SUPPLIER DATABASE REGISTRATION FORM

Registration of prospective suppliers is done according to the following prescripts:

1. Preferential Procurement Policy Framework Act No. 5 of 2000.

2. Preferential Procurement Regulations (of November 2022)
3. Local Government Municipal Finance Management Act No. 56 of 2003
4. Drakenstein Municipality’s Supply Chain Management Policy and Preferential Procurement
Policy as approved by Council from time to time

Supplier database registration forms must be forwarded to the following address:

Postal address Hand delivery

Drakenstein Municipality Drakenstein Municipality
PO Box 1 Civic Centre, 2nd floor
Paarl Berg River Boulevard
7622 Paarl
GPS Coordinates: 33° 44’13”S, 18°58’04” E

For any further enquiries please contact the Supply Chain Management Unit by means of the following:

Contact persons Tel no Email address

Chanelle Cupido (021) 807-4780 supplychain@drakenstein.gov.za

SUPPLIER DATABASE REGISTRATION FORMS THAT ARE FAXED OR EMAILED WILL NOT BE ACCEPTED.

PLEASE NOTE
1. This form must be fully completed, only with a black pen, signed, stamped where requested, and
placed together with supporting documentation as indicated in the sections below.
2. The use of correction fluid is prohibited. All alterations must be initialled.
3. It is the responsibility of the supplier to supply the municipality with all updated information. The
municipality will not be held liable for incorrect information supplied.
4. Registration on Drakenstein Municipality’s supplier database does not guarantee business
opportunities with the municipality.
5. Prospective suppliers are limited to register for six sub-categories of goods, services and
construction works, which must be consistent with its main line of business.
6. All supplier information will be treated strictly confidential.
 7. Prospective suppliers must familiarise themselves with the content of Drakenstein Municipality’s
Supply Chain Management Policy which can be viewed on the municipality’s website.
8. This registration form is also available at:
http://www.drakenstein.gov.za/docs/Documents/DM%20Database%20Registration%20Form_201
9.pdf
9. Fraud Hotline: 0800 555 337 or drakenstein@whistleblowing.co.za

SECTION 1: BASIC SUPPLIER INFORMATION

Registered business name of
supplier

Trading name of supplier

Line 1
Line 2
Registered physical address
Line 3
Town/ city Postal
code
Line 1
Line 2
Registered postal address
Line 3
Town/ city Postal
code
Preferred language Mark the appropriate box English Afrikaans

SECTION 2: SELECTION OF CATEGORIES OF GOODS, SERVICES OR CONSTRUCTION WORKS

Please complete this section by selecting the appropriate sub-categories of goods, services or construction
works for which the enterprise wishes to register for. PLEASE NOTE THAT ENTERPRISES ARE LIMITED TO
SELECT ONE MAIN CATEGORY AND THEN SIX SUB-CATEGORIES UNDER THAT MAIN CATEGORY, AS LISTED
BELOW. Enterprises must select those sub-categories that links with its main line of business.

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 Mark Mark
CONSTRUCTION EQUIPMENT
10000 with 20000 CONSTRUCTION SERVICES with
AND SUPPLIES
“x” “x”
10010 Air conditioning and
temperature control equipment 20010 Burglar proofing and systems
10011 Aluminium products 20020 Concrete manufacturing and works
10012 Aluminium doors installation,
supplies 20030 Construction related transport
10020 Building equipment and
accessories (cement mixers etc) 20031 Cabinet makers
10030 Building materials (brick,
cement, sand etc) 20032 Carpenters
10040 Ceiling boards, skirtings,
cupboard material 20033 Civil construction services
10050 Construction machinery 20034 Ceilings and partition makers
10051 Concrete products 20035 Steel construction services
10052 Concrete furniture 20040 Demolition services
10060 Doors and windows 20050 Earthworks, drilling and landscaping
10070 Electrical systems, lighting,
components and accessories 20060 Electrical installation
10071 Electrical doors and gates,
booms 20070 Fencing
10071
A Fencing material 20080 General building works
10072 Galvanised products (poles etc) General cleaning of sites (erven,
20081 parks, etc)
10075 Hardware and material (paint General cleaning works (cutting of
brushes etc) 20083 trees)
10076 Glass 20084 General cleaning of alien vegetation
10077 Gas and welding consumables 20085 General cleaning of fire belts
10078 Ladders 20090 Glazing
10079 Lime 20100 Mechanical services
10080 Flooring materials (carpets, tiles,
etc) 20110 Metalwork
10081 Floor maintenance 20120 Painting
10090 Plumbing ware and materials 20130 Paving
10091 Paint supplies 20140 Plumbing
10100 Roofing materials 20150 Pre-cast concrete manufacturing
10110 Sanitation ware and equipment 20160 Pump installation

