SUPPLIER REGISTRATION FORM - SAFCOL

Registered address: Podium at Menlyn, 43 Ingersol Road, Lynnwood Glen, Pretoria, 0081, South Africa

Directors:

PM Makwana (Chairperson) J Yawitch, B Hanise, ZP Zatu, L Mnisi, Adv L Mokgatle, F Baleni, Y Pillay, NI Balton, J Maruma (ACFO), OT Monaheng (CEO)

Company Secretary: H Murovhi

SUPPLIER REGISTRATION FORM

SUPPLIER NAME

NEW APPLICATION YES NO

UPDATED APPLICATION YES NO

SAFCOL/KLF SUPPLIER NUMBER (for existing suppliers)

Contact person at your company

Position

Telephone number

Cell phone number

Fax number

Email

Signature

Indicate if responding to an advert for our supplier database

Yes No

Checklist

The following forms (where applicable) must accompany this document at the time of submission.

Proof of company registration or CK documents

Proof of ownership/shareholders certificate

Certified copy of identity document( shareholders, directors, members)

Tax clearance certificate (valid)

Vat registration document (VAT 103)

Copy of COID (Compensation for Occupational Injuries and Diseases) registration certificate e.g Letter of Good Standing

National Treasury Central Supplier Database Registration Summary Report (CSD) / CSD Supplier Number (MAAA…)

Relevant Statutory Body Registration / Accreditation / Compliance Certificates (e.g. PSIRA,CIDB, SAICA, PCO Certificate etc)

Declaration Certificate for Local Production and Content for Designated Sectors (e.g Textile Industry, Furniture)

Valid BBBEE certificate from an accredited SANAS verification Agency OR EME/QSE sworn affidavit signed by the EME representative and attested by a Commissioner of Oaths

E-mail at [email protected],

alternatively call Telephone (013) 754 2700

mailto:[email protected]


Directors:



FOR OFFICE USE ONLY

Received by (Print name and surname)

Position

Date received

Signature


Directors: PM Makwana (Chairperson)

J Yawitch, B Hanise, ZP Zatu, L Mnisi, Adv L Mokgatle, F Baleni, Y Pillay, NI Balton, J Maruma (ACFO), OT Monaheng (CEO)


Legal name

Trading name

Type of company Public Company (Ltd)

Private Company (Pty) Ltd

Joint Venture (JV)

Non-Profit Organisation (NPO)

Non-Governmental Organisation (NGO)

Government Institution

Sole Proprietor

Company Registration number

Income Tax Reference number

VAT registration number (If applicable)

If Exempted from VAT, state reasons

OWNERSHIP DETAILS

Owner 1

Surname

Names

Position in the company

ID number

Nationality

Nationality Gender Race Shares owned Disability Yes No

Owner 2

Surname

Names


ID number

Nationality


Owner 3

Surname

Names


ID number

Nationality


NOTE: If your company has more than three (3) owners, please attach a separate sheet

with


Directors:



COMPANY CONTACT DETAILS

Contact Person (Bids) & email address

Contact Person (Remittances) & email

Telephone number

Cellphone number

Fax number

Email address

Physical address

Line 1

Line 2

Line 3

Line 4

Postal code

Postal address

Line 1

Line 2

Line 3

Postal code

COMMODITIES AND/OR TYPE OF SERVICE YOU PROVIDE

Does your company provide Products Services Both

Area Of Delivery National Provincial Local

Main Product or Service supplied (e.g. Consulting )

COMPLIANCE REGULATORY BODY e.g. Construction CIDB

Membership number

Telephone number

PUBLIC INSURANCE AND INDEMNITY COVER

Does your company have public liability insurance? Yes No N/A

Does your company indemnify the SAFCOL/KLF in the event that someone is injured in the line of duty? Yes No

BANKING DETAILS (only original bank letters will be accepted and dated in the month of

registration)

Verification of bank accounts will also be done on CSD

Account Holder Bank Name Account Number Type of account Branch name Branch code

Cheque

Savings/Transmission

CERTIFIED BY BANK

Date Stamp of Bank Employee name

Employee surname

Position

Telephone number

Fax number





Signature

In the absence of a bank stamp verification kindly furnish us with a bank stamped letter from your bank


Directors:



BROAD-BASED BLACK ECONOMIC OWNERSHIP INFORMATION

What is your broad based BEE status (Level 1 to 9)

DATE OF ISSUE EXPIRY DATE

Important Notes: Exempted Micro Enterprise (EME) have an

Annual Turnover less than R10m. Submit a BBBEE certificate from an accredited SANAS verification agency / EME sworn affidavit signed by the EME representative and attested by a Commissioner of Oaths

Qualifying Small Enterprise (QSE have An annual turnover is between R10m and R50m Submit a BBBEE

certificate from an accredited SANAS verification agency / QSE sworn affidavit signed by the EME representative and attested by a Commissioner of Oaths

Generic Enterprise have an

annual turnover in excess of R50m. Submit a BBBEE certificate from an

accredited SANAS verification agency.

Majority Race of Ownership

% Black Ownership

% Black women ownership % Disabled person/s

ownership

% Youth Ownership Notes: Disabled person/s must submit a medical / assessment report confirming disability. The

Medical assessment report must not be older than 3 months at date of application

PROCUREMENT AND CONTRACTS INFORMATION

The number of contracts obtained from the SAFCOL/KLF in the previous financial year if applicable

The value of contracts obtained from SAFCOL/KLF in the previous financial year if applicable R

TRADE REFERENCE

Client/Company name Contact person

Telephone number

Email address

Fax number

TERMS AND CONDITIONS

1. SAFCOL/KLF reserves the right to terminate supplier’s contract should any form of

misrepresentation (Fronting, etc.) be found. 2. The supplier agrees to supply original or certified copies of documents to SAFCOL/KLF onrequest.

3. Failure to comply with the above terms and conditions shall give SAFCOL/KLF the right to reject the application

DECLARATION OF INTEREST(This must be completed and signed and is COMPULSORY)

I hereby acknowledge that I read and understood the contents of this application form and abide myself And my organization by the terms and conditions stipulated in this form. Moreover, I grant SAFCOL/KLF the right to investigate

authenticate and verify information provided by me with or without my knowledge.

Name and surname Date Signature

Please keep copies of REGISTRATION FORM and all DOCUMENTATION submitted





FICA REQUIREMENTS

SA Companies

Certificate of Incorporation (CM1) and Notice of Registered Office and Postal Address (CM22) containing Registrar’s stamp and signed by the Company Secretary.

A document(s) less than 3 months old containing trade name and business address (i.e.) utility bill, account of landline telephone, bank statement, municipality rates, tax invoice, and lease agreement.

ID document/passport i.r.o the manager, all authorized representatives, all individuals holding 25% or more of the voting rights at a general meeting.

Proof of authority to act for company (i.e.) Director’s resolution.

Applicable documents referred to in institutions holding 25% or more of the voting rights at a general meeting.


Directors:



SUPPLIER GUIDELINES

Dear Supplier

Suppliers do not need to be registered to participate in the SAFCOL/KLF’s bidding process, however, in order to receive a contract award

they must be “Approved”, which requires the completion of a Supplier Registration form, meeting all eligibility requirements and providing

all required documentation which is outlined on page 1 of the Supplier Registration form and detailed in Annexure A of this document.

Completion of a Supplier Registration form, however, does not guarantee that a supplier will be approved. Furthermore, the process of

registration does not automatically qualify or entitle the supplier to receive work from the SAFCOL/KLF. Once a supplier is approved it is

added to the SAFCOL/KLF Supplier Database.

In order to comply with the procedures set out in the Accounting Offices Procurement Procedures (AOPP), as referred to in the Public

Finance Management Act, 1999 (Act 1 of 1999) (PFMA) and the National Treasury Regulations, the SAFCOL/KLF’s Supply Chain

Management Division employs a supplier database to be used by the SAFCOL/KLF Procurement Division in managing the procurement

of goods and services as required by the organization as and when needed.

The SAFCOL/KLF Supplier Database Office receives all fully completed supplier registration forms.

No form will be accepted/loaded if the following has been omitted at the time of submission

a. If the document is not fully completed

b. If the forms are not readable c. If all the required and valid documentation is received (eg., Tax Clearance, BBBEE certificate, CSD Summary

Report/ CSD supplier Number) d. If the banking details are not supported with either a bank stamp, letter from the bank or cancelled cheque is

not attached

e. If the Supplier registration form is not dated and signed

f. If the Supplier Code of Conduct is not signed

g. If the Declaration of Interest is not signed

In the event of a request to amend a supplier’s details becomes necessary, the SAFCOL/KLF would require the supplier to

communicate such changes to the Supplier Database office in writing to: [email protected] Depending on the

nature of the request the following will apply:

Change in banking details

A signed letter by the Financial Director of the organization with a cancelled cheque or a stamped letter from the

bank. Bank Details must be changed/ amended on CSD as well for verification purposes






Company name change

A new supplier registration form has to be completed in the new name and relevant documentation submitted.

