and indexes



Glue, Labels and Tapes

Markers and Highlighters

Paper and Board

Pens and Refills

Pencils, clutch and refills

Punches and staplers

Staples and Staple remover

Stamps

Stamp pad and ink

Graphic and technical drawing

Etc.

Tools and General Equipment

Hand tools

Electrical tools

General equipment

Ladders

Maintenance Services

Electrical Supplies

Plumbing Supplies

General Maintenance Supplies

Cleaning Services

LIST OF SERVICES COMMODITIES

Equipment Hire and Event Management Mark with x Signature

Tents and Marques

Decorations

Event Management Services

Plants

Crockery and cutlery

Chairs and tables

Toilets

Sound and Stage

Conference Facilities

Accommodation

Education and Training Services (Certification Required)

Professional Training

Alternative Educational Systems

Educational Institutions

Specialized Educational Services

Training courses

General Building Maintenance and Repair Services (certification required)

Locksmith Services

Partitioning Services



Window Cleaning Services

Fumigation and Pest Control Services

Electrical Services

Plumbing Services

Health Services

Wellness Services

Occupational Health & Safety

First Aid Training

Interior Decoration

Interior Decorating Services

Installation Services of Curtains and Blinds

Plants Hire and Maintenance

Catering Services

Catering

Consultants Services (certification required)

Policy Development and Research

Project Monitoring and Evaluation

Organisational Monitoring and Evaluation

Development of Business Plan

Human Resources Services

Change Management

Personnel Placement (Recruitment) Agencies

Credentials Verification

Skills Audit

Legal Services (Certification Required)

Legal Advisor

Labour law Specialist

Auditing Services (Certification Required)

Financial and Operational Audit

Forensic and Investigation Audit

Legal Compliance Audit

Financial Services (Certification Required)

Business and Financial Advisory Services

Finance System Designing Services

Chartered Accounts Services

Preparation of Financial Statements

Publications, Communication and Information Services

Advertising on Newspapers

Publications

Books

Marketing

Video Coverage

Multi – Media

Writing and Translations Services

Printing and Reproduction Services



Photographic Services

Graphic Design Services

Transportation

Bus, Taxis and other Public Transport

Travel Services / Management

SECTION: 9

Is your business a permit holder under SABS and/or SANS mark scheme YES? NO

If yes, indicate product(s) for which permits are held, including permit numbers. (Certificate to be attached)

______________________________________________________________________________________

__________________________________________________________________________________

Do you have patent rights for your products? YES/NO

If, yes, please stare the name of the product and certificate number (certificate to be

attached)______________________________________________________________________________

__________________________________________________________________________________

Has your quality Management System (if applicable) been assessed and certified by any National or

Internationally recognized body YES / NO.

If yes, provide copies of certificates.

SECTION 10

Has your business ever been declared insolvent: YES/NO

If so, state date of rehabilitation: _________________________________________________________

Please attach: a letter of recommendation from your bank/credit worthiness documents.

SECTION 11

Do you share any facilities: YES/NO

If, yes which facilities are shared: ___________________________________________________________________________________

With whom do you share facilities:_____________________________________________________________________________

What are the other firms‟ core businesses?

Activities?____________________________________________________________________________



SECTION 12: IMPORTANT CONDITIONS PERTAINING TO PURCHASE ORDERS

12.1. The seller shall not execute any work without an official order number from CSP. The order

number appears on all delivery notes and invoices.

12.2 Invoices without order numbers are seen as private agreements with individuals and will be returned

to the supplier.

12.3 No alterations to the order shall be made.

12.4 CSP has the right to cancel the order in the event where the goods or service are not delivered

within the stipulated time period.

12.5 No deliveries will be accepted after hours, unless prior arrangements are made with the Supply

Chain Management

12.6 All invoices for goods and services rendered must be submitted to Supply Chain Management

offices.

12.7 The seller shall bear the risk of goods being damaged, lost or destroyed until delivery to CSP is

effected and receipt thereof is acknowledged.

12.8 All goods must be new and of the best quality. Goods shall be subject to the approval by CSP.

Should the Seller be unable to fulfill its obligation in terms of the order, it shall advice CSP to this

effect in writing, in which case CSP reserves the right to cancel the order and to purchase the

goods from another supplier. The seller may be obliged to compensate CSP for any difference in

cost.

12.9. In as much as delivery of the goods may require the Seller or its authorized agent to enter CSP‟s

premises, the Seller shall ensure that such precautions as are necessary to protect life and property

anywhere on the CSP‟s premises are taken, and the Seller shall be liable to the CSP‟s for

injury to any person, or damage to the CSP‟s property caused by or incidental upon negligence or

default on the part of the Seller or its authorized agents.

