Vendor Registration; Version 8-2021



VENDOR REGISTRATIONRevision 8-2021APPLICATIONBYName of company (Please print): __________________________________________________________________________________________________________________________Full registered trade name (Please print): __________________________________________________________________________________________________________________Company/CC registration number: _________________________________________MAKE A PRINTOUT OF DOCUMENT, COMPLETE BY HAND AND SUBMIT AS A HARD COPY TO TSHWANE UNIVERSITY OF TECHNOLOGY.Supplier DatabaseTshwane University of TechnologyThese forms must be completed in full, placed in an envelope marked clearly “VENDOR APPLICATION”, sealed and delivered to the following address:Staatsartillerie RoadPretoria West CampusBuilding 30 – Room G07All forms to be completed in black ink onlyPlease PRINT so that all information is legible.Forms that are not readable or are incomplete will be rejected.New ApplicationYes FORMCHECKBOX No FORMCHECKBOX If No, please supply current TUT creditor number. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX PLEASE KEEP COPIES OF THE REGISTRATION FORM AND ALL DOCUMENTATION SUBMITTED FOR YOUR OWN RECORDS AS NO COPIES WILL BE MADE BY THE UNIVERSITY-POINTS TO REMEMBER-COMPLETING VENDOR REGISTRATION APPLICATION FORMMandatory fields – Certain fields and documents are mandatory to certain business types only. Please ensure that all fields mandatory to your business type have been completed and if a field is not applicable to your business type, clearly mark it as N/A.Required documentation – Please refer to the attached table (following page) to determine the mandatory supporting documentation required for your business type. Please ensure that all copies of mandatory documents (certified copies where applicable) are pletion of questions – Clearly state Yes, No or N/A to questions asked. Do not leave any Mandatory fields blank.Certified documents – Please ensure that a Commissioner of Oaths has certified your Company Registration document and Proof of Shareholding Certificates. The stamp of certification should be on the front of the document.Copies of documents - Please keep copies of the registration form and all supporting documentation submitted for your own records and ensure that all data is maintained and up to date on a continual basis. It is required from all applicants to update their detail every five years or as and when a change occurs.Owners, Shareholders and Partners – Please ensure that the percentage of ownership calculated up to 100% and that a field is completed for each of the business owners.Certification of correctness – Please ensure that the Certification of Correctness is signed and dated once all required documents and information have been attached and completed.Collection points – Completed registration forms and supporting documentation can be delivered to the address supplied herein.Processing of registration – Your completed registration will be processed and once verified, will be approved or rejected. The letter of confirmation of registration will be dispatched to the correspondence details supplied on page ten. Please note that this administration process will take a minimum of 5 working days. Once your registration has been included on the TUT Database your details will be accessible to the purchasing officers of TUT. Formal registration as a creditor of TUT shall only be done on placement of the first official order. A formal creditor number shall then be issued which shall have to be quoted in all future correspondence with the University.Business opportunities – Please note that registration on the TUT Supplier Database does not guarantee business opportunities. Inclusion of the name in a database does not in any way guarantee any persons, company, service provider, vendor, etc. any business from the Tshwane University of Technology. All procurement will be subjected to the Procurement- and Tender Policies of Tshwane University of Technology.Amendments – Please notify the Tshwane University of Technology – Procurement Department immediately of any changes to the information submitted.Queries – Should you have any queries or if you require assistance completing the registration form, please contact the Procurement Department on Tel: 012-382 6550 or bekkerh@tut.ac.za If a company has more than one office, each office must fill in a separate form unless the point of transaction is centralized in the company’s head office.Please note that the key facilities in the database are classified as commodities and each potential vendor must indicate the commodity/commodities in which it would like to register for RFQ’s. A vendor shall only be allowed to register for the maximum of four (4) commodity groups.The main objective of this process is to enhance transparency and equality on the part of the University and to facilitate effective communication with its vendors.Applications must be delivered by hand and must be fully completed with all the relevant documentation attached, at Building 30 Room G07/G09 Pretoria West Campus.It is a condition of bidding that a vendor’s taxes must be in order or satisfactory arrangements must have been made with the Receiver of Revenue to meet his/her tax