Suppliers Database Registration Form Supplier Name ZNT 31 FOR OFFICE USE Registration Number Date Date D D M M Y Y Y Y D D M M Y Y Y Y Captured By Approved By KWAZULU-NATAL PROVINCIAL TREASURY DELIVER TO : SUPPLY CHAIN MANAGEMENT OFFICE TREASURY HOUSE GROUND FLOOR 145 CHIEF ALBERT LUTHULI ROAD PIETERMARITZBURG 3200 SUPPLY CHAIN MANAGEMENT OFFICE PRIVATE BAG X9082 PIETERMARITZBURG 3200 ENQUIRIES TEL. (033) 897 4483 / 897 4235 / 897 4231 TOLL FREE. 0800 201 049 OR POST TO :
13
Embed
School of Public Service & Health Public Administration PADM 520
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
The ZNT 31 was specifically designed to provide for the registration of suppliers on the KwaZulu-Natal Provincial
Suppliers Database.
In order to ensure that suppliers are considered legitimate, it is imperative that the following guidelines are adhered to.
GUIDELINES
Applicants must complete pages 2 to 13, where applicable. Failure by an applicant to provide ALL the prescribed information and documents required will result in non-registration. If the information required is not applicable to your business; clearly insert the symbols “N/A” in the appropriate space. All mandatory fields marked by two asteris** are to be filled in. If the space provided is left blank and or mandatory fields are not filled in, it will be regarded as information that is still outstanding and you WILL NOT be registered. Only black ink is to be used when filling in the form.
· Applicants are advised that only ORIGINAL ZNT 31 or PHOTOSTAT copies thereof will be processed. Any document
that has been retyped or redrafted will be disregarded and returned to the applicant.
· It is imperative that only supporting documents with an ORIGINAL signature be submitted.
· All signatures to the document must be commissioned by an authorised Commissioner of Oaths. Failure to do so will
result in the applicant not qualifying for registration.
· A supplier registered on the Suppliers Database MUST notify the Supply Chain Management Office of any
changes to information provided in the initial ZNT 31, as captured onto the Suppliers Database. Failure to do so
may result in such a supplier being removed from the Suppliers Database and/or the cancellation of contracts
awarded to the supplier, on the basis of misrepresentation.
· Suppliers providing information incorrectly or fraudulently in their ZNT 31 will be disqualified from bidding and
removed from the Suppliers Database, in addition to any other action the Province may institute against such a supplier.
Furthermore, in the event of the Province being prejudiced financially, it reserves the right to take legal action against
the supplier.
· For definitions of terminology used in this document, please refer to the definitions set out in Treasury Regulation 16A
and the KwaZulu-Natal Supply Chain Management Policy Framework, located on the KwaZulu-Natal Treasury's
website, www.kzntreasury.gov.za
· Any alterations made by the supplier to its own information inserted on this document, must be initialed by the
supplier. The use of correcting fluid is prohibited and the use thereof will lead to non-registration of the applicant
business/supplier.
SECTION A: INSTRUCTIONS
· Electronic forms are available on the website: www.kzntreasury.gov.za , Select ” Supplier Database” .
· Reminder letters will be issued by the KwaZulu-Natal Provincial Treasury to suppliers to update their information. It
remains the responsibility of the supplier to ensure that their information is updated in the Suppliers Database, therefore
if a reminder letter is not received, the supplier must follow up with Provincial Treasury.
Page 2
Your current database registration number (ZNT number)
PLEASE USE BLOCK LETTERS.
