Supplier Registration Form

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Walter Jacobs
5 years ago
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2 TO ALL SUPPLIERS SEEKING REGISTRATION AS A PREFERRED SUPPLIER OF GOODS AND SERVICES TO GLADAFRICA GROUP (PTY) LTD All suppliers are herewith invited t register as a preferred supplier n the database f GladAfrica Grup (Pty) Ltd, herein- after referred t as GladAfrica Grup. In rder t cmply with the Prcurement Prcedures, set ut by GladAfrica Grup, the Prcurement Divisin develped a supplier database t be used by GladAfrica Grup in managing the prcurement f varius gds and services as required by the cmpany frm time t time. The purpse f this database is t give all prspective suppliers an equal pprtunity t submit future qutatins t the cmpany. It is envisaged hwever, that this database will cntribute t efficient administratin and cmpliance with the regulatins set ut by the gverning cmmittees within the cmpany. Attached please find an fficial applicatin frm t assist in the registratin f yur cmpany n ur supplier database. It is imperative that suppliers read the applicatin dcument carefully, cmplete it in full and sign it. Once cmpleted, please pst the frm t the fllwing address: GladAfrica Grup Attentin: Prcurement Divisin PO Bx 6723 Halfway Huse Midrand, 1685 Or alternatively hand deliver t the address belw. GladAfrica Grup Attentin: Prcurement Divisin GladAfrica Huse Hertfrd Office Cmplex 90 Bekker Rad Midrand, 1685 Alternatively, frms can be ed t: prcurement@gladafrica.cm The abve address can als be used fr ther supplier enquiries

Fax Website Address Cmpany Main E- mail Address Cmpany fax number Pstal Address Physical Address Business Addresses Cmpany Registratin N VAT Registratin N Incme Tax Ref N Parent/Hlding Cmpany Reg.

3 SUPPLIER DETAILS GladAfrica Grup shall evaluate the Cntractrs/suppliers and gds/services n the basis f their ability t meet requirements. Full registered Name f the Cmpany Cmpany Trading Name Name f Parent/ Hlding Cmpany Type f Cmpany (Mark with a X): Public C Private C Partnership Sle Trader Other Main Switchbard Tel Main Switchbard Fax Website Address Cmpany Main E- mail Address Cmpany fax number Pstal Address Physical Address Business Addresses Cmpany Registratin N VAT Registratin N Incme Tax Ref N Parent/Hlding Cmpany Reg. N Letter f Gd Standing Reg. N Tax clearance Expiry Date Descriptin f Gds/ Services Prvided Prvinces Operating in CONTACTS ACCOUNT CONTACT & DETAILS Accunts Cntact Persn ( Full Name) Cntact Mbile number Cntact Fax Address HEAD OF FINANCE CONTACT DETAILS Manager Cntact Persn ( Full Name) Cntact Mbile number Cntact Tel Address

4 COPIES OF DOCUMENTS REQUIRED WITH THIS FORM TO BE INCLUDED Dcuments Required 1. Cmpany Registratin (Certified Cpies) Sle Prprietr N/A Clse Crpratin Certificate f CK1 / CK2 incrpratin Business Type Partnership Duly Signed Partnership Cmpany Public/Private CM39 Nn- prfit Organizatin Certificate f Incrpratin Sectin 21 Institutin CIPC 2. Latest Prf f Business Address Supply Latest Cpy Supply Latest Cpy Supply Latest Cpy Supply Latest Cpy Supply Latest Cpy 1 st preference Municipal accunt. 3. Prf f ing details s 4. Tax Clearance Certificate Fr the individual Fr the business Fr each partner Fr the business Prf f Exemptin Suth African Revenue Services (SARS) 5. Brad- Based Black Ecnmic Empwerment Cmpliance Valid BEE Certificate Valid BEE Certificate Valid BEE Certificate Valid BEE Certificate Valid BEE Certificate SANAS Accredited Agencies 6. Signed supplier r sub- cnsultant terms and cnditin whichever is applicable Signed Signed Signed Signed Signed GA Envirnment PROFESSIONAL & BUSINESS STANDING 1. Did the cmpany exist under a previus name befre? Yes N If Yes, what was the previus trading name? 2. Are yu in a state f bankruptcy, inslvency, cmpsitin with creditrs r subject t Yes N relevant prceedings? 3. Is nt in pssessin f relevant licences r membership f an apprpriate rganizatin Yes N where required by law? 4. Des yur cmpany r any f its emplyees have a vested interest in any f the GladAfrica cmpanies r any f the GladAfrica emplyees? Yes N If Yes, please state the details f the invested interest. 5. Indicate whether any f the Directrs, Prprietrs & Sharehlders are/were in the service f any GladAfrica cmpanies within the previus twelve mnths. If Yes, please state the individual(s). Yes N 6. Have yu previusly supplied any gds/ services t any f the GladAfrica cmpanies befre? If Yes, please state the details f the gds. Yes N When cmplete please ensure this dcument, tgether with all required attachments, is returned t the individual wh crrespnded with yu. Nte: Incmplete applicatins will autmatically be rejected. It will be viewed in a very serius light shuld any dcuments be mitted r any f the applicable fields be left empty. Prspective vendrs shuld be aware that the manner in which this applicatin is cmpleted will be taken int accunt when management review their suitability as Vendrs fr GladAfrica Grup.

