Suppliers Database Registration Form

SUPPLIERS DATABASE REGISTRATION FORM

eDumbe Local Municipality – Suppliers Database 2017/2018 Financial Year

DELIVER TO:

PROCUREMENT SECTION

EDUMBE LOCAL MUNICIPAPLITY OFFICES

10 HIGH STREET

PAULPIETERSBURG

3180

OR POST TO:

THE PROCUREMENT SECTION

EDUMBE LOCAL MUNICIPAPLITY OFFICES

PRIVATE BAG X308

PAULPIETERSBURG

3180

All enquiries to be directed to: The SCM PRACTITIONER

Telephone: 0349951650/2

Fax number: 0349951192

Email: buthelezibw@edumbe.gov.za

For office use:

IMPORTANT NOTES:

Please read carefully

• To be completed by all vendors seeking registration as an approved supplier.
• Form must be completed in full and must be signed.
• Suppliers must comply with the registration criteria for registration to be finalised – failure to do so may result in the application being declined.
• Applicants will be contacted via fax and must therefore submit an operating fax number; failure to comply will result in excluding the supplier from the EFT system.
• It should be noted that eDumbe Local Municipality reserves the right to accept or reject any application without being obliged to give any reasons in this respect.
• Suppliers will not be notified whether the application was accepted or not but will be advised of the outcome if telephonically requested.
• Documents must be hand delivered at or posted to the above address. Faxed documents will not be accepted.
• Only black pen to be used on completion of this form.

GUIDELINES:

1. Applicants are advised that only ORIGINAL eDumbe Local Municipality forms or PHOTCOPIES thereof will be processed. Any document that has been retyped or redrafted will be disregarded and returned to the applicant.
2. It is imperative that only supporting documents with an ORIGINAL signature be submitted.
3. All signatures must be commissioned by an authorized Commissioner of Oaths. Failure to do so will result in the applicant not qualifying for registration.
4. Suppliers registered on the Suppliers Database MUST notify the Supply Chain Management Office of any changes to information provided in the initial eDumbe Local Municipality forms, as captured onto the Suppliers Database. Failure to do so may result in such a supplier being removed from the Suppliers Database and/or the cancellation of contracts awarded to the supplier, on the basis of misrepresentation.
5. Suppliers providing incorrect information or fraudulent in their eDumbe Local Municipality forms will be disqualified from bidding and removed from the Suppliers Database, in addition to any other action the Province may institute against such a supplier. Furthermore, in the event of the Province being prejudiced financially, it reserves the right to take legal action against the supplier.
6. For definitions of terminology used in this document, please refer to the definitions set out in Treasury Regulation 16 A and eDumbe Local Municipality’s Supply Chain management Framework.
7. Any alterations made by the supplier to its own information inserted on this document, must be initialled by the supplier. The use of correcting fluid is prohibited and the use thereof will lead to non-registration of the applicant.
8. Reminding letters will be issued by the eDumbe Local Municipality to suppliers to update their information. It remains the responsibility of the supplier to ensure that their information is updated in the Suppliers Database, therefore if a reminder letter is not received, the supplier must follow up with the eDumbe Local Municipality.

SUBMISSION OF DOCUMENTATION

The following documents must accompany your application: Please indicate

SECTION 1: PARTICULARS OF THE ORGANISATION

Please note that all information will be treated confidentially.

Where organisation is a joint venture the individual members of the joint venture are to separately provide information on their organisation.

1.1. Registered name of the organisation:

1.2. Trading name:

1.3. Type of organisation: (please tick one)

1.4. Company registration number:

1.5. Income tax registration number:

1.6. VAT registration number:

1.7. UIF registration number:

1.8. PAYE number:

1.9. Construction industry development board registration number (CIDB):

1.10. Compensation commissioner registration number:

1.11. (a) Business Postal address:

(b) Business Physical address

1.12. Contact person (Full name) and designation:

1.13. Contact Details:

1.14. State the municipality in which you’re business operates:

1.15. Previous business information (if applicable)

1.16. Banking details:

The eDumbe Local Municipality has adopted a policy of making vendor payments via EFT. To ensure that there are no delays in the processing of payments, ensure that the Electronic funds transfer form and the banking account details form are completed correctly and have the requisite bank authorisations.