The following information must be filled in by the applicant. Failure to submit ALL the required information maylead to non-registration of the applicant's business
Name of business as registered with the Registrarof Companies
Registration number of Company/CC/Trust/Fund number
Postal codeBusiness Postal address
Business Physical address Postal code
Telephone number
E-mail address
Cellular phone number
Website address
Preferred language English AfrikaansIsiZulu
Contact person (Full Name & Surname)
Physical location of HeadOffice (if applicable)
1. Business particulars **
T E L E P H O N E C O D E C O D EFacsimile number F A C S I M I L E
SECTION B: COMPANY INFORMATION
Holding company
2. Financial information **
Bank branch number (at least six numbers)
Name of bank account holder
Type of bank account Current Savings Transmission1 2 3
Bank account number
Trading as
UIF number
Compensation Commissioner registration number
Income tax reference number
PAYE number 7
Financial year-end D D M M
VAT registration number 4
N.B: A certified copy of a tax clearance certificate must be supplied
Tax clearence certificate issue date
Tax clearence certificate expiry date
D D M M Y Y Y Y
D D M M Y Y Y Y
N.B: A certified copy of latest bank statement or original cancelled cheque or original letter from your bank must beattached.
R
R
R
R
R
Total fixed assets at book value (e.g. land, buildings, plants, equipment)
3. Indicate the value of the below stated based on the latest financial statement **
Vehicles at book value
Number of vehicles
Average stock on hand
Cost of goods produced annually
Quantity produced annually
Units of measure (e.g. tons, kilolitres)
Total current assets (e.g. stock, debtors, cash)
Total current liabilities (e.g. creditors, bank overdraft)
4. Municipalities **
Please clearly indicate, with an 'X', the District Municipality/s where your business operates.
5. Previous business information (if applicable)
Did your business exist under a different name previously? ORYes No
If "yes" what was the previous business name?
What was the previous database registration number (ZNT number)?
6. Previous experiences (If applicable)
SurnameInitials
Was the project completed successfully? (Mark applicable block with an "X") ORYes No
Employer/Department
Contact person
Telephone number T E L E P H O N E C O D E C O D EFacsimile number F A C S I M I L E
Y Y Y YWhat year was the project initiated?
What was the contract value? R
CONTRACT 1
List the last three (3) contracts awarded to you ( the supplier) or other previous experience related to yourcore business
Page 3
eThekwini Municipality (DC 20)
Ugu Municipality (DC 21)
Umgungundlovu Municipality (DC 22)
Uthukela Municipality (DC 23)
Umzinyathi Municipality (DC 24)
Amajuba Municipality (DC 25)
Zululand Municipality (DC 26)
Umkhanyakude Municipality (DC 27)
uThungulu Municipality (DC 28)
Ilembe Municipality (DC 29)
Sisonke Municipality (DC 47)
Page 4
SurnameInitials
Was the project completed successfully? (Mark applicable block with an "X") ORYes No
Employer/Department
Contact person
Telephone number T E L E P H O N E C O D E C O D EFacsimile number F A C S I M I L E
Y Y Y YWhat year was the project initiated?
What was the contract value? R
CONTRACT 2
SurnameInitials
Was the project completed successfully? (Mark applicable block with an "X") ORYes No
Employer/Department
Contact person
Telephone number T E L E P H O N E C O D E C O D EFacsimile number F A C S I M I L E
Y Y Y YWhat year was the project initiated?
What was the contract value? R
CONTRACT 3
SECTION C: CLASSIFICATION OF BUSINESS
A. Public Company LTD
B. Private Company (PTY) LTD
C. Close Corporation CC
D. Incorporated
G. Trust
E. Sole Proprietor
H. Co-Operative
F. Partnership
I. Welfare organisation
Certified copy of certificate of incorporation (CM 1)
Certified copy of certificate of incorporation (CM 1)
Certified copy of CK 1 document and CK 2 if applicable
Certified copy of certificate of incorporation (CM 1 and CM 29)
Certified copy of Identity Document
Certified copy of partnership agreement
Certified copy of trust document
Certified copy of proof of registration with the directorate Co-Operatives
Certified copy of constitution
1. Type of business **
Please mark with an "X" the block applicable to your business or firm AND attach the relevant certified copy
R
Annual turnover R
Number of employees
Total Gross Asset value (fixed property excluded) R
Page 5
2. Products & Services **
In order to assist with the classification of suppliers, please indicate the industrial sector related to the goods /services that you supply (Only a maximum of FOUR industrial sectors may be selected). If the supplier selectsmore than FOUR (4) Industrial Sectors, only the FIRST FOUR will be considered).