12.10. Terms of payment are within 30 days from the dare of receipt of the invoice.



SECTION 13: CRITERIA FOR INCLUSION IN THE SUPPLIER DATABASE

13.1. The forms must be duly completed, initialed and signed by the prospective service providers.

13.2. No alterations to the forms shall be allowed and all 14 pages of the applications must be returned.

13.3. All applicable and relevant documentation must be attached to the returned forms.

13.4. The service providers must have a reliable and working telephone, fax line or e-mail address.

13.5. Applicants must submit certified copies of Identity documents of the registered owners.

13.6. All applications must be accompanied by company registration certificates.

13.7. Original valid TAX CLEARANCE CERTIFICATE must be submitted together with the application.

13.8. The bank details forms must be verified and endorsed with the BANK stamp.

13.9. The declaration of interest must be duly completed and signed by the Commissioner of Oaths.

13.10. Only a maximum of five commodities will be allowed per application.

13.11. Application forms must be submitted or posted to the office where the service providers require to

be registered.

13.12. Preference will be given to enterprises located within the borders of the province in which they

apply to register

13.13. The forms must be submitted before the closing date.

13.14. Failure to comply with the above requirements shall render the application unsuccessful for

inclusion in the CPS Supplier Database.



CIVILIAN SECRETARIAT FOR Captured By:

Date Captured:

Authorised By:

Date Authorised:

SUPPLIER MAINTENANCE: Supplier code:

NB Enquiries. :

1. SECTIONS C TO F TO BE COMPLETED BY SUPPLIER. Tel. No.:

2. SECTIONS A; B & G TO BE COMPLETED BY HEAD OFFICE.

SECTION A SYSTEM REGISTRATION

BAS LOGIS

HEAD OFFICE

SECTION B REGISTRATION DETAILS

New Supplier Update Supplier information

Supplier Type: Employee Department

Supplier Other ( Specify )

SECTION C REGISTRATION DETAILS

Department Number

ID Number

Persal Number

Passport Number

Company Registration Number

Tax Number

VAT Number

SECTION D PERSONAL DETAILS

To be filled in by individual or on behalf of an entity to whom the department should pay

Department/

First Names:

Last Name:

SECTION E ADDRESS DETAILS

Postal Code

NB: All relevant fields must be completed

POLICE

Supplier Name

Head Office Only

Title:

Initials:

( Compulsory )

Payment Address

Page 1 of 3



SECTION E ADDRESS DETAILS CONTINUED

SECTION F CONTACT DETAILS

Business

Area Code Telephone Number Extension

Home

Area Code Telephone Number

Fax

Area Code Fax Number

Cell

Cell Code Cell Number

Email Address

Area/Cell Code Telephone Number Extension

PLEASE RETURN THIS FORM TO THE RELEVANT

REGIONAL OFFICE THAT SUPPLIED IT

SECTION G CHECKLIST

Tax certif icate attached?

/ /

Date (dd/mm/yyyy) ID copy attached, for natural persons attached?

Printout of Hogans System on CIS4 for FNB clients attached?

Printout of CIF Screen for ABSA clients attached?

/ /

Date (dd/mm/yyyy) Look-Up screen printout for Standard Bank clients attached?

NB: All relevant fields must be completed

Other Banks, client profile or bank statement attached?

Is the form signed by supplier?

Telephone Number

Contact Person:

Print NamePrint Name

Rank

Finance OfficialSupplier Signature

Supplier MAINTENANCE (continued)

Postal Address:

Street Address:

Postal Code:

Postal Code:

Page 2 of 3



Supplier Maintenance: Bank Details

Supplier Name: …………………………………………………………

SECRETARY OF POLICE: CIVILIAN SECRETARIAT FOR POLICE

/ /

Date dd/mm/yyy

NB. Only original signed forms will be accepted. No exceptions will be made.

Registered Name #

Co. Registration No. #

Account Holder #

Name of Bank: #

Name of Branch: #

Branch Code: #

Account Number: #

Type of Account # Current Account 1 Other ( please specify )

Savings Account 2

Transmission Account 3

Bond Account 4

It is hereby confirmed that these details have been verified against

the following screens and printout is attached: Bank Stamp Here

ABSA-CIF Screen

FNB-Hogans system on the CIS4

STD Bank-Look up screen

Nedbank-Banking Platform under the Client Details Tab

Other Banks-Client Information Screen

NB: IT IS THE RESPONSIBILITY OF THE SUPPLIER TO ENSURE THAT DETAILS PROVIDED Bank Official Name: ______________________

ARE CORRECT. Contact Details:

Initial and Surname Authorised Signature


I/We hereby request and authorize you to pay any amounts which accrue to me/us to the credit of my/ouraccount with the mentioned bank.I/We understand that the credit transfers hereby authorised will be processed by computer through a system

known as the "ACB ELECTRONIC FUND TRANSFER SERVICE", and I/we also understand that noadditional advice of payment will be provided by my/our bank, but details of each payment will be printed onmy/our bank statement or any accompanying voucher. (This does not apply where it is not customary for

banks to furnish bank statements).I/we understand that a payment advice will be supplied by the Department in the normal way, and that it willindicate the date on which funds will be available in my/our account.This authority may be cancelled by

me/us by giving thirty days notice by prepaid registered post.

Page 3 of 3



DECLARATION OF INTEREST

I, __________________________________________________________________________________

Identity number: ______________________________________________________________________

(“the service provider”) hereby declare that I have /do not have direct or indirect family relation to CSP

except that which is specified below:

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

I hereby acknowledge that failure to disclose any direct or indirect family relation as set out above will

constitute a material breach of this agreement.

Duly authorized to sign on behalf:

The undersigned who warrants that he/she is duly authorized to do so on behalf of the Firm, confirms that

the contents of the

Signature Full Name Capacity Date

COMMISSIONER OF OATHS:

Signed and sworn to before me at: ________________________________________________ (place) on

this the___________ day of ________________ by the service provider/supplier, who has acknowledged

that he/she knows and understands the contents of this Affidavit, that it is true and correct to the best of

his/her knowledge and that he/she has no obligation to taking the prescribed oath, and that the prescribed

oath will be binding on his/her conscience.

Commissioner of Oath: _____________________________________

Name : _____________________________________

Signature : ______________________________________

STAMP



SBD 4

DECLARATION OF INTEREST

1. Any legal person, including persons employed by the state¹, or persons having a kinship with

persons employed by the state, including a blood relationship, may make an offer or offers in terms of this invitation to bid (includes a price quotation, advertised competitive bid, limited bid or proposal). In view of possible allegations of favouritism, should the resulting bid, or part thereof, be awarded to persons employed by the state, or to persons connected with or related to them, it is required that the bidder or his/her authorised representative declare his/her position in relation to the evaluating/adjudicating authority where-

- the bidder is employed by the state; and/or - the legal person on whose behalf the bidding document is signed, has a relationship with

persons/a person who are/is involved in the evaluation and or adjudication of the bid(s), or where it is known that such a relationship exists between the person or persons for or on whose behalf the declarant acts and persons who are involved with the evaluation and or adjudication of the bid.

2. In order to give effect to the above, the following questionnaire must be completed and

submitted with the bid. 2.1 Full Name of bidder or his or her representative: …………………………………………………………. 2.2 Identity Number:

………………………………………………………………………………………………… 2.3 Position occupied in the Company (director, trustee, shareholder²):

…………………………………….. 2.4 Company Registration Number:

………………………………………………………………………..……. 2.5 Tax Reference Number:

………………………………………………………………………………….……… 2.6 VAT Registration Number: ………………………………………………………………………………....

2.6.1 The names of all directors / trustees / shareholders / members, their individual identity numbers, tax

reference numbers and, if applicable, employee / persal numbers must be indicated in paragraph 3 below.

¹“State” means –



(a) any national or provincial department, national or provincial public entity or constitutional institution within the meaning of the Public Finance Management Act, 1999 (Act No. 1 of 1999);

(b) any municipality or municipal entity; (c) provincial legislature; (d) national Assembly or the national Council of provinces; or (e) Parliament. ²”Shareholder” means a person who owns shares in the company and is actively involved in the management of the enterprise or

business and exercises control over the enterprise.

2.7 Are you or any person connected with the bidder YES / NO presently employed by the state? 2.7.1 If so, furnish the following particulars:

Name of person / director / trustee / shareholder/ member: ……....……………………………… Name of state institution at which you or the person connected to the bidder is employed : ……………………………………… Position occupied in the state institution: ……………………………………… Any other particulars: ………………………………………………………………

……………………………………………………………… ………………………………………………………………

2.7.2 If you are presently employed by the state, did you obtain YES / NO

the appropriate authority to undertake remunerative work outside employment in the public sector?

2.7.2.1 If yes, did you attached proof of such authority to the bid YES / NO

document? (Note: Failure to submit proof of such authority, where applicable, may result in the disqualification of the bid.

2.7.2.2 If no, furnish reasons for non-submission of such proof:

……………………………………………………………………. ……………………………………………………………………. …………………………………………………………………….

2.8 Did you or your spouse, or any of the company’s directors / YES / NO trustees / shareholders / members or their spouses conduct



business with the state in the previous twelve months? 2.8.1 If so, furnish particulars:

………………………………………………………………….. ………………………………………………………………….. …………………………………………………………………...

2.9 Do you, or any person connected with the bidder, have YES / NO any relationship (family, friend, other) with a person employed by the state and who may be involved with the evaluation and or adjudication of this bid?

2.9.1If so, furnish particulars. ……………………………………………………………... …………………………………………………………..….

………………………………………………………………

2.10 Are you, or any person connected with the bidder, YES/NO aware of any relationship (family, friend, other) between

any other bidder and any person employed by the state who may be involved with the evaluation and or adjudication of this bid?

2.10.1 If so, furnish particulars.

……………………………………………………………… ……………………………………………………………… ………………………………………………………………

2.11 Do you or any of the directors / trustees / shareholders / members YES/NO

of the company have any interest in any other related companies whether or not they are bidding for this contract?

2.11.1 If so, furnish particulars: ……………………………………………………………………………. ……………………………………………………………………………. …………………………………………………………………………….



3 Full details of directors / trustees / members / shareholders.

Full Name Identity

Number

Personal Tax

Reference

Number

State Employee

Number / Persal

Number

4 DECLARATION

I, THE UNDERSIGNED (NAME)………………………………………………………………………

CERTIFY THAT THE INFORMATION FURNISHED IN PARAGRAPHS 2 and 3 ABOVE IS CORRECT. I ACCEPT THAT THE STATE MAY REJECT THE BID OR ACT AGAINST ME IN TERMS OF PARAGRAPH 23 OF THE GENERAL CONDITIONS OF CONTRACT SHOULD THIS DECLARATION PROVE TO BE FALSE. ………………………………….. ..…………………………………………… Signature Date …………………………………. ……………………………………………… Position Name of bidder

May 2011



SBD 8

DECLARATION OF BIDDER’S PAST SUPPLY CHAIN MANAGEMENT PRACTICES

1 This Standard Bidding Document must form part of all bids invited.

2 It serves as a declaration to be used by institutions in ensuring that when goods and

services are being procured, all reasonable steps are taken to combat the abuse of the

supply chain management system.

3 The bid of any bidder may be disregarded if that bidder, or any of its directors have-

a. abused the institution’s supply chain management system;

b. committed fraud or any other improper conduct in relation to such system; or

c. failed to perform on any previous contract.

4 In order to give effect to the above, the following questionnaire must be completed

and submitted with the bid.

Item Question Yes No

4.1 Is the bidder or any of its directors listed on the National Treasury’s Database of

Restricted Suppliers as companies or persons prohibited from doing business with the

public sector?

(Companies or persons who are listed on this Database were informed in writing

of this restriction by the Accounting Officer/Authority of the institution that

imposed the restriction after the audi alteram partem rule was applied).

The Database of Restricted Suppliers now resides on the National Treasury’s

website(www.treasury.gov.za) and can be accessed by clicking on its link at the

bottom of the home page.

Yes

No

4.1.1 If so, furnish particulars:

4.2 Is the bidder or any of its directors listed on the Register for Tender Defaulters in

terms of section 29 of the Prevention and Combating of Corrupt Activities Act (No 12

of 2004)?

The Register for Tender Defaulters can be accessed on the National Treasury’s

website (www.treasury.gov.za) by clicking on its link at the bottom of the home

page.

Yes

No


http://www.treasury.gov.za/

http://www.treasury.gov.za/



4.3 Was the bidder or any of its directors convicted by a court of law (including a court

outside of the Republic of South Africa) for fraud or corruption during the past five

years?

Yes

No


4.4 Was any contract between the bidder and any organ of state terminated during the past

five years on account of failure to perform on or comply with the contract?

Yes

No


SBD 8

CERTIFICATION

I, THE UNDERSIGNED (FULL NAME)…………………………………………………

CERTIFY THAT THE INFORMATION FURNISHED ON THIS DECLARATION FORM

IS TRUE AND CORRECT.

I ACCEPT THAT, IN ADDITION TO CANCELLATION OF A CONTRACT, ACTION

MAY BE TAKEN AGAINST ME SHOULD THIS DECLARATION PROVE TO BE

FALSE.

………………………………………... …………………………..

Signature Date

………………………………………. …………………………..

