Application For Registration On The Western Cape Supplier .
Application for Registration on theWestern Cape Supplier Database (WCSD)SAP Ariba, on behalf of the Western Cape Government, is responsible for populating and maintaining the WCSD. This supplier databaseserves to enable the effective implementation of Preferential Procurement Policies. These policies are in line with the Preferential ProcurementPolicy Framework Act (PPPFA) No. 5 of 2000, the Broad Based Black Economic Empowerment Act, (B-BBEE Act), No 53 of 2003, and theRegulations pertaining to these Acts. In terms of the latest Regulations forth-flowing from these Acts, preference points are allowed inaccordance with the scores obtained for price and B-BBEE status level of companies, accompanied by an original signed Preference PointClaim form (WCBD 6.1).The original, duly completed, registration form with accompanying documentation must besubmitted to:AribaSAP Africa, 4 Waterford Place, 2nd Floor, Century City,Cape TownAribaPO Box 1207, Cape Town, 8000Direct enquiries to the Western Cape Supplier Database Helpdesk - Tel: 0861 – 225577 or021 – 680 4666 Email: sa-supplierdatabase@sap.comPLEASE KEEP COPIES OF THIS REGISTRATION FORM AND ALL DOCUMENTATION SUBMITTED FOR YOUR RECORDSName of BusinessTrading NameY.Company Registration Document (Certified Copy)An Original Valid Tax Clearance Certificate (TCC) or a TCC downloaded from SARS E–filing and aresult summary pageVAT Registration number to appear on the TCC if VAT registeredU.I.F Registration number to appear on the TCC if registered for U.I.FSecurity Officer’s Board Certificate (applicable to security services only) (Copy)Construction Industry Development Board Certificate (CIDB) / I Tender website printout (Copy)Co-Operatives – Registration Certificate (Certified Copy)B-BBEE Rating Certificate (Original /Original legible Certified copy)Affidavit (Original)Companies and Intellectual Property Commission (CIPC) affidavitDeclaration of Interest – WCBD 4 (Original)Remunerative Work Outside the Public Service (RWOP)Identity Document for Certificate of Correctness Signatory (Original Certified Copy)Preference Point Claim Form - WCBD 6.1 (Original)WCSD Form Ver 3 1 24 Nov 2016.docxSupplier Database Helpdesk 0861 225 577NN/A
PAGE 21.COMPANY REGISTRATION DOCUMENTSNB. DOCUMENTARY PROOF MUST BE PROVIDED WHERE APPLICABLE (Please mark N/A if not applicable.)1.1PUBLIC COMPANY LTDSOLE PROPRIETORPRIVATE COMPANY (PTY) LTDPARTNERSHIPCO-OPERATIVEBUSINESS TRUSTCLOSE CORPORATION CCOTHERCOMPANYTYPE (NB Documentary Proof of registration must be provided)1.2COMPANY, CK NUMBERYNot applicable to all companies, please specify if N/ANNAHave you attached a Certified copy of your Company Registration document or other applicable documentation if N/A? (see attached table)1.3VERIFICATION OF BANKINGYBank Stamp and signature (Pg. 5)Has the bank stamped and signed page 5 of this document?1.4VAT REGISTRATIONVAT Registration No. as reflected on the Tax Clearance Certificate1.5TAX CLEARANCE CERTIFICATEIncome Tax Registration number as reflected on the Tax Clearance CertificateYHave you attached an original valid Tax Clearance Certificate or a TCCdownloaded from SARS E filing accompanied by result summary page?1.6Tax Clearance Certificate number1.7UNEMPLOYMENT INSURANCE FUNDUnemploy Unemployment Insurance fund No.1.8SECURITY OFFICERS BOARD REGISTRATION NO. ( M A N D A T O R Y , I F A P P L I C A B L E )Security officers board registration No.Applicable to security industry only, please specify if N/AYNAYNAHave you attached your Security Officers Board Registration document?1.9CONSTRUCTION INDUSTRY DEVELOPMENT BOARD (CIDB) REGISTRATION (MANDATORY, IF APPLICABLE)CIDB Contractors registration No.Applicable to Construction industry only, please specify if N/AHave you attached your CIDB