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APPLICATION TO BE REGISTERED AS A VENDOR

ACCOMPANYING DOCUMENTS

Please note that the following documents MUST accompany your application:

Certified copies of the accompanying documents must be submitted to the Municipality’s Supply Chain Office within 14 (fourteen) days of submission of application. Failure to submit relevant documentation within the prescribed period will result in disqualification of your application.

NO.		DESCRIPTION	YES/NO

1.		Company Profile (maximum of 3 pages)

2.	Copy of the Company registration (CK)

3.		Copies of the owner(s) ID documents (Certified)

4.	Business Letterhead/company stamp

5.	Cancelled cheque or Bank confirmation on bank details

6.		Valid & Original Tax Clearance Certificate

7.		VAT Registration Certificate (if applicable)

		Municipal Rates Clearance Certificate or Copy of a lease agreement (if
8.		renting/leasing) Not Monthly Account (to be collected at Bram Fischer Building,
		Debt Collection Division)
9.		B-BBEE status level verification Certificate*

10.		CIDB Certificate (for construction, plumbing, electrical, etc)

11.	SIRA Certificate (for security)

12.		For Consulting Services we need CVs of consultants who are going to provide the
12.		service
		service

*Companies with an annual total revenue of R5 million or less qualify as Exempted Micro Enterprises (EMEs) in terms of the Broad-Based Black Economic Empowerment Act, and must submit a certificate issued by a registered auditor, accounting officer (as contemplated in section 60(4) of the Close Corporation Act, 1984 (Act No. 69 of 1984)) or an accredited verification agency.

PO Box 3704, Bloemfontein 9300, 6 Mannion Road, Oranjesig, Bloemfontein, 9301

Tel: +27 51 411 3215 Fax: +27 51 411 3240 E-Mail: sele.thebane@mangaung.co.za Website: www.mangauang.co.za

___________________________________________________________________________

Application form to be registered as a Vendor

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SCM#001

VENDOR INFORMATION

The following information should be completed in full.

Name of Business	: _______________________________________________________
Trading Names	: _______________________________________________________

Company Registration Number/ID No.: ___________________________________________________

Income Tax Reference Number. : _______________________________________________________

Vat Registration Number	: _______________________________________________________
Contact person	: _______________________________________________________
Telephone number	: _______________________________________________________
Fax number	: _______________________________________________________
Cell phone number	: _______________________________________________________
E-mail address	: _______________________________________________________
Physical Address	: _______________________________________________________
Postal Address	: _______________________________________________________
BANKING DETAILS
Name of Bank

Address of Bank

Branch Code of Bank

Bank Account Number

Type of Account

(If cheque account, please attach cancelled cheque)

___________________________________________________________________________

Application form to be registered as a Vendor

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NB: SERVICE PROVIDERS TO CHOOSE ONLY THREE AREAS OF SPECIALTY

Suppliers are expected to choose three services (Tick x were applicable)

A.	FINANCE & ADMINISTRATION	B.	TECHNICAL SERVICES & MAINTENANCE
	Transport of Cash		Provision of services such as erection of car ports, kerbs
	Tracing agencies		fixing, cleaning of storm water system, electrical work,
 Seals and money bags for pay points			painting, fencing, pothole fixing
	Credit Ratings		Geo-Hydrology
	Printing & Stationery		Consulting Engineering
	Office furniture and equipment		Building contractors
	Newspaper suppliers		Cellular
	Supply of uniform and protective clothing		Land-line telephones
	Provision of security services		Escalators
	Cleaning services of buildings		Air Conditions (installation and repairs)
	Supply of cleaning materials and related items		Partitioning and ceiling
	Car Rental		Supply of vehicles and related accessories
	Travel Agencies		Panel beating and spray painting
	Advertising		Supply chemicals for pool maintenance
	Curtains and blinds		Supply of coal for swimming pool boilers
	Computer accessories		Repairs on irrigation systems and water pipes
	Courier Services		Servicing of equipment
			Grading of soccer fields
			Repairs alarm systems
			Waterproofing
C.	EMERGENCY SERVICES	D.	EVENT MANAGEMENT
	Pneumatic rescue equipment		Provision of catering services
	Hydraulic rescue equipment		Photographic and Videos
	Lubricants		Sound systems
	Fire fighting equipment		Decorations
	Electrically driven power tools		Guest Houses
	Petrol driven power tools		Venue for Conferences
	Portable fire fighting pumps		Performers
			Beverages
			Corporate Gifts
			Promotional items