Change in contact details, change of address and/or contact persons

Written notification on a company letterhead must be sent to our Supplier Database office

Verification – the verification of the information supplied will be performed against third party sources such as CSD, SARS,

CIDB, CIPRO, SANAS etc.

Your Tax Clearance certificate and BBBEE certificate is only valid for a period of one (1) year from the date of issue. You are

required to submit an updated tax clearance certificate, and BBBEE Certificate on, or before the currently submitted Tax

Clearance Certificate and BBBEE Certificate to maintain your verified status on SAFCOL/KLF’s supplier database. Failure to

do so may result in your status becoming inactive until the valid documentation is received. Always remember to update your

details on CSD as this is the main source of verification for government.

SAFCOL/KLF fully endorses and supports the Government’s Broad-based Black Economic Empowerment Programme and it

is strongly of the opinion that all South African Business Enterprises have an equal obligation to redress the imbalances of the

past.

If your annual turnover is less than R10 million, then in terms of the DTI codes, you are classified as an Exempted Micro

Enterprise (EME). Your company is classified as an EME, please include in your submission, BBBEE certificate from an accredited

SANAS verification agency / EME Sworn Affidavit signed by the EME representative and attested by a Commissioner of Oaths

If your annual turnover is between R10 million and R50 million, then in terms of the DTI codes, you are classified as a

Qualifying Small Enterprise (QSE), please include in your submission a BBBEE certificate from an accredited SANAS verification agency

/ QSE Sworn Affidavit signed by the EME representative and attested by a Commissioner of Oaths

If your turnover is in excess of R50 million, then in terms of the DTI codes, you are classified as a Generic Company, please

include in your submission a BBBEE certificate from an accredited SANAS verification agency

No payments can be made to a supplier until the supplier has been registered.

Once a supplier has been registered on the SAFCOL/KLF’s supplier database, a letter of confirmation will be forwarded to the

supplier advising of the registration number. The supplier registration number can be quoted on all future correspondence to

the SAFCOL/KLF


Directors:



DECLARATION OF INTEREST

1 Declaration of interest

1.1 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 authorized representative declare his/her position in relation to

the evaluating/adjudicating authority where:

1.1.1 The bidder is employed by the state; and/or

1.1.2 the legal person on whose behalf the bidding document is signed, has a relationship with

persons/a person who are/is involved in the evaluation and/or adjudication of the bid(s), or

where it is known that such a relationship exists between the person or persons for or on

whose behalf the declarant acts and persons who are involved with the evaluation and/or

adjudication of the bid.

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

submitted with the Bid.

2.1 Full name of bidder or his or her representative:

2.2 Identity number:

2.3 Position occupied in the company (director, trustee, shareholder)

2.4 Company registration number

2.5 Tax reference number

2.6 VAT registration number

2.6.1

The names of all directors / trustees / shareholders / members, their Individual identity

numbers, tax reference numbers and, if applicable, employee / persal numbers must be indicated in

paragraph 3 below.

“State” means:

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

(b) any municipality or municipal entity; (c) provincial legislature; (d) national Assembly or the national Council of provinces; or (e) Parliament.

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 not, 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 other particulars:


Directors:



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?


2.10 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?


2.11 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?


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.

Signature Date

Position Name of bidder


Directors:



SUPPLIER REGISTRATION FORM

By signing the SUPPLIER REGISTRATION FORM documents, the Supplier is deemed to acknowledge and accept that all

the conditions governing this SUPPLIER REGISTRATION FORM including the SUPPLIER CODE OF CONDUCT attached as

Annexure A of this form

SIGNED at this

day of

NAME OF COMPANY

NAME OF THE SIGNATORY

CAPACITY:

Are you authorised to sign on behalf of the company (YES/NO)

WITNESSES:

1.

2.