Please mark with an "X" the appropriate block to clearly indicate the industrial sector related to the goodsand services that you supply
Finance and Business service
Banking
Insurance
Investments Credit institutions Engineering
Exchanges
Other (Please Specify)
Legal services
Securities broker
Business & management consultants
Chartered accountants
Architects & quantity surveyors
Community, social & personal services
Collectibles & awards
Fitness equipment Cleaning & Janitorial equipment
Field & court sports equipment Winter sports equipment
Identify by name the Historically Disadvantaged Individual (HDI) status and the length of services of theindividuals in the business. Include owners and non owners responsible for the day-to-day Managementand Business decisions.
SurnameInitials
White Black Indian ColouredRace (Mark applicable block with an "X")
Other (Please Specify)
Y YNumber of years in service?
Cheque signing
Signing & co-signing for loans
Business financing (overdraft, lease agreements)
Sureties
3. Business management **
Number of years in service?
SurnameInitials
Race (Mark applicable block with an "X")
Other (Please Specify)
Y Y
Number of years in service?
SurnameInitials
Race (Mark applicable block with an "X")
Other (Please Specify)
Y Y
Number of years in service?
SurnameInitials
Race (Mark applicable block with an "X")
Other (Please Specify)
Y Y
Approval of major purchases or acquisitions
Number of years in service?
SurnameInitials
Other (Please Specify)
Y Y Race (Mark applicable block with an "X")
Contract signing
Number of years in service?
SurnameInitials
Race (Mark applicable block with an "X")
Other (Please Specify)
Y Y
Black Indian Coloured White
Black Indian Coloured
Black Indian Coloured
Black Indian Coloured
Black Indian Coloured
White
White
White
White
Page 10
Signature: Date signed D D M M Y Y Y Y
Signed at
SurnameInitials
Signed before The Commissioner of Oaths: (Supplier representative)
Supplier name
Signed by the deponent who has acknowledged that he/she knows and understands the contents of this document and he/she has acknowledged that he/she has no objection to affirming that he/she regards the affirmation to be binding on his/herconscience.
Commisioner of Oaths signature:
Signed and affirmed before me at: (Commissioner of Oaths)
Date signed D D M M Y Y Y Y
SurnameInitials
Business Physical address Postal code
Capacity Area
OFFICIAL STAMP
Page 11
A. The supplier will be required to furnish documentary proof of the information relating to preferences, if requested to do so.
4. Verification of Information **
I/We, the undersigned, who warrants that he/she is duly authorised to do so on behalf of the supplier, certifiesthat the information supplied in terms of this document (ZNT 31) including the annexure/s with additionalinfromation, is correct and accurate and acknowledges that:
B. If the information supplied is found to be incorrect then the Province may, in addition to any remedies it may have:
i Disqualify the supplier/contractor for a particular bid/contract/project it may be considered for, or whichhad been awarded to the supplier/contractor;
ii. Recover from the supplier/contractor all costs, losses or damages incurred or sustained by the Province as aresult of breach of the contract;
iii. Cancel the contract and claim any damages which the Province may suffer by having to make less favourablearrangements after such cancellation: and/or;
iv. De-register the supplier registered on the Supplier Database
Page 12
The following fields have been completed:
Business Particulars
Municipalities
Financial Information
Type of Business
Products & Services
Ownership Information
Business Management
Verification of Information
FOR OFFICIAL USE
Surname
Initials
Date D D M M Y Y Y Y
I acknowledge that this form has been checked by me, and all the required Information/Documents have beenfurnished.
Signed
Certified copy of the Company Registration Certificate
SECTION E: CHECKLIST
The following Documents have been attached:
Supplier For official use
Original Tax Certificate
Proof of Banking Details
Please use this checklist as confirmation that ALL the required Information/Documents have been submitted.Please indicate with an "X".