APPLICATION FORM TO REGISTER ON THE SERVICE PROVIDER DATABASE OF THE SABS

APPLICATION FORM TO REGISTER ON THE SERVICE PROVIDER DATABASE OF THE SABS

THE FOLLOWING DOCUMENTS/ INFO MUST BE ATTACHED (REQUIREMENTS) Operating contact and fax numbers including email address. Company profile with company letterhead must be attached. Certified copies of ID (shareholders/ members). CK1. Proof of registration for any services/ consultancy that requires registration with professional bodies.e.g. CIBD for construction services, PSIRA for security services and etc. Valid and original tax clearance certificate. Valid BEE certicate. Signed declaration of Interest. For purposes of section 256 of the Tax Administration Act of 2011 (the TAAct), the contractor / service provider authorises the South African Revenue Service to disclose taxpayer information as contemplated under the provisions of Chapter 6 of the TAAct in relation to the compliance status of tax registration, tax debt and filing requirements. Name of other party here Signature Date

SECTION ONE: CONDITIONS 1.1 Please note that all information will be treated confidentially. 1.2 Forms that are incomplete or which are not accompanied by the required documents will be disqualified. 1.3 Completed f o r m s should be posted to or hand delivered to no1 Dr Lategan Road, Groenkloof, for the attention of Khuliswa Mazizi by 20 January 2015. 1.4 THE SABS s Service Provider Database will be used mainly for the purposes of identifying entities that can be approached when price quotations for goods and services are to be invited. The fact that an entity is registered as a supplier does not constitute any contractual relationship between that business and THE SABS. 1.5 For procurement above the financial limit applicable to price quotations, as determined from time to time by National Treasury, The SABS will normally invite competitive Bids by means of advertisements. The onus is on entities to ensure that they obtain copies of the Bidding documents that are available at THE SABS when Bids are advertised. 1.6 It is the responsibility of a Registered Entity to inform the SABS immediately in writing of any changes in the particulars as stated in the application, especially changes in respect of the BBBEE status of the entity. Should a contract be awarded to an entity as a result of incorrect particulars on the status of an entity, THE SABS shall have the right to, in addition to any other remedy that it may have in terms of the Preferential Procurement Regulation, cancel the contract and to claim for damages. 1.7 THE SABS reserves the right to cancel the registration of an entity if the entity has provided incorrect or false information in the application form or any correspondence relating to the application: Failed to inform the SABS of any changes of the particulars as furnished in the application Failed to comply with the conditions of any contract that might have been awarded to the entity Failed to respond on requests for price quotations The entity being blacklisted by National Treasury If the entity has acted in an improper, fraudulent or corrupt manner

SECTION TWO: SUPPLIER INFORMATION 2.1 Supplier Details Registered Name Trading Name Holding Name Company Registration Number Income Tax Registration Number Vat Registration Number Telephone Number Fax Number Cell Phone Number E-Mail Address 2.2 Company Addresses Postal Address Town Region Code Physical Address Town Region Code 2.3 Company Type (Mark with an X in the applicable column) Public Company Private Company Close Corporation Section 21 Company Trust Partnership Sole Proprietor Parastatal Non-Governmental Organisation Other If selected other, please specify:

2.4 Contact Person Details Contact Person Full Name Position in Company Telephone Number Fax Number E-Mail Address Telephone Number Cell Phone Number 2.5 Contact Person Addresses Postal Address Town Region Code Physical Address Town Region Code 2.6 Supply Region and Town Please indicate which province you will be capable of delivering goods or services, and indicate the town names within the region. Goods Service Providers must supply proof of satellite office existence should they wish to link themselves to a region where their main offices are not based or attach proof of Goods delivered previously around the area on other projects. Regions Mark Towns e.g. Region Town A, Town B Eastern Cape Free State Gauteng Limpopo Kwa-Zulu Natal Mpumalanga Northern Cape Western Cape Northwest

2.7 Ownership of Company Full Name Position in Company Identity Number Telephone Number Fax Number E-Mail Address Telephone Number Cell Phone Number Percentage Owned Please indicate ownership on other Companies with percentage owned. Name of Company Company Registration Nr Percentage Ownership

2.8 Commodities Please indicate on Annexure A (attached), the goods and/or services, in terms of your Core Business you can offer the SABS. Service Providers are limited to five (5) Commodities NB: (Please note that the highlighted areas in BOLD are commodities and sub-commodities are listed below, therefore you may select all subcommodities under one commodity.) ANNEXURE A List of Goods Commodities ELECTRO-TECHNICAL ENGINEERING LABORATORIES Tick (A) Electronics Laboratory Lab instrument Testing instrument Other (Please specify) (B) Appliances Laboratory Lab instrument Testing instrument Other Please specify