Directors:



FOR OFFICE USE ONLY: Application Verified by:

Verified by:

Name

Designation

Signature

Date

Application Approved/ Not Approved

Approved By:

Name

Designation

Signature

Date


Directors:



Conflict of Interest

ANNEXURE A - SUPPLIER CODE OF CONDUCT

SUPPLIER CODE OF CONDUCT

These include, but are not limited to: Misrepresentation of their product (origin of manufacture, specifications, intellectual property rights, etc);

– Collusion

– Failure to disclose accurate information required during the sourcing activity (ownership financial situation, BBBEE

status, etc.);

– Corrupt activities listed above; and

– Harassment, intimidation or other aggressive actions towards SAFCOL/ KLF employees.

>> Suppliers must be evaluated and approved before any materials, components, products or services are purchased from

them. Rigorous due diligence must be conducted and the supplier is expected to participate in an honest and straight forward manner.

>> Suppliers must record and report facts accurately, honestly and objectively. Financial records must be accurate in all

material respects.

A conflict of interest arises when personal interests or activities influence (or appear to influence) the ability to act in the best interests of SAFCOL/ KLF. Examples are: >> Doing business with family members. >> Having a financial interest in another company in our industry

TIP OFFS ANONYMOUS HOTLINE 012 436 6379 Email: [email protected]



Directors:



Supplier Code of Conduct

SAFCOL / KLF aims to achieve the best value for money when buying or selling goods and obtaining services. This, however, must be done in an open and fair manner that supports and drives a competitive economy. Underpinning our process are several acts and policies that any supplier dealing with SAFCOL / KLF must understand and support.

These are (but not limited to): >> SAFCOL / KLF Procurement Policy - A guide for tenderers; >> Section 217 of the Constitution - the five pillars of Public PSCM (Procurement and Supply Chain Management):

fair, equitable, transparent, competitive and cost effective; >> The Public Finance Management Act (PFMA); >> The Broad Based Black Economic Empowerment Act (BBBEE); >> Prevention and Combating of Corrupt Activities Act (PRECCA); and >> The Construction Industry Development Board Act.

This code of conduct has been compiled to formally appraise SAFCOL / KLF Suppliers of SAFCOL / KLF’s expectations regarding behaviour and conduct of its Suppliers.

Prohibition of Bribes, Kickbacks, Unlawful Payments, and Other Corrupt Practices

SAFCOL / KLF is in the process of transforming itself into a self- sustaining State Owned Enterprise, actively competing in the logistics industry. Our aim is to become a world class, profitable, logistics organisation. As such, our transformation is focused on adopting a performance culture and to adopt behaviours that will enable this transformation.

SAFCOL / KLF will not participate in corrupt practices. Therefore, it expects its suppliers to act in a similar manner. >> SAFCOL / KLF and its employees will follow the laws of this country and keep accurate business records that

reflect


Directors:



actual transactions with, and payments to, our suppliers. >> Employees must not accept or request money or anything of value, directly or indirectly, from suppliers.

Employees may not receive anything that is calculated to:

– Illegally influence their judgement or conduct or to influence the outcome of a sourcing activity;

– Win or retain business or to influence any act or decision of any person involved in sourcing decisions; gain an improper advantage.

>> There may be times when a supplier is confronted with fraudulent or corrupt behaviour of SAFCOL / KLF employees. We expect our suppliers to use our “Tip-offs Anonymous” Hotline to report these acts – 012 436 6379 SAFCOL / KLF is firmly committed to free and competitive enterprise. >> Suppliers are expected to comply with all applicable laws and regulations regarding fair competition and

antitrust practices >> SAFCOL / KLF does not engage non-value adding agents or representatives solely for the purpose of

increasing BBBEE spend (fronting).

SAFCOL / KLF’s relationship with suppliers requires us to clearly define requirements, to exchange information and share mutual benefits. >> Generally, suppliers have their own business standards and regulations. Although SAFCOL / KLF cannot

control the actions of our suppliers, we will not tolerate any illegal activities.

I, the undersigned, for and on behalf of the supplier, hereby confirm that I/we understand the information as stated above and that I/we will comply with all of the above.

……………………………….….. ………………… ………………………………………….. Name (print) Signature

…………………………………….. …………… ……….……….. ……………………….. Capacity Date





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.


Directors:



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

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.

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.

…………………………………… …………………………………

Sig Signature Date

………………………………. …………………………………

Position Position Name of Bidder

Documents

SUPPLIER REGISTRATION FORM - SAFCOL