Application to be registered in the
University of Venda Supplier Database
NB: Forms must be returned either by post or hand to the under mentioned address and
not via faxes or e-mail.
TO: Head: Supply Chain Management Section
Private Bag X5050
Thohoyandou
0950
For office use
Documents required Yes No N/A
Company registration certificate (certified copies)
Proof of ownership with ID copies(certified)
Two year audited financial statement
Proof of banking details
Original tax clearance certificate
VAT registration
UIF certificate
Workman compensation
Proof of registration to professional body regulating the industry
Proof of BBBEE certificate
Name of directors other than ownership with ID copies (certified)
Skills Development levy
Company profile
CIDB registration certificate
Income Tax reference number of the business
Checked by: Signature
Date
Approved by: Signature
Date
2 Database Registration Form
Instruction
1. Questionnaire to be completed by all current and prospective suppliers and service
providers to the University of Venda.
2. This form must be completed in detail and returned to the University of Venda as soon as
possible
3. Please note
1 Registration in the supplier database does not entitle the supplier to any business
opportunity offered by the University nor will it place any obligation to the University
whatsoever
2 Arrangements may be made for officials of the University of Venda to inspect your
premises in order to assess your competency before your company is accepted.
3 A specific requirement of registration will be signing a Declaration of Interest to ensure no
corruption will be tolerated.
4 Details of offices and staff in the Limpopo province must be provided
5 All service provider information will be treated strictly confidential
6 It should be noted that should any information provided be found to be incorrect, The
university of Venda reserve the right to exclude the service provider from the database at
any time prior to or after acceptance of the database registration form.
3 Database Registration Form
1. Particulars of the Enterprise (Business entity or Person)
Enterprise Registered
Name
Trading Name
Previous Name
Registration Number
Income Tax Number
VAT Registration
number
Physical Address
Postal Code
Postal Address
Postal Code
Operating Province
Operating Municipality
E-mail Address
Telephone Number
Fax Number
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2. Particulars of the contact person
Initials and Surname
Designation
Direct Telephone
number
Direct fax number
Cell phone number
E-mail address -
representative
Email address- Director
Cell phone number
3. Type of Business
Partnership Company
Sole Proprietor State Owned Enterprise
Close Corporation Trust
Other Specify
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3. Relationship with employees of the University of Venda
Surname and Initials Relationship
1.
2.
4. Detailed work done for the University of Venda for the past five years .
1.
2.
3.
4.
5.
5. Other References
Client Type of service Contact person Contact Number
1.
2.
3.
6. Category of work to be registered for: (One service /or product the company
specialise on:
1.
6 Database Registration Form
7. Current contract (Past 18 months)
1.
2.
3.
9. Size of the company based on Annual Turnover
Turnover ()
<R 1,000,000
R 1,000,000 -- R 10,000,000
R 10,000,000 -- R 50,000,000
>R 50,000,000
10 Credit order instruction
1. I/We hereby request and authorize the University of Venda to pay any amount which is
accrued to me/us to the credit of my/our account with the mentioned bank.
2. I/We understand that the credit transfer hereby authorized will be processed through a
system known as EBT (Electronic Bank Transfer), and I/We understand that no additional
advice of payment will be provided by my/our bank, but details of each payment will be
printed on my/our bank statement or any accompanying voucher.
3. I/We also understand that a payment advice will be supplied by the University of Venda in the
normal way and that it will indicate the date on which funds will be available in the account.
4. This authority may be cancelled by giving thirty days’ notice.
5. I/We will not hold the department of transport liable for payment not made into the bank
account if the bank account details are incorrect or were not supplied to the University of
Venda prior to payment.
7 Database Registration Form
11. Declaration by the Supplier
I, the undersigned, hereby:
Declare that:
I am duly authorised to sign this application on behalf of the enterprise.
The information furnished and all documentation submitted for this application, is true and
correct in every respect; and have been lawfully obtained;
The enterprise will abide by the Companies amendment Act, 2011 for trading in South
Africa;
No partner, member, director, manager or other person, who wholly or partly exercises, or
may exercise, control over the business, has been convicted of fraud or corruption in the
past five years.
Understand that:
Registration is subject to the conditions referred to in this form;
Incomplete applications may result in a delay in processing the application.
Applications without supporting documentation will not be processed.
False information provided or a false declaration remains a punishable offence
Authorise:
I/We grant permission that the above information may be audited by the University of
Venda.
NAME: _________________________ SIGNATURE: ____________________
DESIGNATION: ______________________ DATE: ______________________
8 Database Registration Form