1.17. Declaration of Interest

No bid will be accepted from persons in the service of the state.

Any person, having a kinship with persons in the service of the state, including a blood relationship, may make an offer or offers in terms of this invitation to bid. In view of possible allegations of favouritism, should the resulting bid, or part thereof, be awarded to persons connected with or related to persons in service of the state, it is required that the bidder or their authorised representative declare their position in relation to the evaluating/adjudicating authority and/or take an oath declaring his/her interest.

Are you presently in the service of the state?

If so, furnish particulars.

Have you been in the service of the state for the past twelve months?

If so, furnish particulars.

ELECTRONIC FUNDS TRANSFER

Name of company/ partnership/individual:

Trading as:

Fax:

Address:

I/ We, the undersigned, hereby authorise and instruct the eDumbe Local Municipality to pay all amounts that may hereafter, from time to time, become due and payable to me/us by the eDumbe Local Municipality by electronically transferring the same to the bank mentioned below for the credit of my/our account detailed below.

I/ We, the undersigned, understand and agree that:

• Any such transfer shall constitute a full and final discharge of the eDumbe Local Municipality’s obligation to make such payments to me/us. The eDumbe Local Municipality shall not be liable to make good any loss. I/ We may suffer consequent upon such transfer pursuant to this authority and instruction.
• This payment authorisation and instruction will be applied to both goods purchased and services rendered.
• This authority and instruction will remain valid unless cancelled by either party upon thirty (30) days written notice.
• Should any transfer attempted in respect of this authorisation be unsuccessful due to incorrect information supplied by me/us, I/We agree to pay all bank charges for this transfer attempt.

In the event that the details set out herein should change, I/ We agree to notify the Municipality forthwith.

BANK ACCOUNT TO WHICH PAYMENTS ARE TO BE MADE

Name in which account is held:

Name of bank:

Branch:

Bank clearing number:

Account Number:

ACCOUNT TYPE:

Important: Please ensure that you have included a certified copy of your identification and a copy of a cancelled cheque or bank statement as per the documents required.

SECTION B: BEFORE RETURNING, THIS SECTION MUST BE COMPLETED BY YOUR BANK

I/We confirm that the above information on the client’s account at this bank is correct.

Note: This information will supersede any previous authorisation and instruction lodged with eDumbe Local Municipality. Original completed forms must be hand delivered or posted to the above address. Photocopies or faxed copies will not be accepted.

For Office Use Only

SECTION 2: SERVICE TYPE AND CATEGORIES

Please indicate your Service Type (ONE ONLY) by marking the appropriate box with an X.

Service providers may choose a MAXIMUM OF 5 (five) categories by marking the appropriate box with an X.

If your service is not indicated, write it clearly under "OTHER".

SECTION 3: EVALUATION SECTION

Failure to complete this section will result in the application being declined.

3.1. Please indicate size of the organisation based on annual turnover in the past three year’s turnover:

3.2. Please provide total number of staff members employed by the company:

SECTION 4: REFERENCES

List at least three completed projects and their contactable reference. List per each type of service registered for:

NB: A supplier can attach additional references per service type. References will be contacted, thus inaccurate contact details or poor service delivery may be used as valid grounds for registration being declined.

SECTION 5: DECLARATION

I the undersigned hereby declare that the information given in this document is to the best of my knowledge true, and correct in every respect.

Full names of owner or supplier representative:

Signed at:

Supplier name:

SIGNED AND AFFIRMED BEFORE ME (COMMISSIONER OF OATHS):

Full name:

Capacity: