SUPPLIER REGISTRATION FORM
IMPORTANT NOTES
Please read carefully before completion of registration form
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To be completed by all vendors seeking registration as an approved supplier.
The supplier registration form must be completed in full, and signed. Failure to complete the *
mandatory fields, will lead to the application not being processed.
Please note that Registration on the Sentech Supplier Database does not guarantee business
for your company. All procurement will be subjected to the procurement policy of Sentech.
Successful applicants will be contacted via fax and /or email, it is therefore imperative to
submit an operating fax number and/or email address. Failure to comply with this requirement
will result in your application not approved for registration in the database,
Only successful suppliers will be notified in writing if their application has been accepted.
No faxed or e-mailed application forms will be accepted.
Business blacklisted by any organs of state* must first be removed or cleared from blacklist
before registration.
Copies of the following documents must be attached to this application form:
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Original Valid Tax Clearance Certificate
Income Company Certificate or Shareholder(s) Register
Proof of Company Registration – CIPC
VAT Registration Certificate (for VAT vendor only)
ID Copy/ies for all company members/ partners/ directors
BEE Certificate or Letter from a registered Accountant
CIDB Number – applicable to construction related services
PSIRA Certificate – applicable to security related services
Proof of SETA AND OR SAQA accreditation – applicable to training related services
If members/ directors/ owners are employed by the state, proof that they are allowed
to conduct business outside remunerative work should be attached
Completed registration forms and supporting documentation must be handed at Sentech Head
Office, Radiokop Ext 3,Octave Street, Radiokop 2040 or post to Sentech SOC, Private bag X06,
Honeydew, 2040
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FOR OFFICE ONLY
Captured by
Date captured
Authorised by
Date Authorised
1. *SUPPLIER DETAILS:
SUPPLIER REGISTERED NAME
SUPPLIER TRADING NAME (if different
from Registered Name)
COMPANY REGISTRATION NUMBER
COMPANY or
REFERENCE
FIRM
INCOME
TAX
VAT REGISTRATION NUMBER
TELEPHONE DATE
FACSIMILE NUMBER
PHYSICAL ADDRESS
POSTAL ADDRESS
POSTAL CODE
1.1 Please confirm the attachment of the following mandatory documents.
YES
NO
*SARS – BUSINESS ENTITY TAX CLEARANCE CERTIFICATE
*COMPANY REGISTRATION CERTIFICATE
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2. *CONTACT PERSON DETAILS:
Contact Name
Position
Telephone Number
Cellular Number
Facsimile Number
E-mail Address
Notification (E-mail or
SMS)
3. *TYPE OF COMPANY/FIRM (Tick applicable box):
Individual /Sole Trader/Proprietor
Partnership / Consortium
Close corporation registered in terms of the SA Close Corporations Act
Public / Private company registered in terms of the SA Companies Act
Non Profit company registered in terms of the SA Companies Act
Trust as defined in the Income Tax Act
Cooperative Society as defined in the Co – Operatives Act
Government / State Owned Enterprise / Constitutional Entity
Other : (Specify)
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4. *BANK DETAILS: (No Personal Account information)
Name Bank
Name of Branch
Branch Code
Name of Account Holder
Account Number
Cheque
Savings
Transmission
Bond
DATE STAMP OF BANK
CERTIFIED AS CORRECT
NB.Please ensure that your bank details have been verified by the bank, and also attach a
cancelled Cheque or Bank acknowledgement letter.
Please have this page stamped at the bank
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5. TO BE COMPLETED ONLY IF COMPANY/ FIRM IS A REGISTERED BUSINESS ENTERPRISE
(Tick applicable box and complete relevant percentages)
Black Owned (At least 50.1%)
Black Enterprise (At least 25.1%)
Black Owned Women (At least 25.1%)
Other Women
Disabled Persons
SMME
%
%
%
%
%
%
Total
100%
Note: Where owners are themselves a company or partners, owners of the holding firm must
be identified. Certified ID copies of partners, members, shareholders or owners must be
attached.
6. BBBEE CONTRIBUTION LEVEL
Please attach Scorecard. Exempted Enterprises please submit letter from Auditor confirming
Exemption
B-BBEE Status
B-BBEE Recognition Level % Mark with an (X)
Level 1 Contributor
135%
Level 2 Contributor
125%
Level 3 Contributor
110%
Level 4 Contributor
100%
Level 5 Contributor
80%
Level 6 Contributor
60%
Level 7 Contributor
50%
Level 8 Contributor
10%
Non – Compliant Contributor
0%
Exempted Micro – Enterprise
(EME)
Any enterprise with an annual total Revenue of R5million or less qualifies as an Exempted
Micro Enterprise (EME).A start-up enterprise must be measured as an Exempted MicroEnterprise for the first year following its formation or incorporation. Please submit
confirmation letter from your Auditors/Accountant
6.1 SMME Status of your Enterprise: (Please tick the relevant box)
Micro
Very Small
Small
Medium
Large
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7. *DIRECTORS / OWNERS DETAILS: (Complete table for each Director/Owner)
Director Name
ID Number
Position
Tel Number
Citizenship
8. *LIST A MAXIMUM OF FIVE (5) CONTRACTS, WHICH YOUR COMPANY HAS BEEN
ENGAGED IN
CONTRACT
DESCRIPTION
LOCATION
CLIENT
CONTRACT
AMOUNT
COMPLETION
DATE
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9. COMMODITY CATEGORIES :( Please Select / Specify a maximum of Three (4) Commodity
Categories (Mandatory) that you can supply from ANNEXURE A).
10. *INDICATE WETHER THE following mandatory documents are attached /submitted:
(Mandatory)
General
1.
2.
3.
4.
5.
Y/N
Company Registration Documents
Tax Clearance Certificate
BBBEE Certificate
Detailed Banking information
Certified ID copies of all owners / shareholders
The undersigned warrants that he / she is duly authorised to do so on behalf of the Company,
confirms that the contents of the application are within my personal knowledge and are to the best of
my believe both true and correct.
11. DECLARATION:
Any legal person, including persons employed by Sentech, or persons having kinship with persons
employed by Sentech including a blood relationship, may apply to register and or to submit a tender.
However full disclosure of the particulars of the relationship is required in the interest of fairness and
transparency, as indicated in this declaration of interest form.
11.1 Are you or any person connected with your organization employed by Sentech? YES/NO
If so, furnish particulars
……………………………………………………………………………………………
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11.2 Have you or any person in your organization been employed by Sentech over the past twelve
months?
YES/NO
If so, furnish particulars.
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11.3 Do you have any relationship (family, friend, partner or other) with persons employed by
Sentech?
YES/NO
If so furnish particulars
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11.4 Are any of your company’s directors, managers, shareholders or stakeholders in service of the
Sentech? YES/NO
If so, furnish particulars
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11.5 Are any spouses, children or parents of the company’s directors, managers, shareholders or
stakeholders in service of Sentech? YES/NO?
If so, furnish particulars
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By completing this application form, the firm declares that:
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It agrees to conform to the requirements of the Supplier Register as set out in this document.
The firm agrees to abide by the Procurement Policy of Sentech
All the information supplied in this application is true and correct.
The firm will submit itself to procedures instituted by Sentech, without protest
The firm will supply further information and documentary evidence for scrutiny, if requested to
do so.
Duly authorized to sign on behalf of:
Signature
Name
Capacity
Date
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12. LOCATION WHERE GOODS AND/OR SERVICES MAY BE REQUIRED
EASTERN AREA (NATAL)
Umhlanga
Durban North
(Head Office)
Mooirivier
Estcourt
Greytown
Radio
Kwezi
Link
Eshowe
Empangeni
Richards Bay
Glencoe
Newcastle
Ladysmith
Loskop
Vryheid
Nongoma
Ubombo
Pongola
Louwsberg
Nqutu
Ulundi
Mount Ayliff
Straalhoek
Port Shepstone
Matatiele
Kokstad
Donnybrook
Durban(Alverst)
Durban North
Pietermaritzburg
Overport
Bluff
Verulam
Dullstroom
Nelspruit
Lydenburg
Hectorspruit
Mbuzini
Sabie
Qudeni
Standerton
Volksrust
Ermelo
Piet Retief
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Carolina
Davel
Middleburg
Howick
PROSPECTIVE SERVICE PROVIDERS MUST INDICATE BY MEANS OF AN X WHERE
GOODS AND SERVICE CAN BE PROVIDED BASED ON THE LOCATION OF THEIR
ENTITY. FAILING TO COMPLY WITH THIS CONDITION WILL INVALIDATE THE
PROSPECTIVE SUPPLIERS APPLICATION.
WESTERN AREA (Western Cape)
Cape Town(Constantia)
Worcester
Bn Table Mountain
Napier
Sea Point
Piketburg
Paarl
Matjiesfontein
Simonstown
Ceres
Franschhoek
Hex River
Hout Bay
Touwsrivier
Stellenbosch
Klipheuwel
Amanda Glen
Prieska
Tygerberg
Upington
Aurora
Douglas
Grabouw
Kuruman Hills
Clifton
Faans Grove
Fish Hoek
Kuruman
Villiersdorp
Montagu
Hermanus
Kleinmond
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NORTHERN and CENTRAL AREA (TVL)
SOUTHERN AREA (Eastern Cape)
Welverdiend
Rustenburg
Kareedouw
Komga
Potchefstroom
Pretoria
Port Elizabeth
Graaff-Reinet
Johannesburg
Menlo Park
P.E.City
Cradock
Heidelburg
Pretoria North
Despatch
Queenstown
Bez.Valley
Sunnyside
Hankey
Elliot
Mondeor
Soshanguve
Andrieskraal
Ugie
Mulbarton
Kwamhlanga
Patensie
Sterkspruit
Helderkruin
Kwaggafontein
Paul Sauer Dam
Victoria West
Linmeyer
Pilanesburg
Parsons Hill
Noupoort
Sentech Park
Garankuwa
Grahamstown
Colesberg
Pankop
Grootfontein
Somerset East
Aliwal North
Mabopane
Marks Park
Suurberg
Barkley East
Kagiso
Bedfordview
Kirkwood
Burgersdorp
Mogwase
Nylstroom
Bedford
Elands Height
Thlabane
Thabazimbi
East London
De Aar
Behanie
Haenertsberg
King Williams Town
Maraisburg
Hoedspruit
Bisho
Ga-Mabula
Tolwe
Butterworth
Potgietersrus
Blouberg
Cala
Tzaneen
Louis Trichardt
Umtata
Punda Maria
Molema
Ngangelizwe
Sibasa
Malamba
Port St.Johns
Entshatshongo
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