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Mthatha: ECDC House, 7 Sissons St, Fort Gale, Mthatha, 5100, t 047 501 5100 | f 047 501 5110 East London: Arundel Park, Unit 2 & 3A, 12 & 14 Old Transkei Rd, Stirling, t 043 735 1673 | f 043 735 2679 Postnet Suite 385, Private Bag X 9063, East London 5200 |

www.asgisa-ec.co.za

SUPPLIER REGISTRATION FORM GUIDE

If you are a supplier at a Governmental Department please complete the following: DEPT NAME

SUPPLIER #

DEPT NAME

SUPPLIER #

DEPT NAME

SUPPLIER #

DEPT NAME

SUPPLIER #

DEPT NAME

SUPPLIER #

DEPT NAME

SUPPLIER #

WHAT DOCUMENTS DO YOU NEED TO ATTACH TO THESE APPLICATION FORMS? 1. 2. 3. 4. 5.

Tax Clearance Certificate Copy of ID’s of Directors - Certified Company Profile Letter from Bank Acc with Bank Acc Details or a crossed cheque CK1 and/or CK2 or any other company registration documents

Please submit original documents.

SUPPLIER REGISTRATION FORM AsgiSA Eastern Cape

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SUPPLIER REGISTRATION FORM By completing and submitting this form you hereby grant permission to AsgiSA Eastern Cape to capture this data as part of its vendor database profile. Completion of this form does not in any way guarantee any contracts whatsoever.

COMPANY DETAILS: Registered name of the organisation: Trading name: Company registration number: Income tax registration number: VAT registration number: UIF registration number:

CONTACT DETAILS: Contact person

Title:

Surname:

First names:

Position: Telephone

Code:

Facsimile

Code:

Cellular: Email: Website: Postal address: Code: Physical address:: Code:

BUSINESS OVERVIEW: Sole trader:

Partnership:

Type of company

Close corporation:

Ltd:

(mark with an X)

Pty Ltd:

Other:

Business activities / services:

If Other (please specify): Catering, accommodation and other trade

(mark with an X)

Travel Marketing, advertising Event management Printing Office equipment, furniture

2 SUPPLIER REGISTRATION FORM AsgiSA Eastern Cape


Office stationery Training Finance and business service Manufacturing Year of establishment: Turnover per annum (mark with an X)

Less than 5 million Between 5 million and 35 million More than 35 million

3 SUPPLIER REGISTRATION FORM AsgiSA Eastern Cape


All information must be filled in spaces provided. If additional space is required, additional sheets may be attached. The onus is on the Tenderer to fill in all the information. Failure to do so will result in points being lost under equity. The full company composition is required including HDI and Non-HDI status. The ownership must accumulate to 100%. HDI Status (Y/N) Name

Identity Number

Date RSA Citizenship Obtained

No franchise prior to elections

Female

Disabled

Percent of business/ enterprise owned

Voting percent owned

Date of Ownership

*HDI: Historically Disadvantaged Individuals (HDIs) mean a South Africa citizen who, due to apartheid policy that had been in place, had no franchise in national elections prior to the introduction of the Constitution of the RSA, 1983 (Act no 110 of 1983) or the constitution of the RSA, 1993 (Act no 200 of 1993).

4 SUPPLIER REGISTRATION FORM AsgiSA Eastern Cape


DECLARATION: I/we the undersigned, who warrants that he/she is duly authorised to do so, on behalf of the business, acknowledge that the information furnished is true and correct. Any misrepresentation of facts may lead to disqualifications. Should such misrepresentation be uncovered after the commencement of contracted work, AsgiSA-EC reserves the right to terminate the contract and recover all payments made to the business.

Full name: Signature: Date:

SUPPLIER REGISTRATION FORM AsgiSA Eastern Cape

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http://www.asgisa-ec.co.za/asgisa_supplier_registration_new