Application for Registration as a Vendor to. North-West Development Corporation.

Transcription

1 Application for Registration as a Vendor to North-West Development Corporation. 22 James Watt Crescent, Industrial Area, Mafikeng Tel: Section One - General Information on Completing this form. Referral to the Corporation in this form pertains to the North-West Development Corporation as indicated above. This form has been compiled to make the completion thereof as user-friendly as possible for your convenience. Each section contains a table with four columns. Column 1 ('Fld') is a sequence number which does not require anything from you. Column 2 ('Data Description') describes the type of input needed from you in Column 3 ('Data Supplied'). You only have to complete Column 3 unless otherwise indicated. Column 4 ('# Chars') indicates the maximum number of characters your supplied information may contain (please remember that a space is counted as a character.) Where necessary an explanation of certain required information will be given after each table. All fields in Column 3 ('Data Supplied') are MANDATORY and must be completed. The rest under the same column with a light-grey background should only be completed if necessary. Please note that Section 2 is for OFFICE USE only. Please do not use the following characters in any information you * & %! # { } [ or ]. 2 Section Two Office Use Only Fld. Data Description Data Supplied # Chars 1 Client Database ID 10 2 Vendor Reference Number 20

2 3 Section Three - Vendor Details This section deals with general company information. Fld. Data Description Data Supplied # Chars 3 Company / Vendor Trade Name 30 4 Company / Business Type (* see below) If Company / Business Type = 6 (Other) Please Specify 6 South-African Company? (Y/N) 1 7 If not South-African Company please specify country in which business is registered. 8 Postal Address Postal Address Postal Address Postal Address Physical Address Physical Address Physical Address Physical Address Physical Address 30 Details for Contact Person 1 17 Person 1 - Name 2 18 Person 1 Home Telephone No Person 1 Work Telephone No Person 1 Cell No Person 1 Fax No Person 1 Address 40 Details for Contact Person 2 23 Person 2 - Name 2 24 Person 2 Home Telephone No 16 2 Person 2 Work Telephone No Person 2 Cell No Person 2 Fax No Person 2 Address 40 Miscellaneous Company Info 29 Company Registration No

3 Fld. Data Description Data Supplied # Chars 30 Company TAX No Company VAT No Company Tax Clearance Certificate No Tax Clearance Certificate Expiry Date First Three Directors / Members ** see below) Format --> YYYY/MM/DD[ ] Director 1 - Full Name 2 3 Director 1 - Nationality 8 36 Director 1 ID Number 1 37 Director 1 Contact Tel No Director 2 - Full Name 2 39 Director 2 - Nationality 8 40 Director 2 ID Number 1 41 Director 2 Contact Tel No Director 3 - Full Name 2 43 Director 3 - Nationality 8 44 Director 3 ID Number 1 4 Director 3 Contact Tel No * - Company / Business Type Indicators: 1 = One Man Concern; 2 = Closed Corporation; 3 = Partnership; 4 = Private Company; = Public Company; 6 = Other ** - Companies / Closed Corporations / Partnerships with more than three directors / members / partners MUST give the details of at least THREE persons. 4 Section Four Vendor Representative Details In each venture there are a few individuals who are to be the 'face' of said venture. These are the individuals who will (mainly) be dealing with the Corporation, negotiating business, signing contracts, delivering goods or collecting documents. In order for the Corporation to positively identify such individuals when needed, please supply the requested information here. You may supply details for up to 4 (four) persons for this purpose. Fld. Data Description Data Supplied # Chars 46 Representative 1 Full Name File Name of Photo on CD (*** 0

4 Fld. Data Description Data Supplied # Chars see below) 48 Representative 2 Full Name File Name of Photo on CD (*** see below) 0 Representative 3 Full Name 30 1 File Name of Photo on CD (*** see below) 2 Representative 3 Full Name 30 3 File Name of Photo on CD (*** see below) Marking on Media Supplied (**** see below) *** - Digital photographs of each representative must be supplied for each nominated representative. The photographs must preferably be frontal head-and-shoulders images, size 100mm x 10 mm would be best) in any of the following formats:.jpg,.jpeg,.bmp or.gif. In the table above please supply the name of the file containing the image for the named person. Photographic images may also be ed to the Corporation as long as a full name is given for each attached image, thereby achieving the same as above. **** - Please supply the exact text used to mark the media supplied. Section Five Vendor Banking Details In order to facilitate ease of payment to you via Electronic Funds Transfer (EFT) please supply us with the details of the account into which you would prefer payment be made to you Fld. Data Description Data Supplied # Chars 4 Account Name 30 Bank / Branch 30 6 Branch Code 8 7 Account Number 16 8 Account Type (***** see below) ***** - Account types are: 1 = Current (Cheque); 2 = Savings; 3 = Transmission; 4 = Credit Card. 6 Section Six Supply Category Details This section is of utmost importance in this application. For the Corporation to know what products and / or services you can render, we need to classify your offerings in Categories and Sub-Categories. You can register for a maximum of THREE major categories and a 1

5 maximum of NINE sub-categories for each major category. Please Note: Should you make use of the opportunity to define your own descriptions it must be borne in mind that the total of THREE major- and NINE minor categories can not be exceeded in total. Fld. Data Description Data Supplied # Chars 9 Major Category 1 (****** - see below) 60 Sub-Category Sub-Category Sub-Category Sub-Category Sub-Category 1. 6 Sub-Category Sub-Category Sub-Category Sub-Category Major Category 2 (****** - see below) 70 Sub-Category Sub-Category Sub-Category Sub-Category Sub-Category 2. 7 Sub-Category Sub-Category Sub-Category Sub-Category Major Category 3 (****** - see below) 80 Sub-Category Sub-Category Sub-Category Sub-Category Sub-Category 3. 8 Sub-Category Sub-Category Sub-Category 3.8

6 Fld. Data Description Data Supplied # Chars 88 Sub-Category Opportunity to enter / add your own definitions below if needed Major Category Undefined 1 (******* see below) 90 Sub-Category Undefined 1 91 Major Category Undefined 2 (******* see below) 92 Sub-Category Undefined 2 93 Major Category Undefined 3 (******* see below) 94 Sub-Category Undefined 3 9 Major Category Undefined 4 (******* see below) 96 Sub-Category Undefined 4 97 Major Category Undefined (******* see below) 98 Sub-Category Undefined ****** - APPENDIX A to this application shows currently defined Major and Sub- Categories. Select the descriptions most appropriate to the nature of your business. In Column 3 ('Data Supplied), only enter the CODE for the major- or sub-category. The descriptions in APPENDIX A are not needed. Repeat, enter only the code in the above table. ******* - Should you feel that an appropriate definition of the nature of your business and business- or service offerings are not to be found in APPENDIX A you may provide us with a description of your OWN creation. Should the Corporation see fit to add such a new item to it's Category / Sub-Category Database it will be done. However, the Corporation may decide to classify your Category / Sub-Category participation in an existing one. 7 Section Seven - Professional Body Membership If your business has a valid membership of a recognized professional body for your nature of business or profession, please give us the details here. You have the opportunity to enter your details of up to THREE of such bodies / organizations. Fld. Data Description Data Supplied # Chars 99 Professional Body 1 Full Name 100 Official Abbreviation Your Membership Reference Professional Body 2 Full 0 0

7 8 Section Eight BEE Rating and Information. Please give us a much information about your BEE-rating, if any. 9 Section Nine Declaration and Signature(s), I, the undersigned do declare? and that all details contained in this application to be the truth; that I / We, in signing this application, wish to render services in good faith to the Corporation. that I / We understand that the supply of false information to the Corporation may lead to the entity making this application be removed from the Approved Vendor list of the Corporation. that I / We, being the signatory(ies) to this application, are fully authorized to do so on behalf of the entity represented herein.

8 that I / We consent to the NWDC conducting any search or inquiry into the affairs of the Vendor. Signed on this day of 20 at Name: (Please Print) Deponent I certify that this affidavit has been signed and sworn to / affirmed before me at on this day of 20 by the deponent who acknowledges that:- I. He/ she /they know/s and understand/s the contents of this affidavit; II. III. He/ she/ they has/have no objection to taking the prescribed oath/affirmation; and He/she/they consider/s the prescribed oath to be binding on his/her/their conscience. and that he/she/they uttered the following words I swear that the contents of this affidavit are true, so help me God I truly affirm that the contents of this affidavit are true. Full names: Address: Designation: Area for which appointment is held: Office held if appointment is ex-officio: COMMISSIONER OF OATHS

9 APPENDIX A Supply Category Selection For the NWDC The NWDC uses an automated system to select possible suppliers for an item or service it wishes to purchase according to different criteria. One of these is the division of the itinerary in categories, both MAJOR and MINOR. IMPORTANT: The list provided is CLIENT SPECIFIC and may differ if applying for registration as a vendor to a different institution. In accordance with Section 6 Supply Category Details please select at least one MAJOR and one MINOR category from the list below. The order of precedence in the list is NOT sorted in any specific sequence. It is generated from a database and according to the Administrator's selected preferences in order to maintain allocated sequence numbers as a number permanently allocated to that specific category. In the appropriate spaces provided enter ONLY THE RELEVANT CATEGORY NUMBER according to your selection. MAJOR CATEGORIES Seq. No Description Seq. No Description MINOR CATEGORIES M0001 Food and Beverage F0001 Perishable / Fresh Products F0002 F0003 Meat Alcoholic and Soft Drinks M0002 Office Equipment E0001 Furniture All types. E0002 E0003 E0004 E000 Stationary Training Aids and Devices Signs and Accessories Air- Conditioning Sales, Installation and Service M0003 Building Material B0001 All material for building construction. M0004 Uniforms / Clothing U0001 Corporate U0002 U0003 U0004 Field Dress Promotional Protective Clothing M000 Electronic Equipment L0001 Computers - complete L0002 L0003 L0004 Computers - Parts Printers Facsimile Machines

10 MAJOR CATEGORIES Seq. No Description Seq. No Description L000 L006 L007 L008 L009 MINOR CATEGORIES Computers - Laptops Computer Software Copiers Monitors Cameras M0006 Kitchen Equipment K0001 Kitchen Manufacturing K0002 K0003 Appliances Cutlery & Crockery M0007 Chemicals C0001 Sanitary & Cleaning Chemicals C0002 C0003 Industrial Chemicals Fuel, Oil And Lubricants MS001 Services & Consultancy S0001 Printed Matter S0002 S0003 S0004 S000 S0006 S0007 S0008 S0009 S0010 S0011 S0012 S0013 S0014 S001 S0016 S0017 S0018 S0019 S0020 S0021 S0022 S0023 Catering Equipment Hiring Catering - Food Cleaning Swimming Pool Maintenance Laundry Building Maintenance - Electrical Building Maintenance - Plumbing Building Maintenance - Steelworks Building Maintenance - Carpentry Maintenance - Grounds Maintenance - Roads Building - Construction Road - Construction Road - Maintenance Consultancy Accountancy & Auditing Consultancy Information Technology Consultancy Structural / Building Accommodation Conference Facilities Telecommunication Services Advertising Marketing

11 MAJOR CATEGORIES MINOR CATEGORIES Seq. No Description Seq. No Description S0024 Travel Agency S002 Maintenance - Vehicles S0026 Maintenance - Heavy Equipment S0027 Maintenance - General S0028 Fencing Installation & Maintenance S0029 Training - IT S0030 Training - General S0031 Refuse Removal S0032 Security S0033 Marketing / Promotional S0034 Legal Fees S003 Seminars and Workshops S0036 Wellness S0037 Health and Safety S0038 Transport Services S0039 Repairs Office Furniture S0040 Hire Tent and Chairs S0041 Renovations & Refurbishment S0042 Paving S0043 Tiling S0044 Painting S004 Partitioning Of Office S0046 Repairs Maintenance Building S0047 Repairs Air Conditioners S0048 Repairs Refrigerator S0049 Solar System Lights\Geyser S000 Valuation of Property S001 Installation of Blinds S002 Furniture Removal S003 Carpet Cleaning S004 Cleaning of Office Chairs S00 Installation of Ceiling S006 Car Wash S007 Cold & Hot Mix Asphalt (Tar Rd) S008 Concrete Block Paving

12 MAJOR CATEGORIES MINOR CATEGORIES Seq. No Description Seq. No Description S009 Procurement Management S0060 Risk Management S0061 Feasibility Studies S0062 Security Access Control System S0063 Project Management S0064 Monitoring & Evaluations S006 Skills Training & Development S0066 Quantity Surveyor S0067 Tender Advertising S0068 Roofing S0069 Bottled Mineral Water S0070 Elevator Services S0071 Toilet Paper Supply S0072 P.A. System Hire S0073 Graphic Design S0074 Web Design & Hosting S007 Events Management & Conference S0076 Strategic Planning S0077 Policy Development S0078 Recruitment S0079 Human Resources Consulting S0080 Corporate Governance Consulting S0081 Rental Photo Copiers S0082 Counseling S0083 Windscreen Repairs S0084 Locksmith S008 Trellidors S0086 Glazing S0087 Septic Drainage/Removal M008 Tools / Maintenance Equipment G001 Gardening Tools G002 Loose Tools M009 Vehicles V001 Trucks V002 Trailers V003 Bakkies V004 Cars