SERVICES SETA SUPPLIER REGISTRATION APPLICATION FORM

The Supply Database Administrator (SCM Unit) 15 Sherborne Road

Parktown 2193

Telephone: +27(11) 276 9600

Email Address: [email protected]

SERVICES SETA SUPPLIER

REGISTRATION APPLICATION FORM

Attention: Procurement Manager

Name of the Applicant:

SSETA Physical Address: 15 Sherborne Road Parktown

2193

Closing Date: Closing Time:

Description: INVITATION FROM SERVICES SECTOR EDUCATION AND TRAINING AUTHORTY

(Services SETA) TO ALL SERVICES AND PRODUCTS SUPPLIERS TO REGISTER ON ITS DATABASE AS APPROVED VENDORS

Delivery Address: SERVICES SECTOR EDUCATION AND TRAINING AUTHORTY

The Supply Database Administrator (SCM Unit) 15 Sherborne Road

Parktown 2193

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DOCUMENT REQUIRED CATEGORY OF SUPPLIER TICK THE RELEVANT

BOX INDICATING SUBMISSION OF THE REQUIRED

DOCUMENTS

Original cancelled cheque or stamped letter from the bank, verifying the banking details of your business

All Suppliers

Certified copy of your business registration

documents if you are incorporated as a partnership, close corporation or a company

All Suppliers

Certified copies of the ID documents of directors and

shareholders / partners / members / sole proprietor

All Suppliers

A valid and original tax clearance certificate All suppliers Proof of registration with the UIF (i.e. reference

number issued by the UIF)

All suppliers who are employers in terms of the Unemployment Insurance Act 63 of 2001 as amended

Proof of professional registration, accreditation or a

copy of any other registration certificate pertaining to your relevant industry, e.g. ECB (Electrical Contractors Board)

All suppliers, where applicable

A copy of the CIDB (Construction Industry

Development Board) certificate NB: You can contact the CIDB on +27 12 482 7200 or +27 086 100 CIDB, or visit www.cidb.org.za for information and registration. You are also required to obtain the document entitled “Code of Conduct for all parties

engaged in construction procurement” from the

CIDB.

All suppliers whose services constitute construction and /or

engineering works in terms of the Construction Industry Development Board Act 38 of 2000 and its Procurement Regulations Supporting documentation confirming the points

scored regarding each element of the applicable scorecard, as used by the relevant verification agency

All suppliers submitting a valid verification certificate in terms of the BBBEE Codes of Good Practice

An Affidavit from the Police Confirming disability Disabled Shareholders/members

Latest verified annual financial statements confirming annual turnover, Net Profit Before Tax (NPBT) and total cost of labour NB: Financial statements must be verified by an auditor for a company or a certified accounting officer for a close corporation, partnership or sole proprietorship.

All Suppliers

Letter signed off by an auditor or a certified

accounting officer confirming shareholding of the entity. The auditor or certified accounting officer must also confirm that the company is a startup or newly formed where the company is unable to produce Financial statements.

All Suppliers

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CONTENTS

SECTION 1: NOTE TO THE APPLICANT

SECTION 2: SUPPLIER DETAILS

SECTION 3: BUSINESS BANKING DETAILS

SECTION 4: BROAD BASED BLACK ECONOMIC EMPOWERMENT (BBBEE) COMPLIANCE

SECTION 5: PRODUCTS AND SERVICES (COMMODITIES)

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SECTION 1: NOTE TO THE APPLICANT

RE: REQUEST FOR REGISTRATION AS AN APPROVED SUPPLIER ON THE SUPPLIER DATABASE OF THE SERVICES SETA

Prospective suppliers are herewith invited to register as approved suppliers on the official Supplier Database of the Services Seta. In order to comply with the processes and procedures set out in the Supply Chain Management Policy; Services Seta developed a Supplier database to register all suppliers providing goods, works and services to the organization.

The purpose of the database is to give all prospective suppliers a fair and equal opportunity to submit

quotations for goods, works and services to Services Seta.

Preference will be given to the registered suppliers. However, it does not necessarily follow that those potential suppliers which are not yet registered will be totally exempt from quoting for the goods or services to Services Seta. It is imagined that the Supplier Database will contribute to efficient administration and compliance with the Preferential Finance Management Act (PFMA).

Attached please find an official request for registration, to be completed in full by prospective service providers. It is imperative that suppliers read the registration form carefully, complete all sections in full,

sign and date the form. Please note that minimum requirements required are an original and valid/ current Tax Clearance Certificate, original or certified copy of BEE certificate with the BEE agency accredited by SANAS, registration certificate with any regulatory body e.g. Electrical Contractors Board (ECB) etc. If the supplier or training service provider is accredited with any SETA the accreditation must be submitted, registered companies with (CIPRO) - certified copies CK 1&2 or CM 2 & 29 documents must be submitted and certified ID copies of company owners. Failure to submit the above documents and the incomplete

registration forms will invalidate your application.

The company must attach a separate detailed price list for all commodities and services that have been listed on this application form

SUPPLIER DATABASE REGISTRATION FORM IMPORTANT NOTES – Please read carefully

 To be completed by all vendors seeking registration on Services Seta Prospective Supplier Database

 The questionnaire must be completed in full and be signed;

 A company profile may accompany the registration form but will not be accepted as substitute for the application form- all fields on application form MUST be completed by the applicant;

 Suppliers will be informed of the outcome and will be provided with a supplier registration number

 Supplier must comply with all the registration-criteria for registration to be finalised –failure to do so may result in the application being declined.

The completed application for registration can be hand delivered or posted to:

For attention: The Supply Database Administrator (SCM Unit) 15 Sherborne Road, Parktown, 2193

Or Alternatively posted to:

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SECTION 2: SUPPLIER DETAILS

Supplier Grouping Details – Type of Firm: (please tick the relevant box)

1 Public Company(Ltd) 7 Sole Proprietor

2 Private Company(Pty)Ltd 8 Foreign Company

3 Closed Corporation(cc) 9 Partnership

4 Other (specify) 10 Trust

5 Joint Venture 11 Section 21 Company

6 Consortium 12 Government/Parastatal

Postal Address: (compulsory) Physical Address:

Postal code

Company / Supplier Name Trading As’ Name Of Business

Full Names And Surname of Sole Proprietor Company / Close Corporation Registration Number

Sole Proprietor/Partnership/Trust Id Number VAT registration number (if applicable) Skills Development Levy Registration number Company UIF number:

Company PAYE number: Income tax reference number Web Address

E- Mail Address Telephone Number Fax Number Toll-Free Number

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ISO Listed Importer Services Manufacture Sales

Repairer Black-owned Distributor Exporter

Tax Clearance Certificate: (please tick the relevant box) Attached Not attached Tax Clearance Certificate (please attach to application)

Tax Clearance Certificate Expiry date

Geographical Coverage (Please tick the province/s where you conduct your business provide proof of physical presence e.g. Rental or Lease agreement/Municipal statement if building is owned).

Gauteng

Free State

West Cape

Northern Cape

KwaZulu-Natal

Limpopo

Eastern Cape

Mpumalanga

North West

Main contact person in your company:

Name

Company position Cell phone number Identity (ID) number E-mail address

Contact person (Sales) in your company:

Name

Position in company Cell phone number ID number

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Initials and Surname

Position occupied in the company

Citizenship ID number Physical address

Note: Where owner are themselves a company or partnership, owners of the holding firm must be

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SECTION 3: BUSINESS BANKING DETAILS

Name of Account Holder

Bank Name

Branch Name

Branch Code

Account Number

Account Type

Cheque

Savings

Transmission

Authorisation of electronic transfer of Funds (EFT) to supplier’s bank account

I, the undersigned, hereby authorise Services SETA to credit my business account via Electronic

Fund Transfer as aforementioned with the amount payable / due to specified beneficiary for goods

and services rendered.

Signature __________________________________________________

Name __________________________________________________

Capacity __________________________________________________

Date __________________________________________________

For Completion by your Bank

I certify that I am duly authorised by (Bank Name) ___________________________ to give such

information and that such information is correct.

