Database Capture Form PDF Details

Forms are an essential part of any business. They are the primary way for customers to interact with your company and provide the necessary information to complete a transaction. In the past, this interaction has been handled through paper forms that are filled out by hand. However, as technology advances, more and more businesses are turning to electronic forms or database capture forms. These forms allow customers to enter their information directly into a database, which can then be used to track and manage customer interactions and transactions. Database capture forms offer several benefits over traditional paper forms, including: -Increased accuracy of customer data due to accuracy checks performed by the form software -Reduced administrative time due to automated data entry -Improved customer service through quick response times and easier

QuestionAnswer
Form NameDatabase Capture Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesvukuzakhe database forms, vukuzakhe, vukuzakhe database registration, vukuzakhe database online registration

Form Preview Example

 

Enterprise Database Capture Form

 

 

 

 

Return to

KZN Dept. of Transport

 

 

 

 

 

 

 

 

 

 

 

 

 

Office use

 

 

 

 

 

Private Bag X 9043

 

 

 

 

 

 

 

 

 

 

 

DOT Reference Number

 

PIETERMARITZBURG

 

 

 

 

 

 

 

 

DOT 2009_____________________________

3201

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tel: 033-355 8708 /8950

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company Legal Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company Trade Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please, mark with a X, as to the form of business entity.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sole Proprietor

 

 

Partnership

 

 

Close Corporation

 

Co-Operative

 

 

 

Company

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company / Close Corporation Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

KZN Provincial Supplier Number (ZNT)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vat Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Income Tax Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Association Affiliation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. CIDB Grading

 

 

CRS Number

 

 

 

2. CIDB Grading

 

 

CRS Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Primary Place of Business

Physical Address (Attach proof)

Postal Address (Attach proof)

CODE

CODE

Business Contact Numbers or E-mail

Telephone No.

 

 

 

 

 

 

 

 

 

Fax Number(s)

0

 

0

 

 

 

 

 

 

Cell Number (s)

 

 

 

 

 

 

 

 

 

E-Mail Address

 

 

 

 

 

 

 

 

 

E-Mail Address

 

 

 

 

 

 

 

 

 

Web Address

 

 

 

 

 

 

 

 

 

Ownership Structure

1.

Name &

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Country of

 

 

 

 

 

 

Surname

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Origin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identity No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please, mark the appropriate box with a X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female

 

 

Male

 

Living with a Disability

 

 

Briefly describe disability

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Organisation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%Ownership

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Qualifications

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other courses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

attended

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relevant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Experience

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

Name &

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Country of

 

 

 

Surname

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Origin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identity No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please, mark the appropriate box with a X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female

 

 

Male

 

Living with a Disability

 

 

Briefly describe disability

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Organisation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%Ownership

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Qualifications

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other courses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

attended

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relevant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Experience

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

Name &

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Country of

 

 

 

 

 

 

 

 

Surname

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Origin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identity No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please, mark the appropriate box with a X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female

 

 

Male

 

Living with a Disability

 

 

Briefly describe disability

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Organisation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%Ownership

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Qualifications

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other courses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

attended

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relevant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Experience

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

Name &

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Country of

 

 

 

 

 

 

Surname

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Origin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identity No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please, mark the appropriate box with a X

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Female

 

 

Male

 

Living with a Disability

 

 

Briefly describe disability

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Position in

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Organisation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

%Ownership

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Qualifications

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other courses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

attended

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relevant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Experience

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Total number of Employed staff

Number of Permanent Staff

 

 

 

Number of Temporary staff

 

 

 

 

 

 

 

 

 

Previous Contract or Tendering Experience

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer/Dept

 

Tender No

 

Year Awarded

 

Value (Rand)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTRACTOR REGISTRATION CHECKLIST

Prior to submitting your Enterprise Database Application Form, please ensure that the following documents are attached.

