VENDOR
REGISTRATION
VR 1/2008
APPLICATION
BY
Name of company: _________________________________________________________
_____________________________________________________________________________
Full registered trade name: _________________________________________________
_____________________________________________________________________________
PLEASE PRINT THIS DOCUMENT, FILL IN BY HAND AND SUBMIT HARD COPY TO TUT
Supplier Database
Tshwane University of Technology
The Tshwane University of Technology is developing a vendor database which will
assist with requests for quotations and tenders.
These forms must be completed in full, placed in an envelope marked clearly
“VENDOR APPLICATION”, sealed and placed in the Tender Box at the following
address:
Tender Box
Pretoria Campus
Building 6, Ground Level,
Staatsartillerie Road,
Pretoria West
Complete all detail in forms in black ink.
Please print so that all information is legible.
Forms that are not readable or are incomplete will be rejected.
New Application
Yes
No
If No, please supply current TUT creditor number.
PLEASE KEEP COPIES OF THE REGISTRATION FORM AND ALL
DOCUMENTATION SUBMITTED FOR YOUR OWN RECORDS AS
NO COPIES WILL BE MADE BY THE UNIVERSITY
2
-
POINTS TO REMEMBER
-
COMPLETING VENDOR REGISTRATION APPLICATION FORM

Mandatory fields – Certain fields and documents are mandatory to certain business types only.
Please ensure that all fields mandatory to your business type which are marked as “Mandatory
Field” have been completed and if a field is not applicable to your business type, clearly mark it as
N/A.

Required documentation – Please refer to the attached table (Following page) to determine the
mandatory supporting documentation required for your business type. Please ensure that all copies
of Mandatory documents (certified copies where applicable) are attached.

Completion of questions – Clearly state Yes, No or N/A to questions asked. Do not leave any
Mandatory fields blank.

Certified Documents – Please ensure that a Commissioner of Oaths has certified your Company
Registration document and Proof of Shareholding Certificates. The stamp of certification should be
on the front of the document.

Copies of Documents - Please keep copies of the registration form and all supporting
documentation submitted for your own records and to ensure that all data is maintained and up to
date on a continual basis.

Owners, Shareholders and Partners – Please ensure that the percentage of ownership
calculated up to 100% and that a field is completed for each of the business owners.

Certification of Correctness – Please ensure that the Certification of Correctness is signed and
dated once all required documents and information have been submitted.

Collection points – Completed registration forms and supporting documentation can be delivered
to the address on the registration form.

Processing of registration – Your completed registration will be processed and once verified, will
be approved and you will be issued with a Vendor Registration Number to be used in all future
communication with Tshwane University of Technology. The letter of verification will be dispatched
to the correspondence details supplied on page three. Please note that this administration process
will take a minimum of 5 days. Once your registration has been included on the TUT Database your
details will be accessible to the purchasing officers of TUT.

Business Opportunities – Please note that registration on the TUT Supplier Database does not
guarantee business opportunities. Inclusion of the name in a database does not in any way
guarantee any persons, company, service provider, vendor, etc. any business from the Tshwane
University of Technology. All procurement will be subjected to the Procurement- and Tender
policies of Tshwane University of Technology.

Amendments – Please notify the Tshwane University of Technology – Procurement Department
immediately of any changes to the verified information submitted.

Queries – Should you have any queries or if you require assistance completing the registration
form, please contact the Procurement office on (T) 012-3825207.

If a company has more than one office, each office must fill in a separate from unless the point of
transaction is centralized in the company’s head office.

Please note that the key facilities in the database are classified as commodities and each potential
vendor must indicate the commodity/commodities in which it would like to register for RFQ’s.

The main objective of this process is to enhance transparency and equality on the part of the
University and to facilitate effective communication with its vendors.

Applications must be delivered by hand and must be fully completed with all the relevant
documentation attached.

It is a condition of bidding that a vendor’s taxes must be in order or satisfactory arrangements must
have been made with the Receiver of Revenue to meet his/her tax obligations. In bids where
consortia/joint ventures/sub contractors are involved, each party must submit a separate valid Tax
Clearance Certificate.
3
PLEASE KEEP COPIES OF REGISTRATION FORM AND ALL DOCUMENTATION SUBMITTED
Name of Business
Registration Number
Documents
required
Where to get
documents
Business Type
Sole
Proprietor
Close
Corporation
and Private
Companies
Partnerships
Public
Company
Business
Trust
Non Profit
Organizations
N/A
Certificate of
incorporation
CK1/CK2
Partnership
agreement
Certificate of
incorporation
CM3
Trust
agreement
Certificate of
incorporation
Section 21
N/A
Certificate of
incorporation
CK1/CK2
Partnership
agreement
Certificate of
incorporation
CM3
Trust
details:
Letter of
Authority
Auditor’s
letter – no
shareholding
Yes
Yes
Yes
Yes
Yes
Yes
Bank
Statement/
cancelled
cheque
For the
owner or
the
business
For the
owner or
the
business
Bank
Statement/
cancelled
cheque
Bank
Statement/
cancelled
cheque
Bank
Statement/
cancelled
cheque
Bank
Statement/
cancelled
cheque
Bank
Statement/
cancelled
cheque
Branch of Bank
where account
is held
For the
company/cc
For the
partnership
For the
company
For the
Trust
For the Trust
Receiver of
Revenue
(SARS)
For the
company/cc
For the
partnership
For the
company
For the
Trust
For the Trust
Receiver of
Revenue
(SARS)
P.A.Y.E
If staff are
employed
If staff are
employed
If staff are
employed
If staff are
employed
If staff are
employed
If staff are
employed
VAT
Registration
If registered
for VAT
If registered
for VAT
If registered
for VAT
If registered
for VAT
If registered
for VAT
If registered
for VAT
U.I.F
Certificate
Workman’s
Compensation
If staff are
employed
If staff are
employed
If applicable
– for
security
industry
If owner is
disabled
Clear copy
of Owner’s
ID doc.
If staff are
employed
If staff are
employed
If staff are
employed
If staff are
employed
If staff are
employed
If staff are
employed
If staff are
employed
If staff are
employed
If applicable
– for security
industry
If applicable
– for security
industry
If applicable
– for ecurity
industry
If owner is
disabled
Clear copy
of Owner’s
ID doc.
If owner is
disabled
Clear copy of
Owner’s ID
doc.
If owner is
disabled
Clear copy
of Owner’s
ID doc.
If staff are
employed
If staff are
employed
If applicable
– for
security
industry
If owner is
disabled
Clear copy
of Owner’s
ID doc.
Company
Registration
Certified
Copies
Proof of
Ownership
Certified
Copies
Regional
Services
Council
Proof of
Banking
Income Tax
Tax
Clearance
certificate
Security
Officer’s
Board
Proof of
Disability
Proof of
Identity
4
If applicable
– for security
industry
If owner is
disabled
Clear copy of
Owner’s ID
doc.
Registrar of
Close
Corporations &
Companies
Registrar of
Close
Corporations &
Companies
City of Tshwane
/Local Authority
if not based in
Tshwane
Receiver of
Revenue
(SARS)
Receiver of
Revenue
(SARS)
Department of
Labour
Department of
Labour
Security Service
Industry
Regulatory
Authority
Medical
Practitioner
Department of
Home Affairs
CONTACT DETAILS
Registrar of Close Corporations & companies
Zanza Building, 116 Proes Street, Pretoria
086 184 3384
Department of Labour (U.I.F certificates)
94 Church street, Pretoria
012 337 1802
City of Tshwane/Local Authority if not based in
Tshwane
HB Phillip Building, 320 Bosman Street, Pretoria.
Department of Labour (Workman’s Compensation
Compensation House, Cnr Hamilton & Soutpansberg Rd,
Pretoria
012 319 9111
012 337 4000
Receiver of Revenue (SARS)
c/o Schoeman & v.d. Walt Street, P.O. Box 436, Pretoria
0001
012 317 2000
Security Service Industry Regulatory Authority
481 Belvedere Street, Arcadia
012 337 5500
COMMODITY GROUPS
PLEASE NOTE:
Any vendor may only register for a maximum of four commodity groups
Tick
Cat
No
Description
001
Laboratory equipment
032
002
Fasteners, Bolts,
Nuts, Rivets &
Washers
033
003
Containers &
Packaging
034
004
Bricks & Blocks
035
005
006
Canteen, Kitchen &
Cooking equipment &
Appliances
Tableware,
Hollowware &
Utensils
Tick
Cat
No
036
037
007
Sand, Soil, Cement &
Concrete
038
008
Home & Industrial
Fabrics & Textiles
039
009
Clothing, Safety
Clothing & Footwear
040
010
Cordage, Ropes,
Twines, String & Nets
041
011
Electronic
Components &
Equipment
042
012
013
014
015
Computer Hardware
& Supplies
Computer Software &
Solutions
Electric & Data Cable,
Wire &Equipment
Electric Lamps,
Lighting &
Accessories
043
Description
Welding & Flame
Cutting Equipment
Office Furniture,
Components &
Accessories
Hospital, Medical &
Surgical Equipment &
Furniture
Outdoor & Pavement
Furniture
Agricultural &
Horticultural Equipment
& Machinery
Compressors, Blowers &
Vacuum Equipment
Air conditioners,
Ventilation, Fans &
Coolers
Furnaces, Kilns, Ovens
& industrial Dryers
Office Machines &
Equipment
Machine Tools &
Accessories
Radio, Television,
Audiovisual &
Communication
Equipment
Pumps, Engines, Spares
& Accessories
Tick
Cat
No
063
Catering & Events
Equipment Hire
064
Engineers & Contractors
065
Castors, Ladders, Trolleys
& Wheels
066
Recreational & Sports
Requisites
067
Artwork, Crafts, Curios &
Gifts
068
Hygiene, Beauty &
Cosmetic Products
069
Publications, Videos &
Films
070
071
072
Fresh Flowers, Plants &
Seeds
Medications &
Pharmaceuticals by
General Classification
Financial, Insurance &
Legal Services
073
Analysis, Inspection &
Evaluation Services
074
Installation Services
044
Fertilizers
075
045
Animal Feeds
076
046
Transport Vehicles,
Trailers, Motorcycles,
Boats, Aircraft & Spares
& Accessories
077
5
Description
Maintenance & Repair
Services
Manufacturing &
processing Services
Cleaning Services
016
017
018
019
020
021
022
023
024
025
026
027
028
029
General Electrical
Equipment & Parts
Control, Process &
Measurement
Instrumentation
Test & Analysis
instrumentation
Scopes, Lenses &
Optical Equipment
Security Equipment &
Requisites, Walling,
Fencing & Gates
Signs, Nameplates,
Notices & Labels
Engravers, DieSinkers & Embossers
Insulation Products
Precious Stones and
Materials
Building requisites,
fittings & Materials
Flooring Products
Sanitary ware &
Accessories
Sewing, Knitting &
Textile Machines &
Equipment
Printing, Marking,
Engraving & Labeling
Equipment
047
Washing, Scrubbing,
Cleaning Plant and
Supplies
078
Administration &
Management Services
048
Nails, Pins, Screws &
Staples
079
Engineering & Related
Services
080
Advertising & Marketing
Services
081
Consultants
049
050
Fuels, Petrol, Oils &
Lubricants
Coatings, Waterproofing
& Paints
051
Stationery
082
Communication, Publishing
& Printing Services
052
Steel, Pipes and Profiles
083
Consulting Engineers
084
Chemicals & Associated
Products
085
Security Services
086
Food Services
087
Computer Related Services
088
Accommodation, Tourism &
Entertainment
053
054
055
056
057
Valves and Pressure
Vessels
Pest Control and
Cleaning materials
Adhesives
Heaters and Heating
Equipment
Timbers and Timber
materials
058
Plant & Equipment Hire
089
Agricultural Services
059
Brush ware
090
Retailers & Wholesalers
060
Power Tools &
Accessories
091
Government Services –
National, Local & Municipal
030
Printing Supplies
061
031
General Foodstuffs
062
Hand Tools &
Accessories
Transport Hire &
Transport and Cartage
Services
Documents Attached
Please tick box
Yes
No
N/A
Workman’s Compensation Certificate (Certified)
Regional Council/District Registration (Certified)
VAT 103 (Certified)
P.A.Y.E./SDL/UIF (EMP103) (Certified)
Company Registration Document (Certified)
Proof of Ownership/Shareholder certificate (Certificate)
Tax Clearance Certificate (Original)
Proof of Banking Document
Disability Documents (Certified)
Security Officer’s Board registration (Certified)
Municipal Account
Labour Broker
Company Profile with organogram
Joint Venture Agreement/s
Please note: Proof of documents for all of those above are required to ensure successful registration on the Supplier
Database. In event of a document not being required please tick the N/A box.
6
1. COMPANY REGISTRATION DOCUMENTS
NB. DOCUMENTARY PROOF MUST BE PROVIDED WHERE APPLICALE (Please mark N/A if not applicable.)
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable
1.1
COMPANY TYPE * (NB. Documentary Proof of Registration must be provided)
PUBLIC COMPANY LTD
CERTIFIED COPY OF CERTIFICATE OF INCORPORATION
(CM 3) and
REGIONAL COUNCIL REGISTRATION NUMBER
PRIVATE COMPANY (PTY) LTD
CERTIFIED COPY OF CERTIFICATE OF INCORPORATION
(CM 3) and
REGIONAL COUNCIL REGISTRATION NUMBER
CLOSE CORPORATION CC
CERTIFIED COPY OF CK1 DOCUMENT OR CK2 IF
APPLICABLE and
REGIONAL COUNCIL REGISTRATION NUMBER
SOLE PROPRIETOR
COPY OF REGIONAL COUNCIL REGISTRATION
DOCUMENT
PARTNERSHIP
COPY OF REGIONAL COUNCIL REGISTRATION
DOCUMENT and
PARTNERSHIP AGREEMENT
BUSINESS TRUST
COPY OF REGIONAL COUNCIL REGISTRATION
DOCUMENT and
CERTIFIED COPY OF REGISTRATION DOCUMENT
OTHER (If Joint Venture)
COPY OF REGIONAL COUNCIL REGISTRATION
DOCUMENT and
CERTIFIED COPY OF REGISTRATION DOCUMENT
Company, CK or Regional Council Number
Not applicable to all companies, please specify if N/A.
Did you attach your company Registration document?
Y
N
N/A
1.2 PROOF OF SHAREHOLDING DOCUMENTS *
CERTIFIED COPIES of Shareholders certificates or CK members share allocation documents
must be supplied.
Not applicable to all companies, please specify if N/A.
Did you attach your proof of shareholders documents?
Y
N
N/A
Y
N
N/A
1.3 REGIONAL COUNCIL REGISTRATION DOCUMENTS *
Regional Council Reference Number
Did you attach your proof of shareholders documents?
7
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable
1.4 PROOF OF BANKING DOCUMENTS *
Current bank statement or copy of cancelled cheque.
Did you attach your proof of banking document?
Y
N
N/A
Y
N
N/A
Y
N
N/A
Y
N
N/A
Y
N
N/A
Y
N
N/A
Y
N
N/A
1.5 VAT REGISTRATION NUMBER #
VAT Registration Number
If you qualify for VAT exemption, please attach a VAT exemption document
Not applicable to all companies, please specify if N/A
Did you attach proof of your VAT registration (VAT 103)?
1.6 P.A.Y.E. DOCUMENT #
Not applicable to all companies, please specify if N/A
Did you attach proof of your P.A.Y.E. document?
1.7 UNEMPLOYMENT INSURANCE FUND DOCUMENTS #
U.I.F Number
Not applicable to all companies, please specify if N/A
Did you attach proof of your UIF document?
1.8 WORKMAN’S COMPENSATION FUND DOCUMENTS #
Workman’s Compensation Fund No.
Not applicable to all companies, please specify if N/A
Did you attach proof of your Workman’s Compensation Fund Number?
1.9 SECURITY OFFICERS BOARD REGISTRATION #
Security officers board registration no.
Not applicable to all companies, please specify if N/A
Did you attach proof of your Security Officers Board Registration?
1.10
DISABILITY DOCUMENTS #
Not applicable to all companies, please specify if N/A
Did you attach proof of your disability?
8
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable
1.11
INCOME TAX REGISTRATION #
Income Tax Registration No.
Not applicable to all companies, please specify if N/A
Did you attach proof of your Income Tax Registration?
1.12
Y
N
N/A
Y
N
N/A
Y
N
N/A
Y
N
N/A
TAX CLEARANCE CERTIFICATE *
Original of valid Tax Clearance Certificate must be supplied
Did you attach a valid Tax Clearance Certificate?
1.13
CIDB REGISTRATION #
CRS Registration No.
Current CIDB Grading
Not applicable to all companies, please specify if N/A
Did you attach proof of your CIDB Registration?
1.14
NHBRC REGISTRATION #
NHBRC Registration No.
Not applicable to all companies, please specify if N/A
Did you attach proof of Registration?
1.15
TRANSPORT OPERATORS #
PDP Permit No.
Not applicable to all companies, please specify if N/A
Y
Did you attach a copy of your PDP Permit?
9
N
N/A
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable
2. BUSINESS PARTICULARS *
2.1 Name of Business*
2.2 Physical address *
City
Code
Province
2.3 Postal address *
City
Code
Province
2.4 Telephone Number. *
2.5 Fax Number. *
2.6 Cell Number. *
2.7 E-Mail Address. *
2.8 Web-Page Address. *
2.9 How would you like to receive your correspondence from us? *
Post
Fax
E-Mail
2.10 Correspondence Address *
City
Code
Province
2.11 Contact Person for correspondence as per 2.10
Title
Name
Surname
10
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable
3. SALES AND ACCOUNTS DEPARTMENT *
3.1 Sales Department *
Contact Name
Cell No
E-Mail Address
Telephone
Fax
3.1 Accounts Department *
Contact Name
Cell No
E-Mail Address
Telephone
Fax
4. CORE BUSINESS OPERATION *
(Mark with X in applicable fields)
Prime Contractor
Sub-Contractor (Less than 25% generated turnover as prime contractor
Labour-only Contractor
Supplier
Manufacturer
Labour Agency
Professional Services
Education, Development &
Training Service Provider
Construction (CIDB)
Other, please specify ………………………………………………………………………………………
…………………………………………………………………………………………………………………
5. ANNUAL AVERAGE TURNOVER *
Indicate annual average turnover excluding Value Added Tax during the past three years:
.
R
Indicate total gross asset value (fixed property excluded:
.
R
Indicate Number of permanent employees
0–5
11
6–50
51+
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable
6. FINANCIAL DETAIL (BANKING) *
Banking institution name
Branch
Town/City
Banking account number
Account type
Account holder’s name
NB. DOCUMENTARY PROOF OF BANKING INSTITUTION MUST BE SUPPLIED (Cancelled
Cheque/ Bank Statement)
7. PREVIOUS BUSINESS INFORMATION *
7.1
Did your business exist under a previous name?
7.2
If Yes, what name did it trade under?
7.3
Previous business registration number?
Yes
No
8. BUSINESS INFORMATION *
The following table must be completed in order to establish whether a business can be classified
as an SMME in terms of the National Small Business Act 102 of 1996. Indicate the sector by
ticking the appropriate block in column 1.
Economic Sector
Type of Business
Agriculture
ISO Listed
Mining and Quarrying
Manufacturer
Manufacturing
Distributor
Electricity, Gas and Water
Sales
Construction
Services
Retail, Motor Trade and Repair Services
Importer / Exporter
Wholesale Trade, Commercial gents & Allied Services
Catering, Accommodation & other Trade
Repairer
Transport, Storage and Communications
Finance and Business Services
Community, Social & Personal Services
12
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable
9. LABOUR BROKERS
Please answer the questions by marking the appropriate column with an “X”. Please do not leave
out any questions relating to your special circumstances.
1. Do you render service to TUT through a Company, Close Corporation or Trust?
Yes
No
2. Are you an Independent Contractor?
Yes
No
3. Are you a Labour Broker?
(If yes = taxable unless IRP30 certificate is received. If no, see next questions)
Yes
No
4. Are the services personally rendered by a person who is a connected person
(shareholder, member, trustee, beneficiary, relative of the afore-mentioned, etc.)
in relation to the Company/Close Corporation or Trust?
(If yes, see question 5, 6, 7, 8 and 9. If no = not subjected to employees tax)
Yes
No
5. Does the entity employ four or more employees. (other than shareholders, members
or connected persons) who are on a full-time basis engaged in the business of
rendering services to clients?