5 PARTICIPATION CAPACITY Mark the apprpriate participatin capacity with a Principal Cntractr If a Sub- cntractr, are yu a Subcntractr? Gds Supplier Services Supplier (including Prfessinal fees) Manufacturer f gds Repairer f faulty gds Imprter Exprter Distributr Other (Specify): Nminated Dmestic b BUSINESS SECTOR Mark the apprpriate participatin capacity with a b Whlesale trade and Cmmercial Manufacturing Electricity, Gas and Water Cnstructin Retail and Mtr trade Hspitality Catering and Accmmdatin Travel agent Recruitment agent Transprt, strage and ther related trade Cmmunicatin Financial services Cnsulting services Repair/ Allied Services Cmmercial agent Cmmunity and Scial Services Other (Specify): PRINCIPLE CONTRACT DETAILS/ DIRECTORS DETAILS Name f Principle fficer/ Directr Name f Principle fficer/ Directr Name f Principle fficer/ Directr Name f Principle fficer/ Directr

6 BANKING DETAILS I/we hereby request and authrize yu t pay any amunts which accrue t me/us t the credit f my/ur bank accunt with the mentined bank. I/we understand that the credit transfer hereby authrized will be prcessed by cmputer thrugh a system knwn as Electrnic Funds Transfer and I/we als understand that n additinal advice f payment will be prvided by my/ur bank, but details f each payment will be printed n my/ur bank statement r any accmpanying vucher. (This des nt apply where it is nt custmary fr banks t issue bank statements.) I/we understand that a payment will be effected by GladAfrica Grup (Pty) Ltd in the nrmal way, and that it will indicate the date n which funds will be available in my/ur accunt. Accunt Name Branch Cde & Name Accunt Number Name f Accunthlder Type f Accunt Transmissin Cheque Savings Certified as Crrect by: Details BANK STAMP Name and Surname: Telephne number: ( ) Fax number: ( ) I/We the undersigned acknwledge(s) that: The infrmatin furnished is true and crrect The Equity Ownership claimed is in accrdance with the General Cnditins Any cnflict f interest shuld be declared in writing An fficial GA Envirnment purchase rder will be accepted Payment f any gds delivered r services rendered will be affected within 30 days frm statement date. FULL NAME: SIGNATURE: DULY AUTHORIZED TO SIGN: (Name f the Organizatin)

7 DECLARATION BY COMPANY DIRECTOR UNDER OATH I/We declare that the abve particulars and infrmatin furnished t GladAfrica Grup fr the purpses f registering ur rganizatin n the supplier database are true in substance and in fact and that I/We fully understand the meaning theref. By signing belw, yu thus authrize GladAfrica Grup t cnduct an ITC Check and any ther relevant verificatin f the details prvided within this frm and t cntact any persn t verify such details. GladAfrica Grup will use infrmatin prvided in this frm as true and accurate reflectin f the affairs f the cmpany. FULL NAME: SIGNATURE: DULY AUTHORIZED TO SIGN: DESIGNATION: Signed and swrn t me at n this..day f (mnth)..(year) by the Depnent, wh has acknwledged that he/she knws and understands the cntents f this affidavit, that it is true and crrect t the best f his/her knwledge and that she/he has n bjectin t taking the prescribed ath, and that the prescribed ath will be binding n her/his cnscience. COMMISSIONER OF OATH NOTE: SUPPLIERS PROVIDING FALSE OR FRAUDULENT INFORMATION OR DOCUMENTS SHALL SUBJECT THEMSELVES TO IMMEDIATE DISQUALIFICATION.

8 ANNEXURE 1 LIST OF PRODUCTS/SERVICES OFFERED (PLEASE SPECIFY) Discipline Name Accunting, Auditing and Financial Services Prfessinal services (Specify) Facility Management (Specify) Human Resurces Cmmunicatin, Marketing & Crprate Services IT (Specify) Advisry services Operatins services (Specify) General services ( Specify) Other (Specific) Tick where apprpriate FOR OFFICE USE ONLY EMPLOYEE NUMBER SIGN Received by GLAD0 Is the applicatin cmplete Yes N If N, was the supplier infrmed Yes N Frm captured by Vendr Number

Supplier Registration form. Supplier Registration Form

Supplier Registration form. Supplier Registration Form Supplier Registratin frm TO ALL SUPPLIERS SEEKING REGISTRATION AS A PREFERRED SUPPLIER OF GOODS AND SERVICES TO GA ENVIRONMENT (PTY) LTD All suppliers are herewith invited t register as a preferred supplier