(C) Metrology Laboratory Lab instrument Testing instrument Other (Please specify) (D) NETFA: Short Circuit Laboratory Lab instrument Testing instrument Other (Please Specify) (E) NETFA: High Voltage Lab instrument Testing instrument Other (please specify)

56](G) NETFA: Materials & Installations Lab Lab instrument Testing instrument Other (Please specify) (H) Explosion Prevention Technology & Rotation Machines Lab instrument Testing instrument Other, (Please Specify) MINING & MINERALS LABORATORIES Lab instrument Testing instrument

AUTOMOTIVE & MECHANICAL LABORATORIES Lab instrument Testing instrument Control Valves Other (Please Specify) CHEMICALS/BIO & MATERIALS LABORATORIES (A) Materials Technology Laboratories Lab instrument Testing Facilities Scientific Instrument Chemicals supplies Gas supplies

(B) Rubber Plastics Paints Sealants Laboratories Lab instrument Testing instrument (C) Radiation Protection Services Laboratories Lab instrument Testing instrument (D) Radiation Protection Services Laboratories Lab instrument Scientific Instrument

Chemicals supplies Gas supplies (E) Condom Test Lab Laboratories Lab instrument Scientific Instrument Chemicals supplies Gas supplies (F) Fibre & Polymers Laboratories Lab instrument Scientific Instrument

Chemicals supplies Gas supplies (G) Bio Technology Analytical instrument Scientific Instrument Chemicals supplies Glassware (H) Pharmaceutical Microbiology Analytical instrument Scientific Instrument Chemicals supplies Gas supplies Glassware

Other (Please Specify) (I) Food Microbiology Analytical instrument Scientific Instrument Chemicals supplies Gas supplies Glassware Other (Please specify) (J) Chemicals Technology Analytical instrument Scientific Instrument Chemicals supplies Gas supplies Glassware Other, (please specify)

Facilities Air Conditioner Carpentry, Dry walling and Partitioning Painting Cleaning and Waste removal Cleaning Materials Electrical supplies Electrical contractor Glass fitting and Blinds Landscaping and Horticulture Renovations and Refurbishments Protective Clothing Industrial supplies and Tools Cranes supplies Transformer supplies and services Cold & Freezer room Installation, Maintenance and repair Computer Hardware and Software Computer Monitor Computer Drives and Writers Computer Accessories Printers Printer Accessories Printer Toner and Cartridges

Memory Devices Modems and Motherboard Network, Port, Hub and Accessories Software Licenses Servers and Accessories Application Support and Maintenance Hardware Support IT Consulting Other (Please Specify) Cleaning Equipment and Supplies Cleaning Equipment Cleaning Supplies Hygiene Supplies Protective Gear Fire Equipment Fire Beater Fire Trailer Water Pump Vent Fire Knap Sack Spray Wooden Handle Fire Beater Other (Please Specify)

Office Machines and Equipment and Supplies Office Machine Office Equipment Office Supplies Medical Equipment and Supplies Medical Equipment Medical Supplies Office Furniture and Furnishings Desks Chairs Cupboard and Bookcase Drawers Cabinets and Filing Cabinet Bulk Filing Unit Steel Factory Lockers Boardroom Tables Office Furnishings Tables and Counter Tops TV Screen Wall Units

Photographic, Printing and Presentation Equipment and Supplies Printing and Publishing Equipment Audio and Visual Presentation and Composing Equipment Photographic or Filming or Video Equipment Photographic and Recording Media Promotional Items and Gifts Corporate Gifts Promotional Items Displays and Stands Published Products Printed Media Electronic Reference Material Signage and Accessories Safety and Security Equipment and Accessories Safety Equipment

Security Accessories Alarm and Security Systems Locks and Handles Fire Extinguisher Security Gates and Bugler doors Smoke Sensor X-ray Equipment Tools and General Equipment Hand Tools Electrical Tools General Equipment Garden Equipment Grinding, Cutting and Sharpening Equipment Scaffolding and Ladders Sliding Gates Swing Gates Barricades Gate Automation Artwork Equipment Audio Visual Equipment (Screen and Sounds) Maintenance Supplies and Accessories Electrical Supplies

Plumbing Supplies General Maintenance Supplies and Accessories Petroleum Diesel Petrol Transmission oil, Hydraulic oil, Brake fluid Other (Please Specify) List of Services Commodities Cleaning Services (Certification Required) General Building Cleaning Services Interior General Building Cleaning Services Exterior Hygiene Services Carpet Cleaning Services Garden and Plant Maintenance Services Vehicle Cleaning Services Waste Management Services Construction Services (CIDB Certification Required) Building Including Material Civil Roads, Road Markings, Bridges Mechanical - Engineers

Fencing Including Material and Installation, Steel Security Fencing Concrete- SQ Structural Renovation Paving and Drive Ways Fabricators, structural Steelwork Fabrication Roofing Tilling Car Ports General Building Maintenance and Repair Services (Certification Required) Locksmith Services Partitioning Services Window Services Fumigation Services Pest Control Services Electrical Services Plumbing Services Welding Services Health Services Wellness Services Occupational Health & Safety

Information Technology Services Installation Services Specialized IT Services Hardware Repairs and Maintenance Services Data Management and Backup Services Upgrades and Maintenance Database Development and Design Licenses Computer Hardware Logistical Services Catering Services Exhibition Centre and Meeting Facilities Event Management Services Bed and Breakfast Flight Reservations Accommodation and Hotels Seminars/ Workshops/ Conferences Clearing Agent

Management and Business Professionals and Administrative Services (Certification Required) Management Advisory Services Subscriptions Services Marketing and Distribution Services Policy Development and Management Services Document and Information Management Services Business Administration Services Policy Expert : Green and White Paper Other (Please Specify) Human Resources Services Affirmative Management Change Management Discipline, Grievances and Dispute Resolutions Personnel Placement (Recruitment) Agencies In House Training Competency Skills Facilitation Data Captures Conflict Management Performance Management Skills Audit Competency Test Psychometric Test Human Resources Development Services Human Resources Management Services

Legal Services (Certification Required) Legal Advisor Legal Entities Specialist Discipline, Grievance and Dispute Resolutions Labour Law Specialist Commercial Law Arbitrators Auditing Services (Certification Required) Financial and operational Audit Forensic and Investigation Audit Information Technology Forensic Audit Information technology Audit Legal Compliance Audit Performance Management Audit Financial Services (Certification Required) Business and Financial Advisory Services Finance Systems Designing Services

Charted Accounts Services Publications, Communication and Information Services Advertising on newspapers Publications Books Marketing Video Coverage Multi-Media Writing and Translations Services Printing and Reproduction Services Photographic Services Graphic Design Services Solar Installation and Services Solar Installation and Repairs Relocation, Removals and Storage, Transportation and Mail Services Courier Services (Mail and Cargo Transport) Bus and Public Transport

Office Furniture and Household Relocation, Removal and Storage Distribution and Delivery Services Chauffer and Shuttle Services Security and Safety Services (Certification Required) Security and Personal Safety Security Surveying Services Hardware and Software : Installation, Replacement and Labour CCTV Camera Telecommunication Services Telecommunication Installation Telecommunication Maintenance and Repairs Cables and Cabling services Services and Repairs Service and Repairs of Office Machine Service and Repairs of Furniture Service and Repairs of Equipment Engine services (Car service) Repair and Installation of Glasses

Water Provision (Certification Required) Water Provision Contractors / Consultants Borehole Construction Water Tanks Pump Stations Reservoir Water Reticulation Sewerage Systems NB: Entities are free to supply details of any other products or services they render which are not included on the above lists.........

2.9 References Please list contracts/assignments completed by your company in the last three (3) years in relation to the commodities you linked your company to. Work Performed Client Contact Person and Telephone Number SECTION THREE: BBBEE DECLARATION 3.1 Equity Ownership Please indicate in %, shares owned by the following groups: (Compulsory) Group Male Female Disabled African Coloured Indian White 3.2 BEE Please indicate the Management structure in % of the total percentage owned. Group African Coloured Indian White Percentage Owned 3.3 BBBEE Has your company been assessed for BBBEE? (Yes/No) Which assessment company has provided your company with your BBBEE rating? What is your BBBEE rating? Please attach copy of Certificate (Is Certificate attached?)

3.4 SMME Status (Mark with an X in the applicable column) Micro Small Medium Large 4. DECLARATION I/We the undersigned declare that: 1. The information furnished is true and correct 2. The BBBEE Claimed is in accordance with the General Conditions. 3. Any conflict of interest was declared. -------------------------------------------------- ---------------------------------------- Signature of Owner or Authorized Date Representative