 

DOCUMENTS ATTACHED

Yes

No

N/A

1

Proof of Ownership

 

 

 

(a)Identity Document(certified not older than three months)

(b)Company /close corporation documents(certified)

(c)CIDB Grading (if registered)

(d)Original Tax Clearance

(e)Declaration of ownership, Management ,control (affidavit)

(f)Any other proof.(Letter Head, crossed cheque, financial statements, etc.)

2

Proof of Address ( a minimum of three (3 ) documents )

(a)Bank statements

(b)Letter from local leadership

(c)SARS document stating address

(d)Municipal utility account

(e)Any other account (six months and older)

3

Proof of disability (for disabled contractors)

(a)Letter from the district Medical Practitioner

(b)Additional Information(X-Ray, Accident Reports, etc.)

4

Proof of work done (Grade 2 and 3 ) new applicants

(a)Letter of award

(b)Completion letter or certificate

(c)Payment Certificates

5

OPTIONAL DOCUMENTS

(a)Company Profiles

(b)Any other documents

N.B. Grade 4, 5 and 6 contractors, who wish to register for the first time, are not allowed to register on the Vukuzakhe Emerging Contractors Database.

DECLARATION BY EMERGING CONTRACTOR UNDER OATH

I/We …………………………………………………………………………………………declare that I / we are

fulltime active members of this business entity with regard to the management, ownership and control, and that the above particulars and information furnished to the Department of Transport for the purposes of registering our organization on the Vukuzakhe Emerging Contractor database are true in substance and in fact and that I/We fully understand the meaning thereof. I / We further agree to abide with the rules and principles of the Vukuzakhe Emerging Contractor Programme of the Department of Transport KZN.

Name: ……………………………………………………………. Signature: ……………………………

Date: …………………………………… Designation: ……………………………………………….

ID Number…………………………………………….

Name: ……………………………………………………………. Signature: ……………………………

Date: …………………………………… Designation: ……………………………………………….

ID Number…………………………………………….

Name: ……………………………………………………………. Signature: ……………………………

Date: …………………………………… Designation: ……………………………………………….

ID Number…………………………………………….

Name: ……………………………………………………………. Signature: ……………………………

Date: …………………………………… Designation: ……………………………………………….

ID Number…………………………………………….

Name: ……………………………………………………………. Signature: ……………………………

Date: …………………………………… Designation: ……………………………………………….

ID Number…………………………………………….

Signed and sworn before me at …………………………………………………………… on this the

……………day of ……………………………….by the Deponent, who has acknowledged that he/she

knows and understands the contents of this affidavit, that it is true and correct to the best of his/her knowledge and that he/she has no objection to taking the prescribed oath, and that the prescribed oath will be binding on his/her conscience.

…………………………………………………………………………………

COMMISSIONER OF OATHS

Name& Surname:…………………………………………….Signature………………………………….

SAPS NO:…………………………………………… RANK………………………………………………..

STAMP

NOTE: EMERGING CONTRACTORS PROVIDING FALSE OR FRAUDULANT INFORMATION OR NOT DISCLOSING RELEVANT INFORMATION PERTAINING TO THIS APPLICATION OR SUPPORTING DOCUMENTATION SHALL SUBJECT THEMSELVES TO IMMEDIATE DISQUALIFICATION.

FURTHERMORE THE DEPARTMENT RESERVES A RIGHT TO INTERVIEW ALL THE OWNERS OF THIS BUSINESS ENTITY TO VERIFY INFORMATION PROVIDED IN THIS DOCUMENT.

NOTE: INCOMPLETE SUBMISSIONS WILL NOT BE PROCESSED. THIS INCLUDES THE SUPPORTING DOCUMENTATION AS STIPULATED ON THE ABOVE PAGES.

For Office Use Only

_____________________________

____________________________

Recommended/ Not Recommended

Date

Senior Admin Clerk

 

_________________________

____________________________

Supported/Not Supported

Date

Admin Officer

 

____________________________

____________________________

Approved/Not Approved

Date

Signature of Ass Manager Database

 

 

Interview

___________________________________

____________________________

Official Signature

Date