PROCUREMENT
SUPPLIERS DETAIL FORM
 
PLEASE COMPLETE THE FORM HEREUNDER AND SUBMIT
DETAILS
Company Name:
Trading Name:
Registration Number:
VAT Number:
Income Tax Number:
Telephone Number
Fax Number
Website Address:
Postal Address:
Code:
Physical Address:

BANKING DETAILS
Bank Name:  
Branch Name:
Branch Code:
Account Type:
Account Number:
MAIN CONTACT
Name:
Surname:
Position:
Telephone Number:
Facsimile Number:
Cellular Number:
E-mail Address:
SARS Certificate
Included Yes No
Validity Period From (yyyy/mm/dd)
  To (yyyy/mm/dd)
Company Supplier Classification: (Please mark with an the relevant box or boxes)
ISO Listing
Importer
Services
Manufacturer
Repairer
Black Owned
Distributor
Exporter
Sales
Supplier Grouping Detail: Type of Firm (Please mark with an the relevant box)
Public Company (Ltd)
Private Company (Ltd)
Closed Corporation (cc)
Other (specify)
Joint Venture
Consortium
Sole Proprietor
Foreign Company
Partnership
Trust
Section 21 Company
Government / Parastatal

 

CATEGORIES: (please select the Category/ies)

 
ACCOUNTANTS AND AUDITORS
FRIDGES
ADVERTISEMENT
FURNITURE
AIR CONDITIONING SYSTEMS
GIFTS PROMOTIONAL
ARTWORK & PAINTINGS GUESTHOUSE & LODGES
AUDIO VISUAL AIDS & EQUIPMENT HOTELS
BADGES CONFERENCE, EMBROIDERED, METAL LABELS & LABELING SERVICES
BAGS CONFERENCE / TRAVEL / PROMOTIONAL LOCKSMITHS
BATTERIES MANUFACTURING SERVICE
BLINDS, AWNINGS OFFICE CONSUMABLES
CARPETS OFFICE EQUIPMENT
CARTRIDGES OFFICE FURNITURE
CELLULAR TELEPHONES PEST CONTROL SERVICES
CLEANING CHEMICALS PHOTOGRAPHY EQUIPMENT
CLOTHING GENERAL/ PROTECTIVE & UNIFORMS PHOTOGRAPHY SERVICE
COMPUTER CONSUMABLES PLUMBING CONTRACTORS
COMPUTER HARDWARE & PRINTERS PRINTING & DESIGN SERVICES
COMPUTER SOFTWARE RECORDING & TRANSCRIBING SERVICES
CORPORATE GIFTS & PRODUCTS RENOVATION SERVICES
COURIER & DELIVERY SERVICES SAFES & SAFE REMOVAL SERVICES
CROCKERY & CUTLERY SECURITY & ACCESS CONTROL EQUIPMENT
CURTAINING, RAILS & ACCESSORIES SECURITY & ACCESS CONTROL SYSTEMS
DOCUMENT BINDING SERVICES STATIONERY OFFICE BASIC
DOCUMENT DUPLICATING SERVICES

STORAGE SYSTEMS (DOCUMENT & COMPUTER)
DOCUMENT STORAGE SOFTWARE TELECOMMUNICATION EQUIPMENT
DRAIN CLEANING SERVICES TELECOMMUNICATIONS SYSTEMS
DRUMS COPIERS TRAINING MATERIALS & SOFTWARE
ELECTRICAL APPLIANCES TRANSLATION SERVICES

ELEVATORS & CONVEYORS MAINTENANCE & REPAIR

 VEHICLES
ENGRAVING SERVICES VEHICLES HIRING
ENTERTAINMENT FACILITIES WORKSHOP EQUIPMENT
FLAGS & MAPS WORKSHOP FACILITATIONS

Preference Point Claims (See information pack for detail on how this form should be completed)

A
Percentage of black individuals that have economic interests in the enterprise

B
Percentage of black individuals that reflect genuine decision making at board, executive and operational management levels
C
Total number of full-time equivalent paid employees
D

Total number of full-time equivalent paid employees that qualify as black individuals

E
Total annual turnover
F
Total Gross asset value (fixed property excluded)

G
Total amount spend on training of employees at a SETA registered training institute
H
Total amount invested into other black empowered enterprises with an annual turnover of at least R100 000.
I
Total annual expenditure on purchases
J
Total annual expenditure purchased from black empowerment enterprises

 

  Measurement Goal Score Weight Percentage Claimed
Direct Empowerment
Equity Ownership Percentage of black individuals that have economic interests in the enterprises 50.10% A 20%
Management Percentage of black individuals that reflect genuine decision making at board, executive and operational management levels 50.10% B 10%
Human Resource Development
Employment equity Percentage of employees that qualify as black individuals 50.10% D/C*100 10%
Skills Development Amount spent on training of individuals as a percentage of turnover 4% G/E*100 20%
Indirect empowerment
Enterprise development Amount invested into other black empowered enterprises with an annual turnover of at least R100 000 as a percentage of turnover 15% H/E*100 10%
Preferential procurement Percentage of purchases to black empowered enterprises 20% J/I*100 20%
Residual
Small, Medium and Micro Enterprise

SMME preference

MICRO: 100%

Very Small: 80%

Small: 65%

Medium: 50%

    10%
Total       100%
           
Signature
Name
Date (yyyy/mm/dd)

IT IS IMPORTANT THAT YOU SUBMIT THE FORM ELECTRONICALLY, PLEASE REMEMBER TO ALSO PRINT AND SUBMIT A HARD COPY WITH THE SIGNATURE.

 

 

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