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Vendor Registration !

VENDOR REGISTRATION FORM B.Ramgoolam & Associates Inc is a quality focussed company, we adhere to regulations and procedures that are set out by ISO 9001 Standards, hence all service/goods providers are required to fill our Vendor Registration Form prior to the commencement of any business.

Instructions 1. To be delivered or emailed to the following addresses : Dannhauser Attention : Mr V Sookdeo - Head of Administration Division Physical Address : BRA House, 12 Church Street, Dannhauser, Kwa-Zulu Natal, 3080 Email Address : vicky.sookdeo@ramgoolam.co.za Telephone : + 27 34 621 2484 Facsimile : + 27 34 621 2194 Durban Attention : Mrs K Sookdeo - Head of Administration Division Physical Address : 5 Carden Crescent, Parlock, Durban, 4037 Email Address : karmanie@ramgoolam.co.za Telephone : + 27 31 577 0551 Facsimile : + 27 31 577 0521 Johannesburg Attention : Mr V Sookdeo - Head of Administration Division Physical Address : BRA House, 12 Church Street, Dannhauser, Kwa-Zulu Natal, 3080 Email Address : vicky.sookdeo@ramgoolam.co.za Telephone : + 27 34 621 2484 Facsimile : + 27 34 621 2194 2. All required returnables are to be submitted with Vendor Registration Form to be considered as a potential service / goods provider. 3. All applications emailed are to be less then 4MB.

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Vendor Registration !

1. Notice of Confidentiality For purposes of B.Ramgoolam & Associates Inc’s vendor database, the vendor is required to provide confidential information related to its business, which may not be in the public domain or readily available to competitor(s) of the Vendor. B.Ramgoolam & Associates Inc therefore in favor of the vendor, undertakes – a. to maintain and uphold the confidentiality and good faith in relation to the confidential information; b. not to divulge, publish or disclose any of the confidential information to any person, firm, company, corporation, trust or any other third party whatsoever. The undertakings given herein by B.Ramgoolam & Associates Inc shall not preclude disclosing the confidential information contained in this form in so far as such disclosure is required by law. Please complete the following information : 1. Registered Name of Company / Sole Proprietor ................................................................................................................................................ 2. Trading Name ............................................................................................................................................... 3. Company Registration Number / ID Number if Sole Proprietor ............................................................................................................................................... 4. Type of Entity ( Please tick relevant entity type) Company CC Pty (Ltd) Sole Proprietor Trust If other, please state : ................................................................................................................................................ 5. VAT Number (If Applicable) ................................................................................................................................................

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Vendor Registration !

6. Tax Number (Mandatory) ................................................................................................................................................ 7. PAYE Number ............................................................................................................................................... 8. B.Ramgoolam & Associates Inc Vendor Number (Only if existing supplier) ............................................................................................................................................... 9. BBBEE Status ( Please Tick Appropriate Box ) Please Attach Proof ✓

BBBEE Level 1 2 3 4 5 10. General Contact Contact Person Designation Telephone Facsimile Mobile Email Website Postal Address Physical Address

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Vendor Registration !

11. BBBEE Contact Contact Person Designation Telephone Facsimile Mobile Email Website Postal Address Physical Address 12. Sales / Marketing Contact Contact Person Designation Telephone Facsimile Mobile Email Website Postal Address Physical Address 13. Principal Business Activities ( Please tick box ) ✓

TYPE

DESCRIPTION

Retailer Manufacturer Consulting Other 4


Vendor Registration !

14. List Three Main Business Activities ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ 15. Geographical Footprint - Provinces where entities are able to provide goods/ services (Please Tick) ✓

PROVINCES Kwa-Zulu Natal Gauteng Free State Western Cape Eastern Cape Northern Cape Limpopo Provinces North West Province Mpumalanga

16. Total Number of Years in Business ................................................................................................................................................ 17. Website (If Applicable) ................................................................................................................................................ 18. Did the entity exist under another name, if so please provide previous name of entity. ................................................................................................................................................ 19. Detail Trade Associations (If Applicable) ............................................................................................................................................... ............................................................................................................................................... ............................................................................................................................................... 5


Vendor Registration !

................................................................................................................................................ ................................................................................................................................................ ............................................................................................................................................... ............................................................................................................................................... 20. Are you or any of your member(s)/shareholder(s) currently in the service of B.Ramgoolam & Associates Inc? Yes ................ No................ If Yes, furnish particulars ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ 21. Have you or any of your member(s)/shareholder(s) been in the service of B.Ramgoolam & Associates Inc for the past twelve months? Yes ................ No................ If Yes, furnish particulars ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ 22. Do you or any of your member( )/shareholder(s) have any relationship (whether family, friend or other) with a person employed by B.Ramgoolam & Associates Inc who may be involved in the database of vendors, the invitation of price quotations/bids and/or the award of contracts? Yes ................ No................ If Yes, furnish particulars ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................

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Vendor Registration !

23. Record of public service (tick applicable boxes) Has any member, director, partner, principal or shareholder been employed by or held an office in the public sector within the last twelve months? Yes ................ No................ If Yes, furnish particulars ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ 24. Please disclose all shareholders/members or directors of entity. NAME

ID NUMBER

RACE

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GENDER


Vendor Registration !

25. ISO Certification / Accreditation ✓ ISO 9001 (Quality Management) ISO 14001 (Environmental) OSHAS 18001 (OHS Certification) Other 26. Professional Indemnity Details (If Applicable) Insured With Policy Number Amount Insured For Policy Expiry Date 27. Please Provide at least 3 contactable references Company Name

Contact Person

Telephone

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Facsimile

Email


Vendor Registration !

28. Banking Details Bank Name Branch Branch Code Name of Account Account Number Type of Account Confirmation of banking Details by Bank Official : Full Name and Surname of Banking Official........................................................................... Bank Official - Telephone Number ......................................................................................... Signature................................................................................................................................

29. If individual signing Vendor Registration Form is not a shareholder/member/ director or duly authorized, please attach letter confirming authority to sign. 30. Supporting Documents - To be submitted with Vendor Registration Form Company Registration Certificate

Attached

Proof of Ownership Proof of Banking Original Tax Clearance Certificate VAT Registration Medical Certificates for disabled Certified Copies of ID Proof of PAYE Registration BEE/EME Certificate ISO Certificates Authority to Sign Company Brochure/ Profile

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N/A


Vendor Registration !

I, the undersigned duly authorized thereto, hereby confirm that the information provided in this document is true and accurate. Signature: ................................................ Name: ..................................................... Date: ....................................................... Place:.......................................................

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Vendor Registration !

Annexure 1 POWER OF ATTORNEY / CERTIFICATE OF AUTHORITY (EXAMPLE) It was resolved that ......................................................................................................... (full names) in his/her capacity as .............................................................................. (acting capacity) be authorized to sign any documents submitted on behalf of ........................................................................................ (registered entity name) for purposes of B.Ramgoolam & Association Inc’s vendor registration process. Certified a true extract Name: (Name of signatory).................................... Date....................................................................... Place......................................................................

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Vendor Regsitration Form  

For New or Existing Suppliers and Service Providers