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1 Tel: (011) Fax: (011) APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF THE SOUTH AFRICAN COUNCIL FOR THE ARCHITECTURAL PROFESSION THIS FORM MUST BE COMPLETED AND SUBMITTED TO: BY HAND: SACAP 1st Floor Lakeside Place, Cnr Ernest Oppenheimer and Queen Street, Bruma or BY MAIL: SACAP PO Box 408, Bruma, 2026 ENQUIRIES:
2 Required Documentation Checklist Please ensure that all listed documentation below is attached (where applicable) to the registration form. All documentation is to be provided in its original format. Document Name Original Valid Tax Clearance Certificate / VAT Registration Certified Copy of Company Registration Certificate Certified Copy of the Valid B-BBEE Certificate Please submitted documents Attached Certified Copies of Stakeholders (Members, Directors, Shareholders, Partners) ID documents Certified Copies of Compliancy / Accreditation Certifcates Original Verification Letter of Bank (completed by bank) with Bank Stamp / Cancelled Cheque Valid Original Health Certificate (for Catering as Commodity) for premises used. Certified Copy of Proof of Disability (Doctor's Letter) Certified Copy of Proof of Ownership/Shareholding Certificate Company Profile (maximum of 3 pages) Other (please specify): Page 3
3 SERVICE PROVIDER DATABASE REGISTRATION FORM All sections to be completed in black ink, submitted with an original signature commissioned by an authorized Commissioner of Oaths SUPPLIER DETAILS Supplier/Vendor Number Registered Name Trading as Registration Number Tax Registration Number Tax Certificate Expiry Date Branch / Franchise VAT Registered R R VAT Registration Number OFFICIAL USE ONLY Classification: Distributor Exporter Importer Manufacturer R Only the main area of business Services Type: Private Company (Pty) Ltd R Joint Venture R Closed Corporation (cc) Partnership Sole Proprietor Section 21 Company Public Company Trust Consortium Cooperation Foreign Company Unknown Government/Institution/Parastate/Organ of State Area of Operation: Municipal Area Provincial National R Local Municipality Fax Number Toll Free Number Address Website URL ADDRESS Physical Address Postal Address Blacklisted Reason: Expiry date Page 4
4 Supplier Banking Account Details (Please note that this account MUST be in the name of the supplier. No 3rd party payments allowed). Account Name Account Number Branch Name Branch Number Account Type Cheque Account Savings Account Transmission Account Credit Account ID Number Passport Number Company Registration Number / / *CC Registration *Please include CC/CK where applicable Practise Number Bank stamp Business Home Fax Cell Address Contact Person: Area Code Area Code Area Code Cell Number Contact Details Telephone Number Telephone Number Supplier Signature Regional Office Sender Print Name Print Name Rank / / / / Date (dd/mm/yyyy) Date (dd/mm/yyyy) NB: All relevant fields must be completed Page 5
5 CONTACTS R Primary contact Name & Surname Position Nationality ID Number Phone Number Fax Number Mobile Number Address APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABASE OF THE SOUTH AFRICAN COUNCIL FOR THE ARCHITECTURAL PROFESSION
6 OWNERSHIP To be completed for all Proprietors/Members/Shareholders /Partners/Sole Proprietors/Trustees & Owners Name of Person or Entity R R R R R R RSA Resident ID Number Date of Birth Role in Company Male Black White Female Disabled % Owned Date From Page 7
7 ACCREDITATION / COMPETANCY Please attach Valid Certified Copies of ACCREDITATION / COMPETANCY Certificates - Specific to your business/industry Organisation Reference Number Expiry Date Page 9
8 CONFLICT OF INTEREST: Declaration - SBD 4 Are you or any person connected with you company currently working as an employee at SACAP? If "YES", furnish the following particulars: Yes No Name of person/director/shareholder/member Any other particulars Do you, or any person connected with your company have any close relationship (family, friend, other) with a person employed by SACAP? Yes No If "YES", furnish particulars: Is there any other relevant information that you would like to disclose? If "Yes", furnish particulars: Yes No Page 10
9 Declaration Verification of information supplied, including information relating to preferences that the Applicant or Business may apply for: I/we, the undersigned, who warrants that I/we are duly authorised to do so on behalf of the supplier, certifies that the information supplied in terms of this document including the Annexure (s) with additional information, is correct and accurate and acknowledges that: 1. The supplier will be required to furnish documentary proof of the information relating to preferences, if requested to do so. 2. If the information supplied is found to be incorrect, then SACAP may, in addition to any remedies it may have: (i) Disqualify the supplier/contractor for a particular bid/contract/project it may be considered for, considered for, or which had been awarded to the supplier/contractor; (ii) Recover from the supplier/contractor all costs, losses or damages incurred or sustained by SACAP as a result of breach of contract; (iii) Cancel the contract and claim any damages which SACAP may suffer by favourable arrangements after such cancellation and/or; (iv) De-register the supplier, registered on the Supplier Database. 