Logis Supplier Registration Form – Fill Out and Use This PDF

SUPPLIER DETAILS

CREDIT ORDER INSTRUCTION

COMPANY'S FULL TRADING NAME

1. I/We hereby request and authorise you to pay any amounts which accrue to me/us to the

credit of my/our account with the mentioned bank.

2. I/We understand that the credit transfer hereby authorised will be processed by Electronic

(please print clearly)

Fund Transfer (EFT) and I/We also understand that no additional advice of payment will be

Year

Number

Type

ENTERPRISE REGISTRATION NUMBER

provided other than the details of each payment as provided by my/our bank.

3. This authority may be cancelled by me/us by giving thirty day's notice by pre-paid/registered

(Please attach a copy

of the Registration Certificate)

post or by hand delivered instruction.

ID Number

4. I/We will not hold the Eastern Cape Provincial Administration liable for any payment not made

(If Sole Proprietor)

into my/our bank account if the bank account details are incorrect or were not supplied to the

(Please attach a copyofthe

IDDocument)

Department within a reasonable time prior to the expected date of payment, subject to

VAT NUMBER

4

appropriate contracting or order procedures being followed.

5. The information provided for this registration as it applies to the supply of all goods and

services, and the related payment will be subject to the General Conditions of Contract or as

BUSINESS ADDRESS

Line 1:

otherwise agreed with the relevant department.

Line 2:

City:

Telephone no

and area code: (

)

Initials and Surname

Authorised Signature

Date

Fax no and area

DETAILS OF MY/OUR BANK ACCOUNT

code:(

)

E-mail

Address

Name of Bank

Name

POSTAL ADDRESS

Line 1

of

Line 2

Branch Code

City:

Postal Code

Account Name

Account

PAYMENT ADDRESS

Line 1

Number

If Cheque

a blank, canceled cheque

Line 2

Account, attach

Account Type:

3 = Trans-

4 =

5 =

6 = Sub-scription

City:

Postal Code

1 = Cheque Acc

2 = Savings Acc

mission Acc

Bond Acc

(Not in use)

Acc

SARS personal identification number (PIN): ___________________

Please complete this form and forward only original documents to:

FOR INTERNAL USE ONLY

FOR COMPLETION BY BANK OFFICIAL:

Post to:

By Hand:

LOGIK Request Number:

Bank account details are hereby certified as being correct:

SCMO: Logis Registrations

SCMO: Logis Registrations

Provincial Planning and Treasury

Provincial Planning and Treasury

Name:

Private Bag X0029

Shop 5, Tyamzashe Building

LOGIS Supplier Number:

Bhisho

Phalo Avenue

BANK STAMP WITH DATE

5606

Bhisho

ID Number:

CESD Number:

Signature: