CETC Suppliers Database Application FormCSD NumberType Of Entity *Select the type of entityClose CorporationPTY LtdPrivate CompanySole ProprietorPartnershipConsortium/Joint VentureCo-operativeFull Registered Name Of Business *Details Of Owners And DirectoresName *Capacity *Citizenship *ID Number *Gender *Select genderMaleFemaleRaceSelect raceAfricanWhiteColouredIndianSupplier InformationRegistration Number Of Company/Close corporationUpload Copy Of Registration CertificateChoose FileNo file chosenDelete uploaded fileDescription Of The Core Business SupplierDescription of specific expertise vested in the companyIs permission granted by the applicant that the financial position of the supplier and the ability to manufacture or to supply goods or to render a service may be examined before its offer is considered for acceptance?Income Tax Registration NumberVAT Registration number if registered, or indicate if not registeredEmployees Tax Registration Number If Registered for Employees TaxPlease A Valid Tax Clearance CertificateChoose FileNo file chosenDelete uploaded fileUpload an Authorization form for College to obtain a Tax Clearance from SARS if an original copy is not attachedTax Clearance Verification PinDateUIF Number If Registered For UIFWorkmen’s Compensation Fund Registration Number If Registered For Workmen’s Compensation FundPlease Upload A Certificate Of Good Standing From The Compensation CommissionerChoose FileNo file chosenDelete uploaded fileWeb AddressTelephone NumberFax NumberEmail AddressPhysical AddressPostal AddressContact PersonPlease State Your NHBRC StatusPlease Upload A Valid Certificate If ApplicableChoose FileNo file chosenDelete uploaded filePlease State Your CIDB StatusPlease Upload A Valid Certificate If ApplicableChoose FileNo file chosenDelete uploaded filePlease Indicate Any Professional / Regulatory Bodies With Which You Are AccreditedRegistration NumberPlease Upload The Proof Of Registration / Accreditation As May Be RelevantChoose FileNo file chosenDelete uploaded filePlease Indicate Whether You Are Registered In The Central Supplier DatabasePlease Upload Your Proof Of Registration If ApplicableChoose FileNo file chosenDelete uploaded filePlease State ISO StatusPlease Upload The Relevant Proof As May Be ApplicableChoose FileNo file chosenDelete uploaded filePlease Provide The Names And Contact Details Of 3 Trade References For The Goods And / Or Services For Which You Wish To Register On The Supplier Database?Please Upload A Copy Of Your Latest Annual Financial Statement (Audited If Applicable) To Your Application?Choose FileNo file chosenDelete uploaded filePlease State Your Annual Turnover As Per Your Latest Annual Financial Statements?ZARPlease State The Number Of Full Time EmployeesPlease State The Number Of Part Time EmployeesPlease State The Number Of Other Employes (Please Specify)Please Specify The District And The Number Of Residents Of That District That Youy Have In Your EmploymentHow Many Disabled Persons Are In your EmploymentHow Many Women Are In Your EmploymentPlease Provide Proof Of Your Address, In The Form Of A Municipal Account, Or Suitable Alternative Evidence Of Your AddressChoose FileNo file chosenDelete uploaded fileContact Details For Sales And Accounts DepartmentsSales Contact Person NameSales Contact Person Tel NoSales Contact Person Fax NoSales Person EmailAccounts Contact Person NameAccounts Contact Perosn Tel NoAccounts Contact Person Fax NoAccounts Contact Person EmailPlease Complete The List Of The Main Commodities And/Or Services In Respect Of Which You Wish To Be Registered As An Accredited Prospective Service Provider And Provide Information On Those That Are Not ListedBlack Economic Empowerment Act Information (Kindly Supply The Following Information, If Applicable As Set Out Below And Supply Documentary Proof As Requested)Details Of Previously Disadvantaged Equity HoldersNameID NumberEquity Holding %Share Holding CertificateChoose FileNo file chosenDelete uploaded filePlease State Your BBBEE RatingPlease Upload A Valid Supporting Affidavit Or BBBEE CertificateChoose FileNo file chosenDelete uploaded fileHuman Resource Development:Number Of EmployeesNumber Of Previously Disadvantaged Individuals EmployedDetails Of Previously Disadvantaged Individuals In Management Position:NameID NumberPosition OccupiedDetails Of BBBEE Businesses Doing Business With, Attach Proof Of The Three (3) Top Major Suppliers Mentioned BelowNumber Of Your Service ProvidersNumber Of BEE Businesses In Your List Of Service ProvidersDetails Of Your Top Three Major Suppliers:Name Of BusinessName Of The OwnerContact NumberStreet AddressService/Goods ProcuredUpload Proof Of SupplierChoose FileNo file chosenDelete uploaded fileTrade Refferences(Please list at least 3 trade references from recent contracts awarded to you)ClientContact Person And Contact NumberContract DescriptionContract Value In RandsZARProject DurationYearSection B Financial InformationBanking DetailsBank NameBranch CodeBranch NameAccount TypeBank Account NumberName Of Account HolderI/We hereby request and authorize KwaZulu-Natal CET College to pay any amounts that are due to my/our Bank Account held at the abovementioned Financial Institution. This authority will remain in force until such time is cancelled by me/us giving (30) days written notice to your office.I/We hereby declare that I/we will not hold KwaZulu-Natal CET COLLEGE liable for any payment not made to our bank account if the bank account details as provided above, or amended in writing by me/us, are incorrect.Signed By:Initials And SurnameAuthorised SignatureDateTextWho Hereby Warrants That He / She Is Duly Authorised To Sign This Form On Behalf OfTextCOMMODITIES AND SERVICES PROVIDEDPlease Select Your Organization's Types Of Commodities Or Services RenderedAdvertisingAudio Visual Aids & EquipmentBuilding materials & hardwareBuilding ContractorsCateringCleaning chemicalsClothing: General/Protective & UniformsComputer & IT Equipment (Hardware &Software)Corporate Gifts & PromotionConsulting EngineersEvent ManagementFire extinguishingFurniture & EquipmentOffice Equipment & ConsumablesPrinting & Stationery - CartridgesRefrigeration & Air ConditioningSanitationSecurity ServicesTraining and DevelopmentTravel & TransportValuation ConsultantsWorkshop & Training EquipmentPolicy DevelopersLegal servicesPromotion and brandingPlumbing and ElectricityTeaching and learning materialPark homesCourier servicesOffice furniture, office machines, office equipmentPlease tick only three appropriate commodities or service that your organisation renders.Declaration Of Service Provider's Past Supply Chain Management Practices1 This serves as a declaration to be used by institutions in ensuring that when goods and services are being procured, all reasonable steps are taken into combat the abuse of the supply chain management system2 The service of any service provider may be disregarded if that service provider or any of its directors have-a. abused the institution's supply chain management systemb. committed fraud, corruption or any other improper conduct in relation to such system; orc. failed to perform on any previous contract3 In order to give effect to the above, the following questionnaire must be completed and submitted with the bid3.1 Is the service provider or any of itys directors listed on the National Treasury's database as companies or persons prohibited from doing business with the public sectorYesNo3.1.1 If So, Furnish Particulars3.2 Was the service provider or any of its directors convicted by a court of law (including a court outside of the Republic of South Africa) for fraud or Corruption during the pastb five years?YesNo3.2.1 If So, Furnish Particulars:3.3 Was any Contract between the service provider and any organ of the state terminated during the past five years on account of failure to perform on or comply with the contract?YesNo3.3.1 If So, Furnish ParticularsCertificationI, THE UNDERSIGNED (FULL NAME)CERTIFICATION *CERTIFY THAT THE INFORMATION FURNISHED ON THIS DEC LARATION FORM IS TRUE AND CORRECTCERTIFICATION *I ACCEPT THAT, IN ADDITION TO CANCELLATION OF A CONTRACT, ACTION MAY BE TAKEN AGAINST ME SHOULD THIS DECLARATION BE FAKSESignatureDatePositionName Of Service Providerwho hereby warrants that he / she is duly authorised to sign this form on behalf of:Declaration Of Interest1. Any legal person, including persons employed by the State, or persons who act on behalf of the state or persons having kinship with persons employed by the State, including a blood relationship, may make an offer or offers in terms of the invitation to provide a service. In view of possible allegations of favouritism, should the resulting service, or part thereof, be awarded to persons employed by the State, or to persons who act on behalf of the State, or to persons connected with or related to them, it is required that the service provider or his authorised representative shall declare his position visa-vis the evaluating authority and/or take an oath declaring his interest,Where –The service provider is employed by the State or acts on behalf of the State; - The legal person on whose behalf the application form is signed, has a relationship with person/ a person who is/are involved with the evaluation of the application, or where it is known that such a relationship exists between the person / persons for or on whose behalf the declarant acts and performs who are involved with the evaluation application. In order to give effect to the above, the following questionnaire shall be completed and submitted with the application.2 Are you or any person connected with the service provider, employed by the State, or in a Public TVET or CET College?YesNo2.1 If so, state particulars3 Do you, or any person connected with the service provider, have any relationship (family, friend, other) with a person employed in the department concerned or with the State Tender Board or its administration, or in a Public TVET or CET College and who may be involved with the evaluation or adjudication of this application?YesNo3.1 If so, state particulars4 Are you, or any other person connected with the service provider, aware of any relationship (family, friend, other) between the service provider and any person employed by the department concerned, State Tender Board or its administration, or by a Public TVET or CET College, who may be involved with the evaluation or adjudication of this application?YesNo4.1 If so, state particularsSigned ByName Of DeclarantSignature Of DeclarantDatePosition Of DeclarantName Of Companywho hereby warrants that he / she is duly authorised to sign this form on behalf ofSubmit Application