application for registration as a vendor to north-west...

Application for Registration as a Vendor to

North-West Development Corporation.22 James Watt Crescent, Industrial Area, Mafikeng

Tel: 018-3813663

1 Section One - General Information on Completing this form.➔ Referral to “the Corporation” in this form pertains to the North-West Development

Corporation as indicated above.

➔ This form has been compiled to make the completion thereof as user-friendly as possible for your convenience.

➔ Each section contains a table with four columns. Column 1 ('Fld') is a sequence number which does not require anything from you. Column 2 ('Data Description') describes the type of input needed from you in Column 3 ('Data Supplied'). You only have to complete Column 3 unless otherwise indicated. Column 4 ('# Chars') indicates the maximum number of characters your supplied information may contain (please remember that a space is counted as a character.)

➔ Where necessary an explanation of certain required information will be given after each table.

➔ All fields in Column 3 ('Data Supplied') are MANDATORY and must be completed. The rest under the same column with a light-grey background should only be completed if necessary. Please note that Section 2 is for OFFICE USE only.

➔ Please do not use the following characters in any information you supply: , . “ @ * & % ! # { } [ or ].

2 Section Two – Office Use OnlyFld. Data Description Data Supplied # Chars

1 Client Database ID 102 Vendor Reference Number 20

Generated from MYSQL-database: V-Proc1_7

3 Section Three - Vendor DetailsThis section deals with general company information.

Fld. Data Description Data Supplied # Chars3 Company / Vendor Trade Name 30

4Company / Business Type (* see below) 1

5If Company / Business Type = 6 (Other) Please Specify 1

6 South-African Company? (Y/N) 1

7

If not South-African Company please specify country in which business is registered.

30

8 Postal Address 1 309 Postal Address 2 30

10 Postal Address 3 3011 Postal Address 4 412 Physical Address 1 3013 Physical Address 2 3014 Physical Address 3 3015 Physical Address 4 3016 Physical Address 5 30

Details for Contact Person 117 Person 1 - Name 2518 Person 1 – Home Telephone No 1619 Person 1 – Work Telephone No 1620 Person 1 – Cell No 1621 Person 1 – Fax No 1622 Person 1 – E-mail Address 40

Details for Contact Person 223 Person 2 - Name 2524 Person 2 – Home Telephone No 1625 Person 2 – Work Telephone No 1626 Person 2 – Cell No 1627 Person 2 – Fax No 1628 Person 2 – E-mail Address 40

Miscellaneous Company Info29 Company Registration No 20


Fld. Data Description Data Supplied # Chars30 Company TAX No 1831 Company VAT No 18

32Company Tax Clearance Certificate No 18

33Tax Clearance Certificate Expiry Date Format --> YYYY/MM/DD[ ] 10

First Three Directors / Members ** see below)

34 Director 1 - Full Name 2535 Director 1 - Nationality 836 Director 1 – ID Number 1537 Director 1 – Contact Tel No 1638 Director 2 - Full Name 2539 Director 2 - Nationality 840 Director 2 – ID Number 1541 Director 2 – Contact Tel No 1642 Director 3 - Full Name 2543 Director 3 - Nationality 844 Director 3 – ID Number 1545 Director 3 – Contact Tel No 16

* - Company / Business Type Indicators: 1 = One Man Concern; 2 = Closed Corporation; 3 = Partnership; 4 = Private Company; 5 = Public Company; 6 = Other

** - Companies / Closed Corporations / Partnerships with more than three directors / members / partners MUST give the details of at least THREE persons.

4 Section Four – Vendor Representative DetailsIn each venture there are a few individuals who are to be the 'face' of said venture. These are the individuals who will (mainly) be dealing with the Corporation, negotiating business, signing contracts, delivering goods or collecting documents.

In order for the Corporation to positively identify such individuals when needed, please supply the requested information here.

You may supply details for up to 4 (four) persons for this purpose.

Fld. Data Description Data Supplied # Chars46 Representative 1 – Full Name 3047 File Name of Photo on CD (*** 50


Fld. Data Description Data Supplied # Charssee below)

48 Representative 2 – Full Name 30

49File Name of Photo on CD (*** see below) 50





Marking on Media Supplied (**** see below)

*** - Digital photographs of each representative must be supplied for each nominated representative. The photographs must preferably be frontal head-and-shoulders images , size 100mm x 150 mm would be best) in any of the following formats: .jpg, .jpeg, .bmp or .gif. In the table above please supply the name of the file containing the image for the named person. Photographic images may also be emailed to the Corporation as long as a full name is given for each attached image, thereby achieving the same as above.

**** - Please supply the exact text used to mark the media supplied.

5 Section Five – Vendor Banking DetailsIn order to facilitate ease of payment to you via Electronic Funds Transfer (EFT) please supply us with the details of the account into which you would prefer payment be made to you.

Fld. Data Description Data Supplied # Chars54 Account Name 3055 Bank / Branch 3056 Branch Code 857 Account Number 16

58Account Type (***** see below) 1

***** - Account types are: 1 = Current (Cheque); 2 = Savings; 3 = Transmission; 4 = Credit Card.

6 Section Six – Supply Category DetailsThis section is of utmost importance in this application. For the Corporation to know what products and / or services you can render, we need to classify your offerings in Categories and Sub-Categories. You can register for a maximum of THREE major categories and a


maximum of NINE sub-categories for each major category.

Please Note: Should you make use of the opportunity to define your own descriptions it must be borne in mind that the total of THREE major- and NINE minor categories can not be exceeded in total.

Fld. Data Description Data Supplied # Chars

59Major Category 1 (****** - see below) 5

60 Sub-Category 1.1 561 Sub-Category 1.2 562 Sub-Category 1.3 563 Sub-Category 1.4 564 Sub-Category 1.5 565 Sub-Category 1.6 566 Sub-Category 1.7 567 Sub-Category 1.8 568 Sub-Category 1.9 5


70 Sub-Category 2.1 571 Sub-Category 2.2 572 Sub-Category 2.3 573 Sub-Category 2.4 574 Sub-Category 2.5 575 Sub-Category 2.6 576 Sub-Category 2.7 577 Sub-Category 2.8 578 Sub-Category 2.9 5


80 Sub-Category 3.1 581 Sub-Category 3.2 582 Sub-Category 3.3 583 Sub-Category 3.4 584 Sub-Category 3.5 585 Sub-Category 3.6 586 Sub-Category 3.7 587 Sub-Category 3.8 5


Fld. Data Description Data Supplied # Chars88 Sub-Category 3.9 5

Opportunity to enter / add your own definitions below if needed

89Major Category Undefined 1 (******* see below) 5

90 Sub-Category Undefined 1 5









****** - APPENDIX A to this application shows currently defined Major and Sub-Categories. Select the descriptions most appropriate to the nature of your business. In Column 3 ('Data Supplied), only enter the CODE for the major- or sub-category. The descriptions in APPENDIX A are not needed. Repeat, enter only the code in the above table.

******* - Should you feel that an appropriate definition of the nature of your business and business- or service offerings are not to be found in APPENDIX A you may provide us with a description of your OWN creation. Should the Corporation see fit to add such a new item to it's Category / Sub-Category Database it will be done. However, the Corporation may decide to classify your Category / Sub-Category participation in an existing one.

7 Section Seven - Professional Body MembershipIf your business has a valid membership of a recognized professional body for your nature of business or profession, please give us the details here. You have the opportunity to enter your details of up to THREE of such bodies / organizations.

Fld. Data Description Data Supplied # Chars

99Professional Body 1 – Full Name 50

100 Official Abbreviation 1 20101 Your Membership Reference 1 20102 Professional Body 2 – Full 50



8 Section Eight – BEE Rating and Information. Please give us a much information about your BEE-rating, if any.

9 Section Nine – Declaration and Signature(s),

I, _____________________________the undersigned do declare? and

• that all details contained in this application to be the truth; • that I / We, in signing this application, wish to render services in good faith to the

Corporation. • that I / We understand that the supply of false information to the Corporation may lead to

the entity making this application be removed from the Approved Vendor list of the Corporation.

• that I / We, being the signatory(ies) to this application, are fully authorized to do so on behalf of the entity represented herein.


• that I / We consent to the NWDC conducting any search or inquiry into the affairs of the Vendor.

Signed on this _______ day of ____________ 20___ at ________________________ Name: _________________________ (Please Print) Deponent

I certify that this affidavit has been signed and sworn to / affirmed before me at ___________ on this________ day of_________ 20_____ by the deponent who acknowledges that:-

I. He/ she /they know/s and understand/s the contents of this affidavit;

II. He/ she/ they has/have no objection to taking the prescribed oath/affirmation; and III. He/she/they consider/s the prescribed oath to be binding on his/her/their

conscience.

and that he/she/they uttered the following words’’

‘’I swear that the contents of this affidavit are true, so help me God ‘’ ‘’ I truly affirm that the contents of this affidavit are true’’.

_______________________________________

COMMISSIONER OF OATHS

Full names:

Address:

Designation:

Area for which appointment is held:

Office held if appointment is ex-officio:

APPENDIX A

Supply Category Selection

For the

NWDC

The NWDC uses an automated system to select possible suppliers for an item or service it wishes to

purchase according to different criteria. One of these is the division of the itinerary in categories,

both MAJOR and MINOR.

IMPORTANT: The list provided is CLIENT SPECIFIC and may differ if applying for registration

as a vendor to a different institution.

In accordance with Section 6 – Supply Category Details please select at least one MAJOR and

one MINOR category from the list below. The order of precedence in the list is NOT sorted in any

specific sequence. It is generated from a database and according to the Administrator's selected

preferences in order to maintain allocated sequence numbers as a number permanently allocated to

that specific category. In the appropriate spaces provided enter ONLY THE RELEVANT

CATEGORY NUMBER according to your selection.

MAJOR CATEGORIES MINOR CATEGORIES

Seq. No Description Seq. No Description

M0001 Food and Beverage F0001 Perishable / Fresh Products

F0002 Meat

F0003 Alcoholic and Soft Drinks

M0002 Office Equipment E0001 Furniture – All types.

E0002 Stationary

E0003 Training Aids and Devices

E0004 Signs and Accessories

E0005 Air- Conditioning – Sales,

Installation and Service

M0003 Building Material B0001 All material for building construction.

M0004 Uniforms / Clothing U0001 Corporate

U0002 Field Dress

U0003 Promotional

U0004 Protective Clothing

M0005 Electronic Equipment L0001 Computers - complete

L0002 Computers - Parts

L0003 Printers

L0004 Facsimile Machines



L0005 Computers - Laptops

L006 Computer Software

L007 Copiers

L008 Monitors

L009 Cameras

M0006 Kitchen Equipment K0001 Kitchen Manufacturing

K0002 Appliances

K0003 Cutlery & Crockery

M0007 Chemicals C0001 Sanitary & Cleaning Chemicals

C0002 Industrial Chemicals

C0003 Fuel, Oil And Lubricants

MS001 Services & Consultancy S0001 Printed Matter

S0002 Catering Equipment Hiring

S0003 Catering - Food

S0004 Cleaning

S0005 Swimming Pool Maintenance

S0006 Laundry

S0007 Building Maintenance - Electrical

S0008 Building Maintenance - Plumbing

S0009 Building Maintenance - Steelworks

S0010 Building Maintenance - Carpentry

S0011 Maintenance - Grounds

S0012 Maintenance - Roads

S0013 Building - Construction

S0014 Road - Construction

S0015 Road - Maintenance

S0016 Consultancy – Accountancy &

Auditing

S0017 Consultancy – Information

Technology

S0018 Consultancy – Structural / Building

S0019 Accommodation

S0020 Conference Facilities

S0021 Telecommunication Services

S0022 Advertising

S0023 Marketing



S0024 Travel Agency

S0025 Maintenance - Vehicles

S0026 Maintenance - Heavy Equipment

S0027 Maintenance - General

S0028 Fencing – Installation & Maintenance

S0029 Training - IT

S0030 Training - General

S0031 Refuse Removal

S0032 Security

S0033 Marketing / Promotional

S0034 Legal Fees

S0035 Seminars and Workshops

S0036 Wellness

S0037 Health and Safety

S0038 Transport Services

S0039 Repairs Office Furniture

S0040 Hire – Tent and Chairs

S0041 Renovations & Refurbishment

S0042 Paving

S0043 Tiling

S0044 Painting

S0045 Partitioning Of Office

S0046 Repairs Maintenance Building

S0047 Repairs Air Conditioners

S0048 Repairs Refrigerator

S0049 Solar System – Lights\Geyser

S0050 Valuation of Property

S0051 Installation of Blinds

S0052 Furniture Removal

S0053 Carpet Cleaning

S0054 Cleaning of Office Chairs

S0055 Installation of Ceiling

S0056 Car Wash

S0057 Cold & Hot Mix Asphalt (Tar Rd)

S0058 Concrete Block Paving



S0059 Procurement Management

S0060 Risk Management

S0061 Feasibility Studies

S0062 Security Access Control System

S0063 Project Management

S0064 Monitoring & Evaluations

S0065 Skills Training & Development

S0066 Quantity Surveyor

S0067 Tender Advertising

S0068 Roofing

S0069 Bottled Mineral Water

S0070 Elevator Services

S0071 Toilet Paper Supply

S0072 P.A. System Hire

S0073 Graphic Design

S0074 Web Design & Hosting

S0075 Events Management & Conference

S0076 Strategic Planning

S0077 Policy Development

S0078 Recruitment

S0079 Human Resources Consulting

S0080 Corporate Governance Consulting

S0081 Rental – Photo Copiers

S0082 Counseling

S0083 Windscreen Repairs

S0084 Locksmith

S0085 Trellidors

S0086 Glazing

S0087 Septic Drainage/Removal

M008 Tools / Maintenance Equipment G001 Gardening Tools

G002 Loose Tools

M009 Vehicles V001 Trucks

V002 Trailers

V003 Bakkies

V004 Cars

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