(This implies that the tea lady and gardener would not be considered in determining
the full-time staff members rendering services to clients).
Yes
No
6. Would the person who is rendering the services be regarded as an “employee” of TUT? Yes
No
7. Is the person who is rendering the service subject to control or supervision of TUT
as to the manner in which duties are performed or as hours of work?
Yes
No
8. Do the amounts paid in respect of services rendered include earnings that are
payable at regular, daily, weekly, monthly or other intervals? (This is normally on
the basis that you charge your client for the person in question’s salary plus
commission for your service?
Yes
No
9. Does the Company/Close Corporation or Trust, during its financial year, receive or
anticipate to receive more than 80% of income for this specified service from TUT?
(If yes to any of questions 6, 7, 8, or 9, then taxable, except if IRP30 certificate
can be submitted.
If no to all four questions (6, 7, 8 and () = Not subject to employees tax.
Yes
No
Subject to employees tax?
Yes
No
10. HDI INFORMATION *
Explanation of abbreviations used in the tables to follow:
HDI Status
Capacity
Director
D
HDI
H
Partner
P
Women
W
Member
M
Disabled
D
Proprietor
R
Other
O
Please note that proof of disability must be provided by a recognized institution and certified copies of such
certification needs to be attached to this application.
13
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable
Note: Certified copy of shareholder certificates or proof of ownership must be supplied
(Multiple copies of this page may be submitted if required)
10.1 Complete the following for the shareholders who are actively involved in the management and
daily business operation of the business
First Name
Surname
Identification Number
%
Percentage of Share
Capacity
Gender
HDI Status
Disabled (a permanent impairment of a physical, intellectual or sensory function resulting
In restricted or lack of ability to perform in a manner considered normal for a human being) Yes
No
Were you a South African citizen on or before 26th April 1994?
Are you actively involved in the management and the daily business operations
of the business
(Please provide a written breakdown e.g. company profile)
Yes
No
Yes
No
First Name
Surname
Identification Number
%
Percentage of Share
Capacity
Gender
HDI Status
Disabled (a permanent impairment of a physical, intellectual or sensory function resulting
In restricted or lack of ability to perform in a manner considered normal for a human being) Yes
Were you a South African citizen on or before
26th
No
April 1994?
Yes
Are you actively involved in the management and the daily business operations
of the business
(Please provide a written breakdown e.g. company profile)
No
Yes
No
First Name
Surname
Identification Number
%
Percentage of Share
Capacity
Gender
HDI Status
Disabled (a permanent impairment of a physical, intellectual or sensory function resulting
In restricted or lack of ability to perform in a manner considered normal for a human being) Yes
Were you a South African citizen on or before
26th
No
April 1994?
Are you actively involved in the management and the daily business operations
of the business
(Please provide a written breakdown e.g. company profile)
14
Yes
No
Yes
No
NB: All fields marked with * are mandatory. Fields marked with # are mandatory only if
applicable
11. PREVIOUS CONTRACT OR TENDERING EXPERIENCE (Mark with X)
Do you have any previous contract work or tendering experience?
Yes
No
If yes, please complete the table below. List the last 2 contracts per commodity applied for awarded
to you (the tenderer) or previous references related to the type of work or supply you are registering
for.
Commodity Code and description:_______________________________________________________
Employer/Department
Contact Person
Contact Number
R
Contract value in Rands
Year awarded
Documentary proof attached
.
Year completed/Still in Progress
Yes
No
Employer/Department
Contact Person
Contact Number
R
Contract value in Rands
Year awarded
Documentary proof attached
.
Year completed/Still in Progress
Yes
No
Commodity Code and description:_______________________________________________________
Employer/Department
Contact Person
Contact Number
R
Contract value in Rands
Year awarded
Documentary proof attached
.
Year completed/Still in Progress
Yes
No
Employer/Department
Contact Person
Contact Number
R
Contract value in Rands
Year awarded
Documentary proof attached
Year completed/Still in Progress
Yes
No
15
.
Commodity Code and description:_______________________________________________________
Employer/Department
Contact Person
Contact Number
R
Contract value in Rands
Year awarded
Documentary proof attached
.
Year completed/Still in Progress
Yes
No
Employer/Department
Contact Person
Contact Number
R
Contract value in Rands
Year awarded
Documentary proof attached
.
Year completed/Still in Progress
Yes
No
Commodity Code and description:_______________________________________________________
Employer/Department
Contact Person
Contact Number
R
Contract value in Rands
Year awarded
Documentary proof attached
.
Year completed/Still in Progress
Yes
No
Employer/Department
Contact Person
Contact Number
R
Contract value in Rands
Year awarded
Documentary proof attached
.
Year completed/Still in Progress
Yes
No
In terms of section 37(2) of the Occupational health and Safety Act 1993 (Act85 of 1993) as
amended the mandatory (contractor) hereby acknowledges that he is an employer in his
own right. He undertakes to determine all risks associated with the work he is required to
perform and to determine and implement all cautionary measures to mitigate or remove
such risk. The mandatory will take all necessary steps to ensure compliance with the
Occupational Health and Safety Act 1993.
Where the mandatory is found not to comply with the requirements of the Occupational
Health and Safety Act the Tshwane University of Technology or its representative will be
able to stop the activities of the mandatory, without any cost to the University until such
time as the mandatory complies with the requirements of the Act.
16
12. SUPPLIER/TRADE REFERENCE (Mark with X)
List at least 2 current Suppliers per commodity applied for as verifiable reference.
Commodity Code and description:_______________________________________________________
Name of Supplier
Contact Person
Contact Number
.
R
Approximate monthly value
Documentary proof attached (e.g. statement)
Yes
No
Name of Supplier
Contact Person
Contact Number
.
R
Approximate monthly value
Documentary proof attached (e.g. statement)
Yes
No
Commodity Code and description:_______________________________________________________
Name of Supplier
Contact Person
Contact Number
.
R
Approximate monthly value
Documentary proof attached (e.g. statement)
Yes
No
Name of Supplier
Contact Person
Contact Number
.
R
Approximate monthly purchases
Documentary proof attached (e.g. statement)
Yes
No
Commodity Code and description:_______________________________________________________
Name of Supplier
Contact Person
Contact Number
.
R
Approximate monthly purchases
Documentary proof attached (e.g. statement)
Yes
No
Name of Supplier
Contact Person
Contact Number
.
R
Approximate monthly purchases
Documentary proof attached (e.g. statement)
Yes
17
No
Commodity Code and description:_______________________________________________________
Name of Supplier
Contact Person
Contact Number
.
R
Approximate monthly purchases
Documentary proof attached (e.g. statement)
Yes
No
Name of Supplier
Contact Person
Contact Number
.
R
Approximate monthly purchases
Documentary proof attached (e.g. statement)
Yes
No
13. CERTIFICATION OF CORRECTNESS OF INFORMATION SUPPLIED IN THIS
DOCUMENT *
I/We the undersigned is/are duly authorized to do so on behalf of the firm, hereby certify that:
1.
2.
3.
The information supplied is correct.
All copies of relevant information are attached.
The HDI points claimed are correct and based on owners/shareholders who are actively
involved in the day to day management of the enterprise.
I take note that payment will be effected 30 days after delivery was effected if delivered with an
original invoice.
If I am classified as a dependant service provider/labour broker as stated in the fourth
schedule of the Income Tax Act I hereby authorize the University to deduct P.A.Y.E. and
supply me with a yearly IPR 30 (only if no valid Labour Broker Certificate can be supplied).
4.
5.
_____________________________________
________________________________
Signature of authorized person
Date
Personal information in block letters
Name
Surname
Telephone No
Capacity
ON BEHALF OF
(Supplier’s name)
Signed and sworn to before me at _________________________on this the _________.day
of______________________________20_____ by the Deponent, who has acknowledge that
he/she knows and understands the contents of this Affidavit which is true and correct to the
best of his/her knowledge and that he/she has no objection to taking the prescribed oath and
that the prescribed oath will be binding on his/her conscience.
__________________________________________________
Commissioner of Oaths
18
TSHWANE UNIVERSITY OF TECHNOLOGY
Private Bag X680
Pretoria
0001
14. AUTHORISATION FOR ELECTRONIC TRANSFER OF FUNDS (EFT) TO
VENDOR’S BANK ACCOUNT
PLEASE COMPLETE IN BLOCK LETTERS
Surname/Company name
First Names/Company of Account Holder
Address
Telephone
Fax
Mobile
E-mail
Bank
Branch
Bank Account
Branch Number
Type of Account
Cheque
Savings
Transmission
I, the undersigned hereby authorise the Tshwane University of Technology to credit my account
via EFT as afore mentioned with the amount payable/due to specified beneficiary for goods and
services rendered
Please note: That if a cancelled cheque is not attached, an official stamp should be obtained from
the bank to confirm the information given above.
_____________________________________
Signature
________________________________
Date
FOR USE OF BANK (In cases where a cancelled cheque is not attached)
Above information checked and confirmed.
Signature: _______________________ Surname & initials: _____________________________
Official stamp:
19
15. FOR OFFICE USE ONLY
FOR OFFICE USE ONLY – TENDER OFFICE
Information confirmed, scheduled and submitted for validity check
Signature: __________________________________ Date: _____________________________
FOR OFFICE USE ONLY – CREDITORS DEPARTMENT
Creditor Information Validity Check completed and returned to Tender Office
Approved (mark with X):
Yes
No
Reason/s for rejection attached:
Yes
No
Signature: __________________________________ Date: _____________________________
FOR OFFICE USE ONLY – TENDER OFFICE
Vendor approved for:
Commodity Code:_______________ Description:______________________________________
Commodity Code:_______________ Description:______________________________________
Commodity Code:_______________ Description:______________________________________
Commodity Code:_______________ Description:______________________________________
Captured on ITS:
Yes
No
Creditor code: __________________________
Signature: __________________________________ Date: _____________________________
Successful Vendor applicant notified by:
E-mail
E-mail address: ___________________________________________________
Fax
Fax Number:_____________________________________________________
Signature: __________________________________ Date: _____________________________
20