RFI SUBMISSION FORM PROVIDE ALL THE INFORMATION REQUESTED IN THE SPACES PROVIDED. DETAILS OF SERVICE PROVIDER Of Service Provider Trading as (if different from above) Company registration Company Income Tax no. VAT registration no. Professional Registrations Primary-Business- Service Offering Exempt Micro ANNUAL TURNOVER (mark with an X) Qualifying Small FORM OF ORGANISATION Large Business Incorporated Company Sole Proprietor/Practice Other (please specify) Partnership B-BBEE STATUS (Level 1- non-compliant mark with an x) 1 2 3 4 5 6 7 8 Non- Compliant 1 Initial:
ADDRESS Postal Address Postal Code Physical Address Postal Code CONTACT DETAILS Contact Details Of Authorised Signatory (Attach Proxy) Contact Details Of The Project Manager Representing The Service Provider in this RFI Contact Details Of The responsible for Account Enquiries Service Provider Website 2 Initial:
COMPANY MANAGEMENT (List All Partners, Proprietors, Shareholders, Relevant Management of the office which will service the University) Surname ID Number % Owners Date Of Ownership % Voting Provide Details Of (Max 5) Major s That: Aligns Closest With This Tender Was Executed In The Past Five (5) Years You can provide traceable references off Start with Most Recent/ Current. (ZAR) (ZAR) (ZAR) (ZAR) 3 Initial:
(ZAR) ADDITIONAL DOCUMENTS ATTACHED HAVE YOU INCLUDED ADDITIONAL DOCUMENTATION (Tick Appropriate Block) Description Of Document No. Of Pages MANDATORY DOCUMENTS The Following Mandatory Documents Must Be Added At The End Of The Submission Document PLEASE TICK THE COLUMN ON THE RIGHT TO INDICATE DOCUMENTS SUBMITTED Completed RFI form, signed by authorized signatories Brief Company profile (should contain basic details relevant to this tender) Registration document of the enterprise (CK1/CK2 or CM29/CM22) Valid SARS clearance certificate VAT registration certificate Valid BBBEE Certificate from a SANAS/IRBA accredited verification agency Proxy : Attach a director s resolution or proxy, authorizing the signatory on the tender documents on behalf of the Service Provider if applicable Proof of bank account Proof of CIDB Grading (Minimum 7GB) Proof of Public Liability Insurance 4 Initial:
FIN-AUD-2016-003 STATEMENT OF COMMITMENT AND DECLARATION OF INTEREST I/We the undersigned... from ( of Service Provider)... Confirm that I/we have satisfied myself/ourselves as to the correctness and validity of my/our proposal. It is specifically recorded that, should it at any time emerge that I/We willfully or negligently gave or made any guarantee, undertaking or representation in respect of any information required and/or provided for the purposes of this tender, that is fraudulent, false or otherwise inaccurate, the University shall be entitled but not compelled to immediately terminate my/our participation in the tender process. I/We acknowledge that only reputable and recognised service providers who meet all the mandatory requirements with sufficient proof of experience and expertise in the provision of the required goods/ services will be considered in this RFI process. I have the authorisation to sign tenders and tender related documents on behalf of my company (Attached proof - director's resolution or proxy, authorising to sign this document on behalf of the company) Certify that as far as I/we know (Mark option below that is not applicable with a X): No members of our company have any direct or indirect vested interest in the UNIVERSITY OF PRETORIA. Member/s as detailed hereunder has a direct / indirect vested interest in the UNIVERSITY OF PRETORIA. /s and occupation of contact within the UNIVERSITY OF PRETORIA Any conflict of interest has been declared in writing. State that the information submitted is true and correct....... Print & Surname (below) Date:.. Print & Surname (below) Date:.. WITNESS :.. Print & Surname (below) Date:. 5 Initial