Position Name of Bidder



SBD 9 CERTIFICATE OF INDEPENDENT BID DETERMINATION

1 This Standard Bidding Document (SBD) must form part of all bids¹ invited.

2 Section 4 (1) (b) (iii) of the Competition Act No. 89 of 1998, as amended, prohibits an

agreement between, or concerted practice by, firms, or a decision by an association of

firms, if it is between parties in a horizontal relationship and if it involves collusive bidding

(or bid rigging).² Collusive bidding is a pe se prohibition meaning that it cannot be justified

under any grounds.

3 Treasury Regulation 16A9 prescribes that accounting officers and accounting authorities must take all reasonable steps to prevent abuse of the supply chain management system and authorizes accounting officers and accounting authorities to:

a. disregard the bid of any bidder if that bidder, or any of its directors have abused the

institution‟s supply chain management system and or committed fraud or any other improper conduct in relation to such system.

b. cancel a contract awarded to a supplier of goods and services if the supplier

committed any corrupt or fraudulent act during the bidding process or the execution of that contract.

4 This SBD serves as a certificate of declaration that would be used by institutions to ensure

that, when bids are considered, reasonable steps are taken to prevent any form of bid-

rigging.

5 In order to give effect to the above, the attached Certificate of Bid Determination (SBD 9)

must be completed and submitted with the bid:

¹ Includes price quotations, advertised competitive bids, limited bids and proposals.

² Bid rigging (or collusive bidding) occurs when businesses, that would otherwise be expected to compete, secretly conspire to raise prices or

lower the quality of goods and / or services for purchasers who wish to acquire goods and / or services through a bidding process. Bid rigging is,

therefore, an agreement between competitors not to compete.



SBD 9

CERTIFICATE OF INDEPENDENT BID DETERMINATION

I, the undersigned, in submitting the accompanying bid:

________________________________________________________________________

(Bid Number and Description)

in response to the invitation for the bid made by:

______________________________________________________________________________

(Name of Institution)

do hereby make the following statements that I certify to be true and complete in every respect:

I certify, on behalf of:_______________________________________________________that:

(Name of Bidder)

1. I have read and I understand the contents of this Certificate;

2. I understand that the accompanying bid will be disqualified if this Certificate is found not to

be true and complete in every respect;

3. I am authorized by the bidder to sign this Certificate, and to submit the accompanying bid,

on behalf of the bidder;

4. Each person whose signature appears on the accompanying bid has been authorized by

the bidder to determine the terms of, and to sign the bid, on behalf of the bidder;

5. For the purposes of this Certificate and the accompanying bid, I understand that the word

“competitor” shall include any individual or organization, other than the bidder, whether or

not affiliated with the bidder, who:

(a) has been requested to submit a bid in response to this bid invitation;

(b) could potentially submit a bid in response to this bid invitation, based on

their qualifications, abilities or experience; and

(c) provides the same goods and services as the bidder and/or is in the same

line of business as the bidder



SBD 9

6. The bidder has arrived at the accompanying bid independently from, and without

consultation, communication, agreement or arrangement with any competitor. However

communication between partners in a joint venture or consortium³ will not be construed as

collusive bidding.

7. In particular, without limiting the generality of paragraphs 6 above, there has been no

consultation, communication, agreement or arrangement with any competitor regarding:

(a) prices;

(b) geographical area where product or service will be rendered (market

allocation)

(c) methods, factors or formulas used to calculate prices;

(d) the intention or decision to submit or not to submit, a bid;

(e) the submission of a bid which does not meet the specifications and

conditions of the bid; or

(f) bidding with the intention not to win the bid.

8. In addition, there have been no consultations, communications, agreements or

arrangements with any competitor regarding the quality, quantity, specifications and

conditions or delivery particulars of the products or services to which this bid invitation

relates.

9. The terms of the accompanying bid have not been, and will not be, disclosed by the bidder,

directly or indirectly, to any competitor, prior to the date and time of the official bid opening

or of the awarding of the contract.

³ Joint venture or Consortium means an association of persons for the purpose of combining their expertise, property, capital, efforts, skill and knowledge in an activity for the execution of a contract.



SBD 9

10. I am aware that, in addition and without prejudice to any other remedy provided to

combat any restrictive practices related to bids and contracts, bids that are suspicious will

be reported to the Competition Commission for investigation and possible imposition of

administrative penalties in terms of section 59 of the Competition Act No 89 of 1998 and or

may be reported to the National Prosecuting Authority (NPA) for criminal investigation and

or may be restricted from conducting business with the public sector for a period not

exceeding ten (10) years in terms of the Prevention and Combating of Corrupt Activities

Act No 12 of 2004 or any other applicable legislation.

………………………………………………… …………………………………

Signature Date

…………………………………………………. …………………………………

Position Name of Bidder

Js914w 2