Supplier Application Form Important Notes: Compulsory documents to accompany this form are: 1.
Certified copy of the Company registration documents;
...
Supplier Application Form Important Notes: Compulsory documents to accompany this form are: 1.
Certified copy of the Company registration documents;
2.
Certified copies of ID documents of the Shareholders / Members;
3.
Original Tax Clearance certificate
4.
Certified copy of the BBBEE Verification Certificate and detailed Scorecard; OR signed letter from the auditor or accountant confirming the most recent turnover with a certified copy of the most recent financial statement;
5.
Company profile with a list of references.
NB:
1.
Failure to submit the above documentation will delay the supplier being registered on the database.
2.
Suppliers are responsible to update their details on an annual basis.
BUSINESS DETAILS Business Trading Name Business Legal Name Company Registration Numbers Holding Company Type of Business CIDB Registration Number CIDB Grade Tax Reference Number BBBEE Level BBBEE Overall Score
Nelson Mandela Museum | Cnr Owen Str. & Nelson Mandela Dr. | Bunga Building | Mthatha | 5099
BBBEE Expiry Date Postal Code Province Postal Address Postal Code Website
SHAREHOLDERS / DIRECTORS / MEMBERS
Describe the main services rendered:-
Type of firm: (Please tick the relevant box) Partnership Sole Proprietor Close Corporation (CC) Public Company Private Company (Pty) Ltd Other (specify) Company flags: [please tick the relevant box(es)] ISO listed
Manufacturer
Distributors
Sales
Services
Importer
Exporter
Repair
Nelson Mandela Museum | Cnr Owen Str. & Nelson Mandela Dr. | Bunga Building | Mthatha | 5099
SMME status of your enterprise:
Please use this table to determine the SMME Status of your enterprise
Please tick the relevant box in each column
D. Total Gross asset value B. Full time paid employees
A. Sector
Medium
C. Annual Turnover (millions)
Small
Very Small
Micro
(property excluded) (millions)
Medium
Small
Very Small
Micro
Medium
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
18
4.5
1.8
0.1
Manufacturing
200
50
20
5
40
10
4
0.15
15
3.75
1.5
0.1
Construction
200
50
20
5
20
5
2
0.15
4
1
0.4
0.1
Retail & 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
Catering, Accommodation
100
50
10
5
10
5
1
0.15
2
1
0.2
0.1
Transport, Storage
100
50
10
5
20
10
2
0.15
5
2.5
0.5
0.1
Finance & 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
Communications
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 & 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
(According to SMME table) (compulsory) Micro Very Small Small Medium Large
Nelson Mandela Museum | Cnr Owen Str. & Nelson Mandela Dr. | Bunga Building | Mthatha | 5099
SECTION C : BANKING DETAILS (Please provide the banking details to which any payments due are to be transferred. The bank MUST certify this form in the space provided)
Current Banking Details: Please attach an original cancelled cheque or an original bank verification letter. Bank: __________________________________________ Branch number/code ________________ Branch Location: ___________________________________________________________________ Bank Account Number: ___________________________________ Account type: ______________ Date the account was opened: ________________________________________________________ Name of the account: _______________________________________________________________ Signatories Name/s, Surname/s and ID Number/s __________________________________________________________________________________ __________________________________________________________________________________
Certificate from Bank:
(Official Bank Stamp)
I, (full names and surname) (Printed) _____________________________ _____________________________________ an employee and Authorised person / agent of (Bank Name) ____________ _______________________ (Branch Name) ________________ and Telephone number (Code, Number) ______________________herewith certify that the “Current Banking Details” as provided in SECTION C above, are true and correct.
Signed: ____________________________________
Nelson Mandela Museum | Cnr Owen Str. & Nelson Mandela Dr. | Bunga Building | Mthatha | 5099
SECTION D : SUPPLIER PROFILE In order for the Nelson Mandela Museum to build up a profile of its suppliers, we would like you to complete the following:
Section D1: Technical: 1. Is it required of your business / industry to register with any professional bodies? (y/n)_____ If yes, indicate products(s) for which permits are held, including permit numbers: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ (I.e. SOB for Security Industry, Building Federation, etc Section D2: Quality: 1. Does your business operate a Quality Management System covering the product/service to be supplied? (y/n)_________ If yes please elaborate: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 2. Has you Quality Management System been assessed and certified by any National by Internationally recognised accreditation body? (y/n) ____If yes, please provide copy of certificate. Section D3: Fraud Policy It is the intention of the Nelson Mandela Museum to do business with companies that have an acceptable policy on the reporting of all crime and / or misconduct. It is also the policy of Museum that an official may not receive, request or offer any gifts in whatever form. Any such actions or attempts hereto will be considered in a very serious light. 1. Does your company / organisation have a policy on the reporting of crime, including but not limited to theft, fraud and corruption to the authorities as soon as it is suspected? (yes / no) _______________________ 2. Does your company / organisation have a policy on the reporting of any suspected misconduct by employees of your clients, to your clients? (yes / no) ________________________ (Any suspicions that a Museum official might have committed or attempted to commit any act of misconduct MUST be reported in writing to the CFO/CEO/SFLM. Nelson Mandela Museum | Cnr Owen Str. & Nelson Mandela Dr. | Bunga Building | Mthatha | 5099
