APPLICATION FORM TO REGISTER ON THE … Form.pdfAPPLICATION FORM TO REGISTER ON THE SERVICE PROVIDER...

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 rm 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 sub-

commodities under one commodity.)

ANNEXURE A

List of Goods Commodities

ELECTRO-TECHNICAL ENGINEERING LABORATORIES Tick

(A) Electronics Laboratory

Lab equipment

Lab instrument

Testing instrument

Consumables

Maintenance and repairs

Calibration

Other (Please specify)

(B) Appliances Laboratory

Lab equipment

Lab instrument

Testing instrument

Consumables


Calibration

Other Please specify

(C) Metrology Laboratory

Lab equipment

Lab instrument

Testing instrument

Consumables


Calibration


(D) NETFA: Short Circuit Laboratory

Lab equipment

Lab instrument

Testing instrument

Consumables


Calibration

Other (Please Specify)

(E) NETFA: High Voltage

Lab equipment

Lab instrument

Testing instrument

Consumables


Calibration

Other (please specify)

56](G) NETFA: Materials & Installations Lab

Lab equipment

Lab instrument

Testing instrument

Consumables


Calibration


(H) Explosion Prevention Technology & Rotation Machines

Lab equipment

Lab instrument

Testing instrument

Consumables


Calibration

Other, (Please Specify)

MINING & MINERALS LABORATORIES

Lab equipment

Lab instrument

Testing instrument

Consumables


Calibration

Other, (Please specify)

AUTOMOTIVE & MECHANICAL LABORATORIES

Lab equipment

Lab instrument

Testing instrument

Consumables


Calibration

Control Valves


CHEMICALS/BIO & MATERIALS LABORATORIES

(A) Materials Technology Laboratories

Lab equipment

Lab instrument

Testing Facilities

Scientific Instrument

Consumables


Calibration

Chemicals supplies

Gas supplies


(B) Rubber Plastics Paints Sealants Laboratories

Lab equipment

Lab instrument

Testing instrument

Consumables


Calibration


(C) Radiation Protection Services Laboratories

Lab equipment

Lab instrument

Testing instrument

Consumables


Calibration


(D) Radiation Protection Services Laboratories

Lab equipment

Lab instrument


Consumables


Calibration

Chemicals supplies

Gas supplies


(E) Condom Test Lab Laboratories

Lab equipment

Lab instrument


Consumables


Calibration

Chemicals supplies

Gas supplies


(F) Fibre & Polymers Laboratories

Lab equipment

Lab instrument


Consumables


Calibration

Chemicals supplies

Gas supplies


(G) Bio Technology

Lab equipment

Analytical instrument


Consumables


Calibration

Chemicals supplies

Glassware


(H) Pharmaceutical Microbiology

Lab equipment



Consumables


Calibration

Chemicals supplies

Gas supplies

Glassware


(I) Food Microbiology

Lab equipment



Consumables


Calibration

Chemicals supplies

Gas supplies

Glassware


(J) Chemicals Technology

Lab equipment



Consumables


Calibration

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


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


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


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


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.

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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 Percentage Owned

African Coloured Indian White

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

Date post:	25-Mar-2018
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