Contractors Registration Certificate / I Tender websiteprintout?1.10CO-OPERATIVEST Tertiary, S Secondary or P PrimaryTSPIndicate which Co-operative level your company is registered underYNHave you attached a certified copy of your Co-operative registration document?1.11B-BBEE RATING CERTIFICATEYNHave you attached an Original Valid Certified Copy of the B-BBEE Rating Certificate/An Original AffidavitPlease seSelect the relevant status below and attach the relevant document:Large Enterprise:Valid, original or legiblecertified copy of a B-BBEEVerification Certificate issuedby SANAS or a RegisteredAuditor approved by IRBAQSEA valid, original or a legible certified copyof a B-BBEE Verification Certificate issuedby SANAS or a Registered Auditorapproved by IRBA; orA valid, original or a legible certified copyof a B-BBEE Verification Certificate issuedby SANAS or a Registered Auditorapproved by IRBA; orValid, original affidavit confirming annualturnover and level of black ownership;EMEValid, original affidavitconfirming annual turnoverand level of black ownership;orCIPC affidavit1.12Preference Points Claim Form (WCBD 6.1)Have you completed and attached an ORIGINAL Preference Points Claim form?Y1.12.1Will you be claiming preference points for every RFQ and formal bid submitted to WCG for the duration of the validity period of the signed WCBD 6.1?Y1.13DECLARATION OF INTEREST (WCBD 4)Have you completed and attached an ORIGINAL Declaration of Interest form?Have you attached an “RWOP” if you answered “YES” to question B1 and B2 on the WCBD 4?1.14IDENTITY DOCUMENT Have you attached an original certified copy of the ID of the authorised signatory who signed the Certificate of Correctness (Page 7)?WCSD Form Ver 3 1 24 Nov 2016.docxSupplier Database Helpdesk 0861 225 577N
PAGE 32.BUSINESS PARTICULARS2.1Name of Business2.1.1Business Trading Name2.1.2Head OfficePostal addressCityCodeProvince2.1.3Head 2.1.4Head Office Telephone No.2.1.5Head Office Fax No.2.1.6Head Office E-mail Address2.1.7TitleContact Person for correspondenceFirst NameSurnameTelephoneE-mail AddressFax NumberCell No.2.1.8Correspondence MethodPlease select your preferred method of correspondence. All correspondence will be sent using the method you select below.Explanation of abbreviations used in the following tableCapacityFaxFE-mailEWCSD Form Ver 3 1 24 Nov 2016.docxSupplier Database Helpdesk 0861 225 577
PAGE 43.BRANCHES, SALES AND ACCOUNTS DEPARTMENTS3.1Sales DepartmentContact NameTelephoneEmail AddressFax No.3.2Cell NoAccounts DepartmentContact NameTelephoneEmail AddressFax No.3.3Cell NoBranchesYDo you have any other branches in this region?If yes, kindly complete the under-mentioned fieldsMultiple copies of this page may be submitted if required.Name / AreaPhysical AddressCityCodeProvinceTelephoneFaxName / AreaPhysical AddressCityCodeProvinceTelephoneFaxName / AreaPhysical AddressCityCodeProvinceTelephoneFaxName / AreaPhysical AddressCityCodeProvinceTelephoneWCSD Form Ver 3 1 24 Nov 2016.docxFaxSupplier Database Helpdesk 0861 225 577N
PAGE 54.1CORE BUSINESS OPERATION ( M A N D A T O R Y F I E L D ) * *(Mark with X in applicable fields)Prime ContractorSub-Contractor (less than 25 % generatedturnover as prime contractor)Labour-only ContractorSupplierManufacturerLegal Service Provider*Professional Services BUILTEnvironment*Education, Training and Development ServiceProvider (ETD)*Other****Other, please specify*Contact WCSD Helpdesk on 0861 225577 to obtain additional documents.For more detail relating to your classification on the WCSD and commodity grouping, pages 8 and 9 of this registration formmust also be completed.5.1ANNUAL AVERAGE TURNOVER*Indicate annual average turnover excluding Value Added Tax during the past three years (If applicable):15.2R2R3RFINANCIAL DETAILS (BANKING)Banking institution nameBranchBranch CodeTown / CityBanking account numberAccount holders nameAccount TypeNB. MANDATORY REQUIREMENTThe template below must be completed, signed and stamped by your Bank to validate the financial data above.DATE STAMP OF BANKWCSD Form Ver 3 1 24 Nov 2016.docxFOR COMPLETION BY BANK OFFICIALBank Official’s r’s DetailAccountNumber.BranchCodeSupplier Database Helpdesk 0861 225 577