obligations. In bids where consortia/joint ventures/sub-contractors are involved, each party must submit a separate valid Tax Clearance Certificate.PLEASE KEEP COPIES OF REGISTRATION FORM AND ALL DOCUMENTATION SUBMITTEDCONTACT DETAILSRegistrar of Close Corporations & CompaniesThe Dti campus (Block F - Entfutfukweni)77 Meintjies Street, Sunnyside, Pretoria Tel: 0861 843 384Department of Labour (U.I.F certificates)94 Church street, PretoriaTel: 012 337 1802City of Tshwane/Local Authority if not based in TshwaneHB Phillip Building, 320 Bosman Street, Pretoria.Tel: 012 337 4000Department of Labour (Workman’s Compensation)Compensation House, Cnr Hamilton & Soutpansberg Rd, PretoriaTel: 012 319 9111Receiver of Revenue (SARS)c/o Schoeman & v.d. Walt Street, P.O. Box 436, Pretoria 0001Tel: 012 317 2000Security Service Industry Regulatory Authority481 Belvedere Street, ArcadiaTel: 012 337 5500COMMODITY GROUPSPLEASE NOTE:Any vendor may only register for a maximum of four commodity groupsTickCat NoDescriptionTickCat NoDescriptionTickCat NoDescription001Laboratory equipment032Welding & Flame Cutting Equipment063Catering & Events Equipment Hire002Fasteners, Bolts, Nuts, Rivets & Washers033Office Furniture, Components & Accessories064Engineers & Contractors003Containers & Packaging034Hospital, Medical & Surgical Equipment & Furniture065Castors, Ladders, Trolleys & Wheels004Bricks & Blocks035Outdoor & Pavement Furniture066Recreational & Sports Requisites005Canteen, Kitchen & Cooking equipment & Appliances036Agricultural & Horticultural Equipment & Machinery067Artwork, Crafts, Curios & Gifts006Tableware, Hollowware & Utensils037Compressors, Blowers & Vacuum Equipment068Hygiene, Beauty & Cosmetic Products007Sand, Soil, Cement & Concrete038Air conditioners, Ventilation, Fans & Coolers069Publications, Videos & Films, Books, Newspapers, Magazines & Periodicals008Home & Industrial Fabrics & Textiles039Furnaces, Kilns, Ovens & industrial Dryers070Fresh Flowers, Plants & Seeds009Clothing, Safety Clothing & Footwear040Office Machines & Equipment071Medications & Pharmaceuticals by General Classification010Cordage, Ropes, Twines, String & Nets041Machine Tools & Accessories072Financial, Insurance & Legal Services011Electronic Components & Equipment042Radio, Television, Audiovisual & Communication Equipment073Analysis, Inspection & Evaluation Services012Computer Hardware & Supplies043Pumps, Engines, Spares & Accessories074Installation Services013Computer Software & Solutions044Fertilizers075Maintenance & Repair Services014Electric & Data Cable, Wire &Equipment045Animal Feeds076Manufacturing & processing Services015Electric Lamps, Lighting & Accessories046Transport Vehicles, Trailers, Motorcycles, Boats, Aircraft & Spares & Accessories077Cleaning Services016General Electrical Equipment & Parts047Washing, Scrubbing, Cleaning Plant and Supplies078Administration & Management ServicesTickCat NoDescriptionTickCat NoDescriptionTickCat NoDescription017Control, Process & Measurement Instrumentation048Nails, Pins, Screws & Staples079Engineering & Related Services018Test & Analysis instrumentation049Fuels, Petrol, Oils & Lubricants080Advertising & Marketing Services019Scopes, Lenses & Optical Equipment050Coatings, Waterproofing & Paints081Consultants020Security Equipment & Requisites, Walling, Fencing & Gates051Stationery082Communication, Publishing & Printing Services021Signs, Nameplates, Notices & Labels052Steel, Pipes and Profiles083Consulting Engineers022Engravers, Die-Sinkers & Embossers053Valves and Pressure Vessels084Chemicals & Associated Products023Insulation Products054Pest Control and Cleaning materials085Security Services024Precious Stones and Materials055Adhesives086Food Services025Building requisites, fittings & Materials056Heaters and Heating Equipment087Computer Related Services026Flooring Products057Timbers and Timber materials088Accommodation, Tourism & Entertainment027Sanitary ware & Accessories058Plant & Equipment Hire089Agricultural Services028Sewing, Knitting & Textile Machines & Equipment059Brush ware090Retailers & Wholesalers029Printing, Marking, Engraving & Labeling Equipment060Power Tools & Accessories091Government Services – National, Local & Municipal030Printing Supplies061Hand Tools & Accessories092Other (Please specify):031General Foodstuffs062Transport Hire & Transport and Cartage ServicesDocuments AttachedPlease tick boxYesNoN/AWorkman’s Compensation Certificate (Certified)VAT 103 (Certified)P.A.Y.E./SDL/UIF (EMP103) (Certified)Company Registration Document (Certified)Proof of Ownership/Shareholder certificate (Certificate)Tax Clearance Certificate (Original)Proof of Banking DocumentDisability Documents (Certified)Security Officer’s Board registration (Certified)Municipal AccountLabour BrokerCompany Profile with organogramJoint Venture Agreement/sB-BBEE CERTIFICATE - COMPULSORYPlease note: Proof of documents for all of those above are required to ensure successful registration on the Supplier Database. In event of a document not being required please tick the N/A box.1. COMPANY REGISTRATION DOCUMENTSNB. DOCUMENTARY PROOF MUST BE PROVIDED WHERE APPLICALE (Please mark N/A if not applicable.)NB: All fields marked with * are mandatory. Fields marked with # are to be completed only if applicableCOMPANY TYPE * (NB. Documentary Proof of Registration must be provided)PUBLIC COMPANY LTD FORMDROPDOWN CERTIFIED COPY OF CERTIFICATE OF INCORPORATION (CM 3)PRIVATE COMPANY (PTY) LTD FORMDROPDOWN CERTIFIED COPY OF CERTIFICATE OF INCORPORATION (CM 3) CLOSE CORPORATION CC FORMDROPDOWN CERTIFIED COPY OF CK1 DOCUMENT OR CK2 IF APPLICABLE SOLE PROPRIETOR FORMDROPDOWN CERTIFIED COPY OF REGISTRATION DOCUMENTPARTNERSHIP FORMDROPDOWN CERTIFIED COPY OFPARTNERSHIP AGREEMENTBUSINESS TRUST FORMDROPDOWN CERTIFIED COPY OFREGISTRATION DOCUMENTOTHER (If Joint Venture) FORMDROPDOWN CERTIFIED COPY OF REGISTRATION DOCUMENTSCompany or CC number FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Not applicable to all companies, please specify if N/A.Did you attach your company Registration document? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/APROOF OF SHAREHOLDING *CERTIFIED COPIES of Shareholders certificates or CC members share allocation documents must be supplied.Not applicable to all companies, please specify if N/A.Did you attach your proof of shareholders documents? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/APROOF OF BANKING DETAIL *Current bank statement or copy of cancelled cheque.Did you attach your proof of banking detail? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/AVAT REGISTRATION #VAT Registration Number FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX If you qualify for VAT exemption, please attach confirmation of VAT exemption.Not applicable to all companies, please specify if N/ADid you attach proof of your VAT registration (VAT 103)? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/ANB: All fields marked with * are mandatory. Fields marked with # are to be completed only if applicableP.A.Y.E. REGISTRATION #Not applicable to all companies, please specify if N/ADid you attach proof of your P.A.Y.E. registration? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/AUNEMPLOYMENT INSURANCE FUND REGISTRATION #U.I.F Number FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Not applicable to all companies, please specify if N/ADid you attach proof of your UIF registration? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/AWORKMAN’S COMPENSATION FUND REGISTRATION #Workman’s Compensation Fund No. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Not applicable to all companies, please specify if N/ADid you attach proof of your Workman’s Compensation Fund registration? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/ASECURITY OFFICERS BOARD REGISTRATION #Security officers board registration no. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Not applicable to all companies, please specify if N/ADid you attach proof of your Security Officers Board Registration? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/ADISABILITY #Not applicable to all companies, please specify if N/ADid you attach proof of your disability? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/AINCOME TAX REGISTRATION #Income Tax Registration number FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Not applicable to all companies, please specify if N/ADid you attach proof of your Income Tax Registration? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/ANB: All fields marked with * are mandatory. Fields marked with # are to be completed only if applicableTAX CLEARANCE CERTIFICATE *Original of valid Tax Clearance Certificate must be suppliedDid you attach a valid Tax Clearance Certificate? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/ACIDB REGISTRATION #CRS Registration number FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Current CIDB Grading FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Not applicable to all companies, please specify if N/ADid you attach proof of your CIDB Registration? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/ANHBRC REGISTRATION #NHBRC Registration number FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Not applicable to all companies, please specify if N/ADid you attach proof of Registration? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/ATRANSPORT OPERATORS #PDP Permit No. FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Not applicable to all companies, please specify if N/ADid you attach a copy of your PDP Permit? FORMCHECKBOX Y FORMCHECKBOX N FORMCHECKBOX N/ANB: All fields marked with * are mandatory. Fields marked with # are to be completed only if applicable2. BUSINESS PARTICULARS *2.1 Name of Business* FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 2.2 Physical address * FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX City FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Code FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Province FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 2.3 Postal address * FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX City FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Code FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Province FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 2.4 Telephone Number. * FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 2.5 Fax Number. * FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 2.6 Cell Number. * FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 2.7 E-Mail Address. * FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 2.8 Web-Page Address. * FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 2.9 How would you like to receive your correspondence from us? *Post FORMCHECKBOX Fax FORMCHECKBOX E-Mail FORMCHECKBOX 2.10 Correspondence Address * FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX City FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Code FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Province FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 2.11 Contact Person for correspondence as per 2.10Title FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Name FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Surname FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX NB: All fields marked with * are mandatory. Fields marked with # are to be completed only if applicable3. SALES AND ACCOUNTS DEPARTMENT *3.1 Sales Department #Contact Name FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Cell No FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX E-Mail Address FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Telephone FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Fax FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 3.2 Accounts Department *Contact Name FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Cell No FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX E-Mail Address FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Telephone FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Fax FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX 4. CORE BUSINESS OPERATION *(Mark with X in applicable fields) FORMCHECKBOX Primary Contractor FORMCHECKBOX Sub-Contractor (Less than 25% gene- FORMCHECKBOX Labour-only Contractor rated turnover as prime contractor) FORMCHECKBOX Supplier FORMCHECKBOX Manufacturer FORMCHECKBOX Labour Agency FORMCHECKBOX Professional Services FORMCHECKBOX Education, Development & FORMCHECKBOX Construction (CIDB) Training Service ProviderOther, please specify …………………………………………………………………………………………………………………………………………………………………………………………………………5. ANNUAL AVERAGE TURNOVER *Indicate annual average turnover excluding Value Added Tax during the past three years:R FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX . FORMCHECKBOX FORMCHECKBOX Indicate total gross asset value (fixed property excluded):R FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX . FORMCHECKBOX FORMCHECKBOX Indicate number of permanent employees FORMCHECKBOX 0–5 FORMCHECKBOX 6–50 FORMCHECKBOX 51+NB: All fields marked with * are mandatory. Fields marked with # are to be completed only if applicableNote: Certified copy of shareholder certificates or proof of ownership must be supplied(Multiple copies of this page may be submitted if required)10.1 Complete the following for the shareholders who are actively involved in the management and daily business operation of the businessFirst Name FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Surname FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Identification Number FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Percentage of Share FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX %Capacity FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Gender FORMCHECKBOX FORMCHECKBOX HDI Status FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Disabled (a permanent impairment of a physical, intellectual or sensory functions resulting FORMCHECKBOX FORMCHECKBOX in restricted or lack of ability to perform in a manner considered normal for a human being) Yes NoWere you a South African citizen on or before 26th April 1994? FORMCHECKBOX FORMCHECKBOX Yes NoAre you actively involved in the management and the daily business operation FORMCHECKBOX FORMCHECKBOX of the business? Yes No(Please provide a written breakdown e.g. company profile)First Name FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Surname FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Identification Number FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Percentage of Share FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX %Capacity FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Gender FORMCHECKBOX FORMCHECKBOX HDI Status FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Disabled (a permanent impairment of a physical, intellectual or sensory functions resulting FORMCHECKBOX FORMCHECKBOX in restricted or lack of ability to perform in a manner considered normal for a human being) Yes NoWere you a South African citizen on or before 26th April 1994? FORMCHECKBOX FORMCHECKBOX Yes NoAre you actively involved in the management and the daily business operation FORMCHECKBOX FORMCHECKBOX of the business? Yes No(Please provide a written breakdown e.g. company profile)First Name FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Surname FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Identification Number FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Percentage of Share FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX %Capacity FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Gender FORMCHECKBOX FORMCHECKBOX HDI Status FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Disabled (a permanent impairment of a physical, intellectual or sensory functions resulting FORMCHECKBOX FORMCHECKBOX in restricted or lack of ability