E.SPECIALISED SERVICES

 Accredited inspection authority  Accredited laboratories

 Surveying and rezoning

 Skills development and training  Recruitment Consultants

 GIS Consultants

 Legal work such as Labour Law, litigation, contracts, deeds and conveyancing, and debt

collection

 Printing and Design

 Financial Consultants/Accounting Firms  Business Development Support

 Marketing services and Research

F.COMMUNITY SERVICES

 Burial services  Horticulture

 Gardening service

 Environmental impact assessment  Waste management

 Transport Services

___________________________________________________________________________

Application form to be registered as a Vendor

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BLACK ECONOMIC EMPOWERMENT : VENDOR QUESTIONNAIRE

List all Shareholders by Name, Position, Identity Number, Citizenship, HDI status and ownership, as

relevant. Information to be used to calculate the points

Name

Date/Position

occupied in

Enterprise

ID Number

Date RSA

Citizenship

obtained

* HDI Status

o franchise
prior to	omen	Disabled
elections	omen	Disabled
elections

f business / enterprise

owned

*Indicate YES or NO

Notes:

a)The following questions should be completed comprehensively in order for Mangaung Metropolitan Municipality to conduct a representative BEE evaluation of your company.

b)An unwillingness to provide information as requested will result in Mangaung Metropolitan Municipality allocating a minimum score for that area of the questionnaire.

c)Mangaung Metropolitan Municipality reserves the right to request any additional information that would be deemed necessary to verify any answers provided by a company.

d)Misrepresentation of company status with respect to answers provided in this submission will result in disqualification from the evaluation processes or cancellation of contracts as deemed appropriate.

e)The municipality will deem persons completing this questionnaire as individuals authorized to do so.

f)Previously disadvantaged individuals (PDI’s) / Blacks shall mean Africans, Coloureds, Indians, Black Women and

Disabled people, excluding naturalized South Africans.

g)Previously disadvantaged individuals (PDI’s) in the context of this questionnaire shall be applicable to South African

Citizens only.

COMPANY STAMP:

Responding to the request does not automatically qualify a provider as a registered or preferred provider.

Note: The submission of this application form shall under no circumstance qualify a service provider as a preferred provider. The SCM policy will be followed for use of service providers.

___________________________________________________________________________

Application form to be registered as a Vendor

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DECLARATION OF INTEREST

1.The declaration of interest should be completed by all the directors/members/principle shareholders/stakeholders of the Company under oath.

2.No application will be accepted from persons in the service of the state.1

3.In order to give effect the above, the following questionnaire must be completed and submitted with the application.

3.1 Are any of the directors/members/principle shareholders/stakeholders	YES / NO
presently in the service of the state?
If so, furnish particulars.
…………………………………………………………………………………….
…………………………………………………………………………………….
…………………………………………………………………………………….
3.2 Have any of the directors/members/principle shareholders/stakeholders	YES / NO
been in the service of the state for the past twelve months?
If so, furnish particulars.
…………………………………………………………………………………….
…………………………………………………………………………………….
…………………………………………………………………………………….
3.3 Have any of the directors/members/principle shareholders/stakeholders	YES / NO
have any relationship (family, friend, other) with persons in the service of
the state and who may be involved with the evaluation of this application?
If so, furnish particulars.
…………………………………………………………………………………….
…………………………………………………………………………………….
…………………………………………………………………………………….

1MSCM Regulations: “in the service of the state” means to be –

(a)A member of-

(i)Any municipal council;

(ii)Any provincial legislature; or

(iii)The national Assembly or the national Council of provinces;

(b)A member of the board of directorates of any municipal entity;

(c)An official of any municipality or municipal entity;

(d)An employee of any national or provincial department, national or provincial public entity or constitutional institution within the meaning of the Public Finance Management Act, 1999 (Act No. 1 of 999);

(e)A member of the accounting authority of any national or provincial public entity; or

(f)An employee of Parliament or a provincial legislature.

___________________________________________________________________________

Application form to be registered as a Vendor

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3.4 Is any spouse, child or parent of the company’s	YES / NO
directors/members/principle shareholders/stakeholders in the service of
the state?
If so, furnish particulars.
…………………………………………………………………………………….
…………………………………………………………………………………….
…………………………………………………………………………………….