3. A registered supplier MUST notify the \ Supply Chain Management Office of any changes to information supplied on this form. Failure to do so may result in such supplier being removed from the Supplier database and / or the cancellation of contracts awarded to the supplier, on the basis of misrepresentation. Signed on this day of 20 at Signature of Authorised Representative Name in Block Letters Commissioner of Oaths Business Address Capacity Area Commissioner of Oath: Signature Commissioner of Oath: Full Name Page 11
10 SUPPLIER DATABASE COMMODITY LIST Please indicate with Please note: only 5 commodities will be registered Construction Air-Conditioning Systems (New Installations) Auto Sprinkle Fire Protection Systems Blasting/Demolition Contractors Boilers Suppliers/Contractors Brickwork/Masonry/Plastering Building Equipment and Accessories (Cement Mixers, Scafforlding, Trowels etc.) Building Supplies & Hardware (General) Tel: (011) Carpenters/Roofing/Waterproofing Contractors Fax: (011) Ceilings, Partitioning and Shop Fitting Contractors Compressed Air Installations Earthmoving/Civil Contractors Electrical Cables Supply Electrical Contractors (Accredited) Industrial Electrical Appliances Irrigation Contractors Landscaping Lift, Elevator, Escalator Services (New Installations) Painting Contractors Paving Contractors Plant Hire Equipment Plumbing Contractors (Accredited) Plumbing Contractors (General) Pre-Cast Concrete Manufacturer Quarrying Contractors Ready Mix Concrete Suppliers Road Marking & Signage Contractors Road Works/Roads Construction/Road Cleaning Sewerage Installations APPLICATION FOR REGISTRATION ON THE SUPPLIER DATABA Steam Installations & Ancillary Equipment SOUTH AFRICAN COUNCIL FOR THE ARCHITECTURAL PROFESSteel Contractors Fencing Material Supply/Contractors Glass Suppliers/Contractors Hauling/Heavy Equipment/Transport Hot Water Installations Incinerators Installations/Maintenance Steel Fabrications & Erection Storm Water Draining Thatch Roofing & Treatments Water Installations/Reticulations Welding Contractors Professional Services Accountants/Financial Advisory Services Agricultural Engineers Agricultural Service Attorneys, Advocates and Legal Services Auditing Services Business Analysis and Design Chartered Accountants Consulting - Actuaries & Remuneration Services Consulting - Air Pollution Engineers Consulting - Chemical Engineers Consulting - Civil Engineers Consulting - Electrical Engineers Consulting - Electronic Engineers Consulting - Hydraulic Engineers Consulting - Forensics Consulting - Health Care Consulting - Mechanical Engineers Consulting - Metallurgical Engineers Economists Hospitals & Clinics Internal Audit Medical Practitioners Medical/Ambulance/Healthcare Pharmacist Quantity Surveyor Rehabilitation Service (Alcohol & Drug Depend) Teachers & Educators Town and Regional Planners Veterinarian
11 Services (Non Professional Services) Accommodation (Guesthouse, Hotels, Inns & Lodges) Advertising Agricultural Services Air-Conditioning Systems (Repair and Maintenance) Aircraft Charter Services AircraftServiceing & Repairs Drain Cleaning Services Dressmaking Driving Instructors Electrical Equipment Repairs Electronic Contractors Elevators & Conveyors (Services and Repairs) Airlines Commercial Archiving Services & Systems Art- Painters and Sculptors Asset Management Systems/Conssultants Assurance, Insurance Companies Auctioneering Services Audio Systems installation and Maintenance Audio Visual Aids & Equipment Repair and Maintenance Audio Visual Presentations/Productions Auto Electrical/Electronics Automotive Alarm and Tracking Systems Automotive Clutch and Brakes Specialists Automotive Panel Beating & Spray Automotive Radiator Repairs Automotive Spares/Repairs/Maintenance Automotive Windscreen Fitment Banks & Financial Institutions Bar Code Software & Printers Biometrics Solutions/Consultants Blinds & Awnings Broadcasting Station (TV/Radio) Brokers - Finance Brokers - Labour Cabinet/Furniture Making Call Centres Car Wash and Valet Carpet Cleaning Catering and Food Supply Certification Services Chemical Transport Services Cleaning Services Clothing Manufacturers Colleges Computer Cabling Systems Computer Equipment, Networks and Software Conference Centres & Facilities Conferencing Systems Consultant - Acoustic Services & Materials Consultant - Acquisition Management Consultant - Asset Management & Bar Coding Consultant - Change Management Consultnat - Communication Strategies & Systems Consultant - Community Services Consultant - Computer Systems & Solutions Consultant - Database Consultant - Emergency & Disaster Management Consultant - Employee Benefit & Empowerment Consultant - Employee Development Consultant - Environmental Embossing Services Embroidery Services (Logo) Employee Assistance Programmes (EAP) Consultants Engraving Services Entertainment - Performers Entertainment Venues & Theatres Event & Conferencing Management Exhibition Centres Farming Products and Service Fire Extinguishers / Fire Hydrants (Maintenance) Fire Safety & Related Services (Goods & Services) Florists Flower and Plants (Indoors) Framing Services Freight Services (Sea, Air & Land) Funeral Services Furniture Removal and Storage Galvanising Services Gardening Services Generators (Service and Maintenance) GIS Software, Modelling & Analysis Glass Tinting Graphic Design Services Grave Diggers Handyman/General Maintenance Holiday Resorts Hospitality Services Corporate Hydraulics Repairs/Maintenance Interior Decorating, Refurbishment and Equipment Interpreting Services (Language) Interpreting Services (Sign Language) Investigation Services Labels & Labelling Services Land and Property Values Laundry and Dry-Cleaning Services Locksmith Services Magazine Publications/Suppliers Medical Equipment Maintenance & Repairs Newspapers Distribution and Delivery Office Automation Equipment Repairs Payroll Pest Control Services Photography Publications Publishers Recording Services Recruitment Agencies Recycling Services Refuse Bulk Containers
12 Consultant - Exhibitions Consultant - Export & Import Consultant - Fleet Services Management Consultant - Geographical Information Consultant - Human Resources Consultant - Journalism Consultant - Laboratory Consultant - Labour Consultant - Legal Services Consultant - Media Relations Consultant - Occupational Health & Safety Consultant - Performance Management Consultant - Procurement Services Consultant - Public Relations & Services Consultant - Quality Control Consultant - Risk Managment Consultant - Security Consultant - Skills Analysis & Development Consultant - Solar Energy Consultant - System Integration Consultant - Waste Consultant - Computer Programming & Software Development Consultant - Project Management Copy Editing Copywriting Corrosion Protection Services Courier and Mailing Services Data Backup Services & Software Debt Collection Document Binding Services Document Duplicating Services Domestic Appliances (Repairs and Maintenance) Drafting Services Research & Survey Safes & Safe Removal Services Security Alarm Systems, Equipment and CCTV Sytems Self Defence Training Service Providers - Cellular, Telephone and Internet Service Stations & Garages Sheriff of the Court Signage (Interior and Exterior) Solar Heating/Electricity Sound & Music Systems/Equipment Storage Services & Facility Storage Services & Facility Supplier & Procurement Software Towing Services Training Institutes Transcription Services Translation Services Transport Services - Goods Transport Services - Passengers Transport Services (Mini-Busses to Busses) Travel Agencies Tv, Satellite Dish Installation and Maintenance Universities Upholstery Vehicle Dealership Vehicle Fleet Management Vehicles Hiring Vending Machines Water Dispensers Water Purification, Supply & Storage Web Pages & Design Window Cleaning Workshop Equipment (Repair and Maintenance)
13 Wholesalers/Traders (Excluding Construction) Art & Craft Materials Audio Visual Aids & Equipment Bags - Conference/Travel/Promotional Bags - Refuse & Plastics Bar Code Tags & Magnetic Cards Bearing Supplies Beverages & Alcohol Books Cartridges Cleaning Equipment/Materials/Chemicals Clothing and Textiles Communication Systems (Two Way Radios) Computer Components Computer Consumables Computer Equipment/Software Containers & Packaging Corporate Gifts, Clothing, Products Crockery & Cutlery Curtaining, Rails & Accessories Diaries, Calendars, Brochures, Booklets and Pamphlets Domestic Appliances/Equipment Electronic Appliances Electronic Appliances Flags & Maps Food & Beverage Franking Machines Fuels, Oils and Lubrications Functions Equipment Hire (Tables, Chairs, Tents, Toilets) Furniture (Office) Furniture (Other) Gardening and Gardening Equipment Gas & HeatingEquipment Heaters & Heating Equipment Hydraulic Accessories Industrial Chemicals Laboratory Consumables & Equipment Linen, Pillows and Blankets Medical/Pharmaceutical Supplies & Equipment and Consumables Office Equipment Pesticides Photography Equipment Protective Clothing / Footwear Pumps and Spares Sports and Recreational Equipment and Goods Stationery Tents & Canvas Goods Toilet Paper - Manufacturers & Sales Tools (Household) Tools (Industrial) Vehicles Audio & Equipment Workshop Equipment (Mechanical, Steel and Wood) Summary: Core Business In your own words, please state your core business: 1 2 Trade Name (= sole supplier of specific brand name) Fill the specific brand names that the company own or solely distribute, which you wish to register:
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