to perform in a manner considered normal for a human being) Yes NoWere you a South African citizen on or before 26th April 1994? FORMCHECKBOX FORMCHECKBOX Yes NoAre you actively involved in the management and the daily business operation FORMCHECKBOX FORMCHECKBOX of the business? Yes No(Please provide a written breakdown e.g. company profile)NB: All fields marked with * are mandatory. Fields marked with # are to be completed only if applicable6. CERTIFICATION OF CORRECTNESS OF INFORMATION SUPPLIED IN THIS DOCUMENT *I/We the undersigned am/are duly authorized to do it on behalf of the firm, hereby certify that:The information supplied is correct.All copies of relevant information are attached.The HDI points claimed are correct and based on owners/shareholders who are actively involved in the day to day management of the enterprise.I take note that payment will be effected 30 days after delivery was accepted if delivered with an original invoice.If I am classified as a dependent service provider/labour broker as stated in the fourth schedule of the Income Tax Act I hereby authorize the University to deduct P.A.Y.E. and supply me with a yearly IRP 30 (only if no valid Labour Broker Certificate can be supplied)._____________________________________________________________________Signature of authorized personDatePersonal information in block lettersName FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Surname FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Telephone No FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Capacity FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX ON BEHALF OF FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX (Supplier’s name)7. AUTHORISATION FOR ELECTRONIC TRANSFER OF FUNDS (EFT) TO VENDOR’S BANK ACCOUNTPLEASE COMPLETE IN BLOCK LETTERSSurname/Company name FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX First Names/Company of Account Holder FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Address FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Telephone FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Fax FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Mobile FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX E-mail FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Bank FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Branch FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Bank Account FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Branch Number FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX Type of Account Cheque FORMCHECKBOX (attach cancelled cheque as proof)Savings FORMCHECKBOX (attach bank statement as proof)Transmission FORMCHECKBOX (attach bank statement as proof)I, the undersigned hereby authorize the Tshwane University of Technology to credit my account via EFT as aforementioned with the amount payable/due to specified beneficiary for goods and services renderedPlease note: that if a cancelled cheque is not attached, an official stamp should be obtained from the bank to confirm the information given above.____________________________________________________________________Signature DateTO BE COMPLETED BY BANK(in cases where a cancelled cheque is not attached)3543300107315Official Stamp:00Official Stamp:Above information checked and confirmed.Surname & initials:___________________________________________________________________________________Designation:________________________________________________________________________________________Signature:_________________________________________8. AUTHORISATION FOR AGREEMENT FOR TUT TO DO VETTING/SCREENING ON COMPANYI, the undersigned hereby authorize the Tshwane University of Technology to conduct vetting on company. ____________________________________________________________________Signature Date8. FOR OFFICE USE ONLYFOR OFFICE USE ONLY – PROCUREMENT DEPARTMENTInformation confirmed, scheduled and submitted for approval:Signature: __________________________________ Date: _____________________________FOR OFFICE USE ONLY – HOD: PROCUREMENTVendor approved for:Commodity Code:_______________ Description:______________________________________Commodity Code:_______________ Description:______________________________________Commodity Code:_______________ Description:______________________________________Commodity Code:_______________ Description:______________________________________Signature: __________________________________ Date: _____________________________FOR OFFICE USE ONLY – CREDITORS DEPARTMENTCreditor Information Validity Check completed and returned to Tender OfficeApproved (mark with X): FORMCHECKBOX Yes FORMCHECKBOX NoReason/s for rejection attached: FORMCHECKBOX Yes FORMCHECKBOX NoSignature: __________________________________ Date: _____________________________Captured on ITS:Creditor code: __________________________Signature: __________________________________ Date: _____________________________Successful Vendor applicant notified by: FORMCHECKBOX E-mail E-mail address: ___________________________________________________ FORMCHECKBOX FaxFax Number:_____________________________________________________Signature: __________________________________ Date: _____________________________ ................
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