PAGE 66.1. ciariesRace GroupOSDTBAfricanColouredIndianWhiteACIWList all persons who are directors, shareholder, member, partner, trustee, sole proprietor or any persons with aright or entitlement to share in profits, revenue or assets of an entity. Please note, where a director is ashareholder, both should be confirmed. Multiple copies of this page may be submitted, as needed.Name of HoldingCompany/TrustPercentage owned by Holding Company or Trust%First NameSurnameIdentification Number%Percentage ShareCapacityMFIWYNGenderACRace GroupDisabledFirst NameSurnameIdentification Number%Percentage ShareCapacityMFIWYNGenderACRace GroupDisabled6.2PARTICULARS OF EMPLOYEES ( M A N D A T O R Y F I E L D ) * *State the total number of permanent and temporary staff SABLEDTemporaryFEMALEPermanentTemporary
PAGE 77. CERTIFICATE OF CORRECTNESS OF INFORMATION SUPPLIED IN THIS DOCUMENTI, THE UNDERSIGNED, WHO WARRANTS THAT I AM DULY AUTHORISED ON BEHALF OF THE SUPPLIER TO CERTIFYTHAT THE INFORMATION SUPPLIED IN TERMS OF THIS DOCUMENTIN ITS SEMI-COMPLETE, COMPLETE ANDAMENDED STATES, INCLUDING THE SUPPORTING DOCUMENTATION, IS CORRECT AND ACCURATE WITH THEDATE OF VERIFICATION DATE AS THE EFFECTIVE DATE AND ACKNOWLEDGES THAT: 1.The supplier will be required to furnish documentary proof of the claims if requested to do so.2.If the information supplied is found to be incorrect then the client (Western Cape Government) may, in addition to anyremedies it may have: i. Recover from the contractor all costs, losses or damages incurred or sustained by the client as a result of the award ofthe contract, and/orii. Cancel the contract and claim any damages which the client may suffer by having to make less favourable arrangementsafter such cancellations: and/oriii. Impose a penalty on the contractor as provided for in the relevant organisation’s regulations.SIGNED ON THIS DAY OF 201 AT(SIGNATURE)IN HIS /HER CAPACITY AS(PRINT NAME)ON BEHALF OF THE (SUPPLIER’S NAME)IMPORTANT NOTICEYour Tax Clearance Certificate, B-BBEE Rating Certificate/ Affidavit and Declaration of Interest is only valid for a twelve (12) month periodfrom the date of issue.You will be required to submit the following on or before the expiry date of the current documents housed on the WCSD:(a)an updated original/ original legible certified copy of a BBBEE certificate/ original affidavit/ CIPC affidavit; and Preference Points ClaimForm (WCBD 6.1); and/(b)an updated original, valid Tax Clearance Certificate or a Tax Clearance Certificate downloaded from eFiling accompanied by a ResultSummary Page; and/(c)an updated Declaration of Interest (WCBD 4) and RWOP, if applicableFailure to update B-BBEE status will result in the bidder not being eligible to claim preference points.A Tax Clearance Certificate and Declaration of Interest (WCBD 4) are mandatory requirements to conduct business with the Western CapeGovernment, failure to submit these will result in your immediate suspension on the WCSD. Your suspension will only be lifted when therelevant valid documentation is submitted. Whilst in suspension, companies will be regarded as non-compliant and no quotes or tendersof such companies will be considered.Construction/ Infrastructure service providers must submit originally certified copies of their amended CIDB certificate in the event of anychanges to their grading and/or classes of works to ensure that these amendments are effected on the WCSD.