Signature __________________________________________________

Name of Authorised Official __________________________________________________

Date __________________________________________________

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SECTION 4: BROAD BASED BLACK ECONOMIC EMPOWERMENT (BBBEE)

COMPLIANCE

Please attach the B-BBEE certificate issued by Verification Agency accredited by SANAS: (Kindly ignore if valid and current or certified copy of the certificate were already submitted and in SSETA possession)

In terms of Regulation 5 (2) and 6 (2) of the Preferential Procurement Regulations, preference points must be awarded to a bidder for attaining the B-BBEE status level of contribution in accordance with the table below:

Tick Box Your

B-BBEE Status

B-BBEE Status Level of Contributor Number of points (80/20 system) Number of points (90/10 system) 1 20 10 2 18 9 3 16 8 4 12 5 5 8 4 6 6 3 7 4 2 8 2 1 Non-compliant contributor 0 0

Please attach the B-BBEE certificate issued by Verification Agency accredited by SANAS: (Kindly ignore if valid and current or certified copy of the certificate were already submitted and in SSETA possession)

Bidders who qualify as EMEs in terms of the B-BBEE Act must submit a certificate issued by an Accounting

Officer as contemplated in the Close Corporation Act (CCA) or a Verification Agency accredited by SANAS

or a Registered Auditor. Registered auditors do not need to meet the prerequisite for IRBA’s approval for the purpose of conducting verification and issuing EMEs with B-BBEE Status Level Certificates.

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A.

B.

C.

D.

Medium Small Very

small

Micro Medi

um

Small Very small micro

Agriculture 100 50 10 5 4 2 0.4 0.15 4 2 0.4 0.1 Mining and quarrying 200 50 20 5 30 7.5 3 0.15 1 8 4 . 5 1.8 0.1 Manufacturing 200 50 20 5 40 10 4 0.15 1 5 3 . 7 5 1.5 0.1 Construction 200 50 20 5 20 5 2 0.15 4 1 0.4 0.1 Retail and motor trade 100 50 10 5 30 15 3 0.15 5 2 . 5 0.5 0.1 Wholesale trade 100 50 10 5 50 25 5 0.15 8 4 0.5 0.1 Caretering and accomodation 100 50 10 5 10 5 1 0.15 2 1 0.2 0.1 Transport and storage 100 50 10 5 20 10 2 0.15 5 2 . 5 0.5 0.1 Finances and business services 100 50 10 5 20 10 2 0.15 4 2 0.4 0.1 Repair/allied services 100 50 10 5 30 15 3 0.15 5 2 . 5 0.5 0.1 Communication 100 50 10 5 20 10 2 0.15 5 2 . 5 0.5 0.1 Other trade 100 50 10 5 10 5 1 0.15 2 1 0.2 0.1 Commercial agents 100 50 10 5 50 25 5 0.15 8 4 0.5 0.1 Community and social services 100 50 10 5 10 5 1 0.15 5 2 . 5 0.5 0.1 Personal services 100 50 10 5 10 5 1 0.15 5 2 . 5 0.5 0.1

SMME status of your enterprise (Compulsory) (according to SMME table above)

Please tick the relevant box

Micro Very

small

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SECTION 5: PRODUCTS AND SERVICES

Services Seta will only register a maximum of three (3) commodities and services per application (Note that Services Seta will not consider any extra additional commodities/ services but ONLY be limited to three). If

your organisation does provide more than three categories please provide proof (Example: previous work done in a form of Official Order or Certificate of Work Done).

LIST OF COMMODITIES (PRODUCTS AND SERVICES)

ABET TRAINING HANDYMAN SERVICES

ADVANCE IT SUPPORT HEADOFFICE AND REGIONAL OFFICES

HEADOFFICE AND REGIONAL OFFICES IT SUPPORT ADVERTISING AND RECRUITMENT OR PLACEMENT

AGENCY

HET PROGRAMMES

AIR CONDITIONER INSTALLATION & MAINTENANCE HIV PROJECTS AND HIV / AIDS TRAINING SERVICE PROVIDERS

ANNUAL REPORT HOW TO TENDER (SPECIAL PROJECTS)

ANTI VIRUS SOFTWARE INDUSTRIAL RELATIONS (IR)

