5448 CAPRICORN COLLEGE FOR FETcapricorncollege.co.za/downloads/SUPPLIERS DATABAS…  · Web viewAccounting & Bookkeeping Basic Business Skills Costing & Pricing Excel 2007/ Word

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SUPPLIER REGISTRATION APPLICATION FORM

Application form must be completed in legible block letters.

It is the supplier’s responsibility to confirm receipt and submission of this application form

to the College.

It remains the responsibility of a registered supplier to inform the College in writing of any

change on company particulars.

Application form can be forwarded to: Central Office no 16 Market Street, POLOKWANE

at the reception.

NB: Suppliers will be subjected to vetting and screening.

APPLICANT DECLARATION

I declare that all the information provided herein is complete to the best of my knowledge. I understand that any false information supplied could lead to my application being disqualified.

__________________________Initials and Surname

_________________________ ________________________Signature Date

_____________________________________________________________________________________

POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187

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CAPRICORN COLLEGE FOR FETISO 9001:2008 Certificated

CENTRAL OFFICE16 Market Street Tel (015) 291 31180699 POLOKWANE (015) 291 3115Private Bag X9674 Fax (015) 291 27670700 POLOKWANE www.capricorncollege.co.za

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A. FULL DETAILS OF SUPPLIERS

REGISTERED NAME

TRADING NAME

REGISTRATION NUMBER

INCOME TAX REGISTRATION NUMBER

VAT REGISTRATION NUMBER

ID. NUMBER OF CONTACT PERSON

PHYSICAL ADDRESS

CITY/TOWN

LOCAL MUNICIPALITY

PROVINCE

POSTAL ADDRESS

B. TYPE OF BUSINESS(TICK ONE)

_____________________________________________________________________________________

POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187

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Close CorporationPublic Company (Ltd)Private Company (Pty)LtdPartnershipSole TraderBusiness TrustOther (Specify)

C. COMPANY CLASSIFICATION (Tick One)

SupplierManufacturerService ProviderOther Services

D. SMME STATUS OF THE COMPANY

Micro Annual TurnoverSmall Years in BusinessMedium Number of StaffLarge

E. DETAILS OF MAIN CONTACT PERSON

F. FIRST NAMES

G. TELEPHONE NUMBER

H. CELL NUMBER

I. FAX NUMBER

_____________________________________________________________________________________

POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187

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J. EMAIL ADDRESS

K. LIST OF PARTNERS, PROPRIETORS AND SHAREHOLDERS

1. Full name:…………………………………………………………………………………………………………………………Position:…………………………………………………………………………………………………………………………..ID. No.:……………………………………………………………………………………………………………………………..

% owner by Shareholder

Qualify as black Qualify as woman

Qualify as disabled

Qualify as youth

YES NO YES NO YES NO YES NO

2. Full name:…………………………………………………………………………………………………………………………Position:…………………………………………………………………………………………………………………………..ID. No.:……………………………………………………………………………………………………………………………..

% owner by Shareholder

Qualify as black Qualify as woman

Qualify as disabled

Qualify as youth

YES NO YES NO YES NO YES NO

3. Full name:…………………………………………………………………………………………………………………………Position:…………………………………………………………………………………………………………………………..ID. No.:……………………………………………………………………………………………………………………………..

% owner by Shareholder

Qualify as black Qualify as woman

Qualify as disabled

Qualify as youth

YES NO YES NO YES NO YES NO

4. Full name:…………………………………………………………………………………………………………………………Position:…………………………………………………………………………………………………………………………..ID. No.:……………………………………………………………………………………………………………………………..

% owner by Qualify as black Qualify as Qualify as Qualify as youth

_____________________________________________________________________________________

POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187

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Shareholder woman disabledYES NO YES NO YES NO YES NO

5. Full name:…………………………………………………………………………………………………………………………Position:…………………………………………………………………………………………………………………………..ID. No.:……………………………………………………………………………………………………………………………..

% owner by Shareholder

Qualify as black Qualify as woman

Qualify as disabled

Qualify as youth

YES NO YES NO YES NO YES NO

L. DECLARATION OF ANY CONFLICT OF INTERESTSAre you or any of your partner/s presently an employee of the government?

Yes no

If yes, please finish particulars:………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

SUPPORTING DOCUMENTS

_____________________________________________________________________________________

POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187

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Company Profile Certified copy/ies of Company registration certificate. Valid original Tax Clearance Certificate. Certified copy/ies of members ID. Documents. BBBEE status verification certificate. Proof of registration with professional bodies, (If applicable) Proof of Banking Details.

CHECKLIST FOR COLLEGE OFFICIALS

(FOR OFFICE USE ONLY)

DOCUMENT ATTACHED YES NO N/A1. Certified Copy/ies of Company Registration Certificate2. Company Profile3. Valid Original Tax Clearance Certificate4. Affidavit Confirming Disability5. Certified Copy/ies of ID. Documents6. BBBEE Rating Certificate7. Professional Body/ies Registration/ Membership

Information checked by:

Employer’s name:___________________________________

Signature:__________________________________________

Date:_______________________________________________

Information captured by:

Employee’s name:…………………………………Signature…………………..Date……………….

Information verified by:

Employee’s name:…………………………………Signature…………………..Date……………….

_____________________________________________________________________________________

POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187

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LIST OF COMMODITIES AND SERVICES REQUIRED

A. CONSTRUCTION

Air conditioning System Carpentry Electric Contract Plumbing

B. Services

Conference Facilities Office Plant Printing and Photography (Annually Report) Cabling, DSTV, Networking and Visual Printer Cartridges Catering Computer Suppliers/services Courier Services Exhibition Centers Security Services Telecommunication Transport Services/ office movers Travel Agencies Accounting / Financial Advisory Services & Bookkeeping including

assisting incentives, critical Infrastructure FundEvent ManagementFencing and Fencing MaterialsFire Extinguishers & Maintenance Garden Equipment’s & SuppliersGiftsGlasswork & MaintenanceGroceriesIT InfrastructureLock SmithMedia PublicationOffice Curtains & Rails / BlindsPacking ShadesPest Control& Fumigation Promotional MaterialsSound & Stage_____________________________________________________________________________________

POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187

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Sports WearTent and Chairs (Margueese Gazebo)CarpetsCleaning ServicesKitchen Appliances

ADDITIONAL (Add your service)

C. Legal intervention Attorneys/ Legal services Lease / Sales agreements Labour Relations Debt Collection Any Litigation Matters

D. ECD

Plumbing Level 2 Carpentry Leve2 Leather work Level 2 Brick Laying & Plastering Penal beating & Spraying Water & Sanitation Level 2 Welding Level 2 Food preparation Level 3 Computerized Financial System Level 4 Corporate behavior & Office Antiques Level 3

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POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187

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Financial Management Level 3E. PROFESSIONAL SERVICES

EDMS Consultants EPA Consultants Economist Industrial Relations Project Managers Quantity Surveyors

F. SMME’s Short Courses

Accounting & Bookkeeping Basic Business Skills Costing & Pricing Excel 2007/ Word 2007 Project Management Small Business Taxation Business Plan Conflict Resolution Customer Services Negotiations Skills

G. PLANNING INTERVENTION Feasibility Study / Business Plan Business Strategy Planning (Business Growth, Business Expansion,

Business Turnaround Plan and Business Evaluation Marketing Plan Marketing Research (Market Access, Evaluation and Analysis)

H. MARKETING TOOLS

Web Design Bronchus Business Cards Company Logo Branding (Corporate gifts & Clothing) Sign Boards / Street Poles

_____________________________________________________________________________________

POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187

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