PAGE 8CommodityDescription of Commodity GroupTick the applicable Commodity GroupGroupblock/s10000000 Live Plant and Animal Material and50000000Accessories and Supplies11000000 Mineral and Textile and Inedible Plant51000000and Animal Materials12000000 Chemicals including Bio Chemicals52000000and Gas Materials13000000 Resin and Rosin and Rubber and53000000Foam and Film and ElastomericMaterials14000000 Paper Materials and Products5400000015000000 Fuels and Fuel Additives andLubricants and Anti corrosiveMaterials20000000 Mining and Well Drilling Machineryand Accessories21000000 Farming and Fishing and Forestry andWildlife Machinery and Accessories8.22000000 Building and Construction Machineryand Accessories23000000 Industrial Manufacturing andProcessing Machinery andAccessories24000000 Material Handling and Conditioningand Storage Machinery and theirAccessories and Supplies25000000 Commercial and Military and PrivateVehicles and their Accessories andComponents26000000 Power Generation and DistributionMachinery and Accessories27000000 Tools and General MachineryCLASSIFICATION ON WESTERN CAPE SUPPLIER DATABASE30000000 Structures and Building andConstruction and ManufacturingComponents and Supplies31000000 Manufacturing Components andSuppliesDescription of Commodity GroupTick the applicableblock/sFood Beverage and Tobacco ProductsDrugs and Pharmaceutical ProductsDomestic Appliances and Supplies andConsumer Electronic ProductsApparel and Luggage and PersonalCare ProductsTimepieces and Jewelry andGemstone Products55000000 Published Products56000000 Furniture and Furnishings60000000 Musical Instruments and Games andToys and Arts and Crafts andEducational Equipment and Materialsand Accessories and Supplies70000000 Farming and Fishing and Forestry andWildlife Contracting Services71000000 Mining and oil and gas services72000000 Building and Facility Construction andMaintenance Services73000000 Industrial Production andManufacturing Services76000000 Industrial Cleaning Services77000000 Environmental Services78000000 Transportation and Storage and MailServices80000000 Management and BusinessProfessionals and AdministrativeServices81000000 Engineering and Research andTechnology Based Services82000000 Editorial and Design and Graphic andFine Art ServicesIN ORDER TO BE IDENTIFIED / SOURCED AS A POTENTIAL SERVICE PROVIDER, YOUR BUSINESS NEEDSTO BE CLASSIFIED CORRECTLY.32000000 Electronic Components and Supplies39000000 Electrical Systems and Lighting andComponents and Accessories andSupplies40000000 Distribution and ConditioningSystems and Equipment andComponents41000000 Laboratory and Measuring andObserving and Testing Equipment42000000 Medical Equipment and Accessoriesand Supplies43000000 Information Technology Broadcastingand Telecommunications83000000 Public Utilities and Public SectorRelated Services84000000 Financial and Insurance Services85000000 Healthcare Services86000000 Education and Training Services44000000 Office Equipment and Accessoriesand Supplies45000000 Printing and Photographic and Audioand Visual Equipment and Supplies46000000 Defense and Law Enforcement andSecurity and Safety Equipment andSupplies47000000 Cleaning Equipment and Supplies90000000 Travel and Food and Lodging andEntertainment Services91000000 Personal and Domestic Services48000000 Service Industry Machinery andEquipment and Supplies49000000 Sports and Recreational Equipmentand Supplies and Accessories94000000 Organizations and ClubsTick the appropriate block to indicate the correct classification of your company as a service provider:Goods &ServicesEngineering &ConstructionBuilt EnvironmentConsultant /Professional ServiceProviderEducation,Training &Development92000000 National Defense and Public Order andSecurity and Safety Services93000000 Politics and Civic Affairs Services95000000 Land and Buildings and Structures andThoroughfaresLegalServicesTo assist us in the categorization process and to ensure that your company is correctly classified, we requirea short summary of your core business and key words that best describe your business operations and anyspecializations.Our core business is:Key Words:For CIDB indicategrading: e.g. GB Grade 1Please submit certificateor website printoutSpecialization:
PAGE 9 ATrade Name:Legal Name:Co. Registered Code:Please tick the appropriate block (s) applicable to your core businessTickBlockCommodity listTickCommoditylist Machinery and their BlockMaterial Handling and Conditioningand StorageAccessories and SuppliesMaterial handling machinery and equipment2410Containers and storage2411Packaging materials2412Industrial nd Military and Private Vehicles and their AccessoriesLive Plant and Animal Material and Accessories and SuppliesLive animalsDomestic pet productsAnimal feedAnimal containment and habitatsSaddlery and harness goods10101011101210131014Seeds and bulbs and seedlings and cuttings1015Floriculture and silviculture productsFertilizers and plant nutrients and herbicidesPest control products101610171019Mineral and Textile and Inedible Plant and Animal MaterialsMinerals and ores and metalsEarth and stoneNon edible plant and forestry productsNon edible animal productsScrap and w aste materialsFibers and threads and yarns111011111112111311141115Fabrics and leather materials1116AlloysMetal oxideMetal w aste and scrap111711181119Pow er Generation and Distribution Machinery and AccessoriesPow er sources2610Batteries and generators and kinetic pow er transmission2611Electrical w ire and cable and harness2612Chemicals including Bio Chemicals and Gas MaterialsExplosive materialsPow er generation26131213Atomic and nuclear energy machinery and equipment2614Elements and gases1214AdditivesColorantsWaxes and oilsSolvents1216121712181219Compounds and mixtures1235Tools and General MachineryHand tools2711Hydraulic machinery and equipment2712Pneumatic machinery and s andBuildingand Construction and Manufacturing ComponentsandSuppliesComponentsMotor vehiclesMarine transportRailw ay and tramw ay machinery and equipment251025112512Aircraft2513SpacecraftNon motorized cyclesTransportation components and systemsVehicle bodies and trailersTransportation services equipmentAerospace systems and components and equipment251525162517251825192520Resin and Rosin and Rubber and Foam and Film and Elastomeric MaterialsRubber and elastomers1310Resins and rosins and other resin derived materials1311Structural materials and basic shapes3010Concrete and cement and plasterRoads and landscape30113012Paper Materials and ProductsPaper materialsPaper productsIndustrial use papersStructural building products3013InsulationExterior finishing materialsInterior finishing materials301430153016Fuels and Fuel Additives and Lubricants and Anti corrosive MaterialsFuels1510Gaseous fuels and additives1511Lubricants and oils and greases and anti corrosives1512Fuel for nuclear reactors1513Doors and w indow s and glass3017Plumbing fixturesConstruction and maintenance support equipmentPrefabricated structuresPermanent structures3018301930203022Mining and Well Drilling Machinery and AccessoriesMining and quarrying machinery and equipmentPortable Structures30232010Portable Structure Building Components3024Well drilling and operation equipment2011Oil and gas drilling and exploration equipmentOil and gas drilling and operation materialsOil and gas operating and production equipment201220132014Manufacturing Components and SuppliesCastingsExtrusionsMachined castings311031113112Farming and Fishing and Forestry and Wildlife Machinery and AccessoriesAgricultural and forestry and landscape machinery andequipment2110Fishing and aquaculture equipment2111Forgings3113MoldingsRope and chain and cable and w ire and strap31143115Building and Construction Machinery and AccessoriesHeavy construction machinery and equipmentHardw are3116Bearings and bushings and w heels and gears3117Gaskets and seals3118Grinding and polishing and smoothing materialsAdhesives and sealantsPaints and primers and finishesDyeing and tanning extractsMachined raw stockIndustrial opticsPneumatic and hydraulic and electric control systemsHousings and cabinets and casingsMachine made partsStampings and shee
Claim form (WCBD 6.1). The original, duly completed, registration form with accompanying documentation must be submitted to: Ariba SAP Africa, 4 Waterford Place, 2nd Floor, Century City, Cape Town Ariba PO Box 1207, Cape Town, 8000 Direct enquiries to the Western Cape Supplier Database Helpdesk - Tel: 0861 – 225577 or
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