APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN

REGION

Supplier Database

THE SOUTH AFRICAN NATIONAL ROADS AGENCY

LIMITED SOC (SANRAL)

APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL

SOUTHERN REGION

DESCRIPTION: APPLICATION TO BE REGISTERED ON THE SUPPLIER DATABASE / LIST OF PROSPECTIVE SERVICE PROVIDERS

THIS DOCUMENT COMPILED BY:

THE SOUTH AFRICAN NATIONAL ROADS AGENCY SOC LTD

BLOCK C, SOUTHERN LIFE GARDENS

70 2nd AVENUE

NEWTON PARK

PORT ELIZABETH

6001

Tel No.: (041) 398 3200

E-mail: nell@nra.co.za

APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN

REGION

Supplier Database

1. INTRODUCTION AND GUIDELINES

The purpose of this database is to give all prospective suppliers an equal opportunity to submit quotations to SANRAL Southern Region in order to comply with the procedures set out in the Public Finance Management Act 1 of 1999 (PFMA), the Preferential Procurement Policy Framework Act 5 of 2000 (PPPFA), and Supply Chain Management Regulations issued by the National Treasury.

Preference will be given to registered suppliers but it does not necessarily follow that suppliers who are not yet registered will be totally excluded from quoting for the supply of goods or service to SANRAL Southern Region Office.

APPLICATION FOR REGISTRATION ON SANRALS SUPPLIERS DATABASE

THESE FORMS MUST BE COMPLETED AND SUBMITTED TO: SANRAL SOUTHERN REGION BLOCK C, SOUTHERN LIFE GARDENS 70 2nd AVENUE NEWTON PARK PORT ELIZABETH 6001 OR POSTED TO: PO BOX 27230 GREENACRES 6057 ENQUIRIES: TEL NO.: (041) 398 3200

FOR OFFICIAL USE ONLY

NAME OF SUPPLIER

REGISTRATION NUMBER / VENDOR NUMBER

DATE APPROVED

APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN

REGION

Supplier Database

APPLICATION FORM 1 IMPORTANT NOTES

To be completed by all vendors seeking registration as an approved supplier; The questionnaire must be completed in full and be signed; A company profile may accompany the registration form but will not be accepted as substitute

for the application form all fields on application form MUST be completed by applicant; Applicants will be contacted via email and must therefore submit an operating email address.

Failure to comply will result in excluding the supplier from the data base; It should be noted that SANRAL reserves the right to accept or reject any application without

being obliged to give any reasons in this respect; Suppliers will be notified whether application was accepted; Supplier must comply with all the registration criteria for registration to be finalized - failure to

do so may result in the application being declined; Failure to submit all required documents will lead to supplier not being registered on the

database.

CHECKLIST OF DOCUMENTS REQUIRED NO DOCUMENT REQUIRED RECEIVED

YES/NO 1. Completed, Signed & Commissioned Supplier Database Form 2. Completed and Signed SBD 4: Declaration of Interests 3. Completed and Signed SBD 6.1: Preference Points Claim Form 4. Completed and Signed SBD 8: Bidders Past SCM Practices 5. Completed and Signed SBD 9: Certificate Of Independent Bid Determination 6. Valid & Original Tax Clearance Certificate 7. Valid BBBEE Verification Certificate 8. Certified Proof of Company Registration 9. Company Profile

10. Vendor Application Form

APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN

REGION

Supplier Database

1. BUSINESS PARTICULARS

1.1. Name Of Business As Registered With The Registrar Of Companies/Close Corporations

Business registration number:

NB: Attach copy of business registration certificate

1.2. Service providers core business (what is the principle business)

1.3. VAT registration number:

NB: Attach Original Tax Clearance Certificate Tax Clearance Certificate Expiry Date

Income Tax Reference Number:

1.4. Postal Address: Physical Address:

Postal Code Postal Code

1.5. Telephone No: Fax No:

1.6. Cell. No.

1.7. E-Mail Address:

1.8. Contact Person:

APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN

REGION

Supplier Database

1.9 Name of person authorised for signing:

Capacity under which the application is signed:

Date signed:

Signature:

2. Please indicate (X) the geographical areas where your business has offices. Please provide addresses,

telephone numbers and contact person for different offices (add separate sheet, if necessary) Regions Mark ( X )

Gauteng

Kwazulu Natal

Western Cape

Eastern Cape

3. Supplier Group Detail: Type of Firm (Please tick the relevant box)

1 Public Company (Ltd) 2 Private Company ((Pty) Ltd) 3 Closed Corporation (CC) 4 Other (Specify) 5 Joint Venture 6 Sole Proprietor 7 Partnership 8 Trust 9 Section 21 Company

10 Government / Parastatals

4. Range of services offered in relation to the principal business of the enterprise

5. Are you registered with a professional body for the services that you provide?

YES NO

APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN

REGION

Supplier Database

If so, please state particulars: Name of Organisation Contact

Person Telephone number

Membership number

Date of membership

6. BEE INFORMATION

% Of BEE Ownership

Provide BEE verification certificate( (from ABVA accredited verification agencies)

NB: Attach BEE certificate 7. PREVIOUS EXPERRIENCE / TRACK RECORD

List the most important contracts/assignments completed by your firm in the last three years. Service providers Relevant Experience minimum 3 years public sector experience.

WORK PERFORMED

FOR WHOM

CONTACT PERSON AND TELEPHONE NUMBERS

8. SUPPLIERS OF THE FOLLOWING PRODUCTS/SERVICES ARE REQUIRED TO REGISTER ON THE DATABASE.

PLEASE MARK THE MAIN SERVICES YOUR COMPANY SUPPLIES:

TYPE

SERVICES / GOODS TICK RELEVANT BOX

SUPPLIERS

Office Stationery Office Furniture Office Equipment Office Groceries Other Office Supplies (crockery, cutlery, etc.)

SERVICES Catering Services Printing & Binding Shuttle Services Florists

HEALTH AND SAFETY

Fire Extinguishers First Aid Supplies

OTHER SERVICES General Repairs (Handyman) Cleaning products

APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN

REGION

Supplier Database

9. TEAM STRUCTURE Personnel Complement (Add separate sheet to list all personnel)

No

First Name

Surname

Male/Female

Position

Accreditation

Relevant Experience(years)

Geographical Location where service is available

APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN

REGION

Supplier Database

APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF SANRAL SOUTHERN

REGION

Supplier Database

SBD 4 DECLARATION OF INTEREST

1. Any legal person, including persons employed by the state, 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, 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. Shareholder means a person who owns shares in the compa