Nationality. Black. White. Coloured. Asian d. Gender. Female. Male e. Is there equity ownership by previously .... (Plea
REQUEST FOR INFORMATION FORM - RFI
Dear Supplier
The University of Johannesburg values its Supplier relationships and wishes to ensure that information about your company/organization is accurately reflected on our system. We request you to complete all details on this RFI form and provide us with the requested documents. This is a non binding document. The completed form can be emailed to
[email protected] cc: UJ requestor
Mandatory Documents to be submitted: 1. VAT Registration Certificate 2. Company Registration Documents 3. Valid Tax Clearance Certificate 4. Cancelled cheque or Bank Statement Header or Approved letter from your Bank to enable us to verify your company banking details 5. Certified ID copies of Directors 6. Valid B-BBEE Certificate 7. Declaration of Interest 8. Latest Audited Financial Statement 9. Accreditation Certificates (Where Applicable) Conditions of Application The supplier must:
Annually confirm the particulars provided in this form (Ownership) Notify UJ of any changes of particulars relating to the existing information Be free from any restriction of trade in South Africa Annually provide valid, original Tax Clearance certificate, upon expiry of the previous certificate. (The supplier will be inactivated on the date of expiry of Tax clearance certificate) Every two years the supplier must renew their registration on the UJ Database.
1
Supplier Information 1
Supplier Name
2
Trading Name (If Applicable)
3
Company Registration Number
4
VAT Registration Number
5
Products / Services offered
6
Standard Industrial Code - SIC (If Applicable)
7
Postal address
8
Physical address
9
Web Site Address
10
Contact Details for Sales Name Designation Phone Number (incl area code) Fax Number (incl area code) Mobile Number Email Company / Generic Email 2
11
Contact Details for Payments Name Designation Phone Number (incl area code) Fax Number (incl area code) Remittance advice email address
12 a.
Payment Information Please indicate Account Type.
Savings
b.
Cheque
Transmission
Provide the remittance mailing address and bank information.
Mailing Address
Account Name
Bank Name
Account Number
Branch Name and Address
Branch Number Account Currency please select:
ZAR USD GBP EUR 3
Other
13 Payment Terms a.
b. c.
d.
University of Johannesburg’s General Payment terms are 30 days after date of statement. Do you accept these terms?
Please tick applicable If no what would your terms be? Does your company give Trade discount? If “Yes” what percentage trade discount is offered?
Yes
No
Yes
No
Yes
No
14
Does your company give Payment discount? If “Yes” Terms and Percentage offered e.g. 2.5% settlement discount at payment 30 days after statement. Ownership: B-BBEE Information
a.
Name and Surname
b.
RSA Citizen
Yes
No
ID No.
c.
Nationality
Black
White
Coloured
d.
Gender
Female
e. f.
Is there equity ownership by previously disadvantaged individuals? Yes No What is the percentage of Black ownership? (Attach Proof of Ownership)
g.
What is the percentage of Black Women ownership? (Attach proof of Ownership
15
B-BBEE Rating Level
a.
Current B-BBEE Rating When does current B-BBEE Rating expire
e.
b.
Yes (Attach a copy)
4
Asian
Male
No (Specify by when)
c.
16 a.
17 a. b. c. d. e. f. 18
19
20
Are you a Value adding supplier? Value adding as defined Legally)
Yes
No
Joint Ventures Is this a Joint Venture entity? (If “Yes” Yes provide separate application forms for both companies and attach the Joint Venture agreement indicating liability and profit sharing of the Joint Venture. Business Type Start-up Company (