DECLARATION OF BIDDER’S PAST SUPPLY CHAIN MANAGEMENT PRACTICES

1.It serves as a declaration to be used by municipalities and municipal entities in ensuring that when goods and services are being procured, all reasonable steps are taken to combat the abuse of the supply chain management system.

2.The bid of any company may be rejected if that company, or any of its directors have:

a.abused the municipality’s / municipal entity’s supply chain management system or committed any improper conduct in relation to such system;

b.been convicted for fraud or corruption during the past five years;

c.willfully neglected, reneged on or failed to comply with any government, municipal or other public sector contract during the past five years; or

d.been listed in the Register for Tender Defaulters in terms of section 29 of the Prevention and Combating of Corrupt Activities Act (No 12 of 2004).

3.In order to give effect to the above, the following questionnaire must be completed and submitted with the bid.

Item	Question	Yes	No
Item	Question	Yes	No
4.1	Is the bidder or any of its directors listed on the National Treasury’s Database	Yes	No
	of Restricted Suppliers as companies or persons prohibited from doing
	business with the public sector?
	(Companies or persons who are listed on this Database were informed in
	writing of this restriction by the Accounting Officer/Authority of the institution
	that imposed the restriction after the audi alteram partem rule was applied).
	The Database of Restricted Suppliers now resides on the National
	Treasury’s website (www.treasury.gov.za) and can be accessed by
	clicking on its link at the bottom of the home page.
4.1.1	If so, furnish particulars:

4.2	Is the bidder or any of its directors listed on the Register for Tender Defaulters	Yes	No
	in terms of section 29 of the Prevention and Combating of Corrupt Activities
	Act (No 12 of 2004)?
	The Register for Tender Defaulters can be accessed on the National
	Treasury’s website (www.treasury.gov.za) by clicking on its link at the
	bottom of the home page.

___________________________________________________________________________

Application form to be registered as a Vendor

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4.2.1	If so, furnish particulars:

4.3	Was the bidder or any of its directors convicted by a court of law (including a	Yes	No
	court of law outside the Republic of South Africa) for fraud or corruption during
	the past five years?
4.3.1	If so, furnish particulars:

Item	Question	Yes	No
4.4	Does the bidder or any of its directors owe any municipal rates and taxes or	Yes	No
	municipal charges to the municipality / municipal entity, or to any other
	municipality / municipal entity, that is in arrears for more than three months?

4.4.1	If so, furnish particulars:

4.5	Was any contract between the bidder and the municipality / municipal entity or	Yes	No
	any other organ of state terminated during the past five years on account of
	failure to perform on or comply with the contract?
4.7.1	If so, furnish particulars:

I, THE UNDERSIGNED (NAME) ______________________________________________________________

CERTIFY THAT THE INFORMATION FURNISHED ON THIS FORM IS CORRECT. I ACCEPT THAT THE MUNICIPALITY MAY ACT AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE.

_______________________________	______________________________
Signature	Date

I, THE UNDERSIGNED (NAME) ______________________________________________________________

CERTIFY THAT THE INFORMATION FURNISHED ON THIS FORM IS CORRECT. I ACCEPT THAT THE MUNICIPALITY MAY ACT AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE.

_______________________________	______________________________
Signature	Date

I, THE UNDERSIGNED (NAME) ______________________________________________________________

CERTIFY THAT THE INFORMATION FURNISHED ON THIS FORM IS CORRECT. I ACCEPT THAT THE MUNICIPALITY MAY ACT AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE.

_______________________________	______________________________
Signature	Date

___________________________________________________________________________

Application form to be registered as a Vendor

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COMMISSIONER OF OATH

I, _______________________________________, certify that the deponent(s) has acknowledged that

he/she knows and understands the contents of this declaration.

This declaration has been sworn/affirmed before me at ______________________________ on this

day of ________________________________ 20 _____

___________________________________

COMMISSIONER OF OATHS

FOR OFFICE USE


RECEIVED BY: _________________________________	DATE	________________________
CHECKED BY: _________________________________	DATE	________________________
CHECKED BY: _________________________________	DATE	________________________
APPROVED/NOT APPROVED: _____________________	DATE	________________________


SCM OFFICIAL STAMP:

___________________________________________________________________________

Application form to be registered as a Vendor

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Question	Answer
Form Name	Mangaung Metro Municipality Form
Form Length	8 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min
Other names	mangaung metro municipality, mangaung metro municipality vacancies, mangaung metro municipality application forms pdf, municipality application form 2021

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