APPLIANCES AND VENDING EQUIPMENT INSTALLATION AND SERVICING OF FIRE EXTINGUISHES

AUDITORS AND ACCOUNTING SERVICES INTERNAL & EXTERNAL NEWSLETTERS

BANK PROVIDERS AND INSURANCE INTERPRETERS FOR THE FACILITATION FOR DEAF LEARNERS

BOOKS PROVIDERS IT HARDWARE AND SOFTWARE

BUILDING MAINTENANCE & RENOVATIONS IT PABX AND TELEPHONY EQUIPMENT AND NETWORK

CABLING

CATERING SERVICES IT WEBSITE DESIGN, DEVELOPMENT AND MAINTENANCE

CCTV INSTALLATION AND REPAIRS LABOUR RELATION SERVICES

CHAMBER / INDUSTRY SERVICESS AND PROJECTS LEADERSHIP SERVICES AND PROJECTS

CLEANING SERVICES LEARNERSHIPS SERVICES AND PROJECTS

COMPUTER CONSUMABLES LOCKSMITH SERVICES

CONSTITUENCY MODERATORS AND ASSESSORS MEDICAL AID HEALTH SERVICES

CONSULTING: BUSINESS CONSULTANTS & BUSINESS ANALYSTS

NAVISION SYSTEM CONSULTING

CONSULTING: COMPLIANCE SERVICES NEW VENTURE CREATION SSETA ACCREDITED SERVICE

PROVIDERS

CONSULTING: FINANCIAL SERVICES NGO, NPO & CBO CAPACITY BUILDING

CONSULTING: HUMAN RESOURCE OCCUPATIONAL HEALTH & SAFETY TRAINING

CONSULTING: LEGAL SERVICES OFFICE EQUIUPMENT AND MAINTENANCE, PHOTOCOPIERS,

SCANNERS AND PRINTERS ETC.

CONSULTING: MANAGEMENT / BUSINESS OFFICE FURNITURE, EQUIPMENT & MACHINES

CONSULTING: RESEARCH DEVELOPMENT OFFICE FURNIURE REMOVAL SERVICES

CONSULTING: RISK MANAGEMENT SERVICES OFFICE RENTAL / SPACE

CONSULTING: SKILLS DEVELOPMENT ORACLE DATABASE DESIGN, DEVELOPMENT AND

MAINTENANCE

CONSULTING: SUPPLY CHAIN MANAGEMENT SERVICES PASSENGER VEHICLE HIRE (MINI BUSES, BUSES, CARS AND

TOLLGATE CARDS)

CONTRACTOR: WASTE COLLECTION AND RECYCLING PEST CONTROL SERVICES

CONTRACTORS: AUCTIONEERS PHOTOGRAPHY-VIDEOGRAPHER, EVENTS, CORPORATE,

CONFERENCE, AWARDS

CONTRACTORS: CARPET CLEANING SERVICES PR & MEDIA SERVICES, MEDIA MOTORING SERVICES

CONTRACTORS: LANDSCAPING TREE FELLING , PLANTS, FLOWERS AND DECO

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CONTRACTORS: PAVING PROJECTS INFORMATION SYSTEM

CONTRACTORS: PLUMBING QUALITY MANAGEMENT TRAINING SERVICE PROVIDERS

CONTRACTORS: WATERPROOFING REFRESHMENTS

CORPORATE GIFTS RURAL DEVELOPMENT SERVICE PROJECTS

CORPORATE SIGNAGE INDOOR / OUTDOOR SCHOOL FEEDER PROJECTS

COURIER SERVICES: BULK POSTING, BULK FAXING & BULK E MAILING

SDF AUDITORS

DATA LINES SDF TRAINING

DESIGN AND LAYOUT OF PROMOTIONAL MATERIAL / PUBLICATIONS

SECURITY PRODUCTS AND SERVICES DEVELOPMENT OF QUALIFICATION PROFESSIONALS

AND CPD, CURRICULUM DEVELOPMENT, REGISTRATION OF QUALIFICATION AND TRAINING MATERIAL

SME TRAINING, WORKSHOPS, CONFERENCES

DISABILITY CONTENT EDITOR, PORTAL AND MAINTENANCE

SOUND SYSTEM HIRE

DIVERSITY MANAGEMENT STAFF TRAINING PROVIDERS

DOCUMENTS ACHIEVING STATIONERY & PRINTING SERVICES

DRIVER TRAINING K53 SYSTEMS DEVELOPMENTS, MAINTENANCE AND PORTALS

ELECTRICAL INSTALLATION AND MAINTENANCE PLUGS, LIGHT BULBS

TAX CONSULTING SERVICES

ELEVATORS CONVEYERS AND MAINTENANCE TRADE SHOWS TRAINING

EMPLOYMENT EQUITY PLANNING TRAINERS FOR VARIOUS INDUSTRY TOPICS AND SPECIALISED

CONSULTANT PER INDUSTRY

ETQA DEVELOPMENT TOOL TRAINING FACILITIES, DATA PROJECTOR, SCREENS, VIDEO

CONFERENCING ETQA SITE VISITS FOR ACCREDITATION AND LEARNING

PROGRAMME

TRAINING OF CONSTITUENCIES INDUSTRY QCTO FACILITATORS

EVENTS, CONFERENCE AND MANAGEMENT UNIVERSITY PROGRAMMES

FET COLLEGE PROGRAMMES UOT PROGRAMMES

FINGER PRINT READER INSTALLATION AND REPAIR VEHICLE TRACKER

FURNITURE AND FITTINGS VENUE HIRE AND DECO, ACCOMMODATION

GENERATORS AND UPS MAINTENANCE WINDOW CLEANING SERVICES

IF THE PRODUCTS & SERVICES THAT YOUR ORGANISATION IS OFFERING IS NOT LISTED ABOVE PLEASE LIST YOUR CATEGORIES BELOW

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Attach a separate

Detailed Price Listing

-Provide trade references on table below for each commodity/ service your company have applied for (refer list above): Contact person Contact details Company Name Description of Product/Services rendered Start date End Date

NOTE WORTH TAKING: Your company Nature of Business will be considered when assessing your company

database registration documents whether it is aligned to the commodities or services listed by your company.

-State your company Nature of Business (Example- Landscaping, Training and Monitoring etc.) below: ……….. ……… ... ... ... ... ...

For Internal Use Only (PLEASE CIRCLE THE RELEVANT STATUS) Aligned Not Aligned

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SECTION 6: DECLARATION OF INTERESTS

1. Are you or any other person who holds an interest in your business (i.e. a shareholder, a director, or a member or partner, a line manager, or a fellow employee), employed by Services SETA or serves as a director at Services SETA, or was previously employed by Services SETA or served as a director at Services SETA?

Yes No

If yes, state particulars.

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

2. Are you, or any other person who holds an interest in your business, a close family member (i.e. related by birth, marriage, domestic partnership, adoption, guardianship or the like) to or an associate (i.e. a friend, rival, business partner, neighbour, etc) of an Services SETA employee and/or director?

Yes No

If yes, state particulars.

__________________________________________________________________________________________ __________________________________________________________________________________________

3. Have you, or any other person who holds an interest in your business, given a business courtesy to or received a business courtesy from a Services SETA employee and/or director over the last 12 (twelve) months?

Yes No

If yes, state particulars.

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

4. Have you, or any other person who holds an interest in your business undergone Services SETA supplier disciplinary process and / or has been suspended from the Services SETA supplier database over the last 5 (five) years?

Yes No

If yes, state particulars.

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

5. Is your business currently engaged in defending any legal proceedings which have been instituted against it (including against any of its directors / members / partners), or has your business (including any directors / members / partners) either been charged with or been convicted of any criminal act, or has any judgment or decision been made against it by any administrative or regulatory body?

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If yes, state particulars.

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

DECLARATION:

I, the undersigned [insert full name of signatory] ____________________________, duly authorised to complete this application form in my capacity as [insert capacity, i.e., member, director, partner, etc] __________________________ on behalf of the applicant [insert full name of the business entity] __________________________ certify that, to the best of my knowledge, the information furnished herein is true and correct. I accept that SERVICES SETA reserves its right to act against the applicant or me personally in terms hereof, should this declaration prove to be false.

I am aware that, in addition and without prejudice to any other remedy provided to combat any restrictive practices related to bids and contracts, bids that are suspicious will be reported to the Competition Commission for investigation and possible imposition of administrative penalties in terms of section 59 of the Competition Act No 89 of 1998 and or may be reported to the National Prosecuting Authority (NPA) for criminal investigation and or may be restricted from conducting business with the public sector for a period not exceeding ten (10) years in terms of the Prevention and Combating of Corrupt Activities Act No 12 of 2004 or any other applicable legislation.

Declaration

I hereby declare that the above information is correct at the time of

completion. I hereby pledge to inform the SSETA in writing, of any changes of any details that appears on this document. I certify that I have the appropriate authority to

furnish the above-mentioned information on behalf of my

employer.

Applicant's Signature:

………

On behalf of: (Company’s name)

………..

Date:………...

Applicant’s Title /Position and Name of director/member that appears on CIPRO documents

Title:

Position:………...