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10111 Steel supplies 20170 Road works
10112 Tools and equipment 20171 Re-enamelling and plumbing
10113 Wheels, castors, trolleys 20172 Roof and thatches
10114 Solar water heaters 20180 Sewerage systems and construction
ELECTRICAL, ENGINEERING AND Mark
30000 MECHANICAL EQUIPMENT with
SERVICES AND SUPPLIES “x” 20190 Waterworks and pipelines
30010 Bearing supplies 20191 Welding
30020 Bolts, nuts and fasteners 20200 Vibacrete construction
Mark
40000 GENERAL SERVICES with
30021 Boiler services and installations “x”
30025 Coil springs and engineering 40010 Accommodation and lodging
Advertising, communication, design,
30030 Electric cables 10020 editorial etc
30040 Electrical component supplies 40021 Animals and veterinary services
Arts and crafts and promotional
30041 Electrical distribution boards 40022 items
Audio-visual equipment, projectors,
30042 Electrical and electronics 40023 speakers monitors
30043 Electrical circuit breakers 40030 Auctioneering services
30050 Electrical component repairs 40031 Agriculture: Gardening services
Engineering component
30051 suppliers 40032 Agriculture: Compos supply
30059 Hiring services 40033 Agriculture: Plants and nursery
Hiring of equipment, plant and
30060 vehicles 40034 Agriculture: Turf/ lawn supplies
30061 Irrigation services 40035 Agriculture: Poles, droppers etc
Installation and servicing of Agriculture: Support and
30062 burners, boilers, aircons and gas 40036 development
Electronic instruments and
30063 equipment 40037 Agriculture: Sport grounds
Bookkeeping and accounting
30064 Electrical kiosks 40040 services
30065 Laboratory testing 40041 Biotechnology services
30070 Lifting equipment 40042 Beautician
30071 Lighting supplies 40043 Books and libraries
30071
A Festive lighting supplies 40044 Badges, engravings and trophies

4
 Ground probe radar (water leak
30072 detection etc) 40045 Bicycles
30080 Mechanical seals and packing 40046 Books repair
Catering and refreshments
30081 Mechanical plant repairs 40050 (certificate required)
Electrical and water meter
30082 supplies 400501 Catering: Restaurants
30083 Nets and covers 40051 Chemicals for plants and trees
Chemicals and environmental
equipment for waterworks
30090 Pipe and irrigation supplies 40052 laboratory
30091 Poles supply 40054 Canvas
Playground equipment repairs
30092 and supplies 40055 Car wash
Generators and distribution
30100 machinery supply 40056 Carports and shades
Repair and supply of pump
30110 spares 40060 Cleaning services
30111 Rewinders 40061 Clothing: Protective
30112 Refrigerations 40062 Clothing: Corporate
30113 Repair of electrical appliances 40063 Cleaning products
30114 Rigging 40064 Clothing repair
30120 Small tools 40065 Clothing material
Conferencing facilities and
30122 Substations equipment 40070 facilitation
Supply of steel containers and
30130 Transformer services 40071 renovations
Telecommunication (radio's and
30131 electronics) 40080 Cellular services
30132 Tar/ asphalt 40090 Courier services
Crockery, cutlery and catering
30133 Trailer hiring and manufacturing 40091 equipment
30140 Valves and couplings 40092 Concrete stairs
Water meters, pipes, fittings,
30150 PVC, Polyethylene 40100 Diving equipment
Waterproofing of concrete
30151 structures 40101 Driving schools
Weighbridge equipment
30152 supplies and repairs 40110 Environmental impact studies

5
 Environmental products, equipment
30153 Wheels and castors 40111 and services
Engineering manufacturing,
30160 welding etc. 40120 Freight forwarding
30170 Water and waste management 40121 Firefighting equipment
Mark
OFFICE AND FACILITES
50000 with
EQUIPMENT AND SUPPLIES
“x” 40122 Funeral services
Computer equipment, networks
50010 and software 40123 Food wholesalers
50011 IT, internet and media law 40124 Flags and banners
50020 Consumables 40125 Fast foods and food parcels
50030 Corporate gifts 40126 Fibreglass cubicles
50050 Electronic equipment 40127 Field mark paint
Supply of flowers and plants and
50100 Office furniture and equipment 40128 hiring of artificial flowers
Printing, copying and
photographic equipment and
50120 supplies 40129 Framing of photos
50130 Printer repairs and service 40130 General maintenance services
Mark
600000 EVENTS MANAGEMENT with
“x” 40131 Gas
600001 Audio and sound 40140 Health care
600002 Management of events 40141 Hiring: Linen, crockery, cutlery etc
600003 Tents 40142 Hiring: Toilets
600004 Video productions 40143 Hiring: Scaffolding
600005 Hiring of cutlery and crockery 40144 Hiring: Trailers
600006 Puppets/ caberetts 40149 Professional nursing services
600007 Tables and chairs 40150 Horticulture
Training on events, video, films
600008 and reproductions 40160 Infrastructure maintenance
600009 Music band and singers 40170 Inspection services
600010 Story tellers 40180 Insurance
Mark
70000 PROFESSIONAL SERVICES with
“x” 40181 Jewellery
Accounting, auditing and Broadcasting and
70010 management services 40190 telecommunication services
70011 Banking service 40191 IT and component supplies

6
 Interior decorating, refurbishment
70020 Architectural services 40200 and upholstery
70021 Attorney services 40201 Interior decorating: Blinds
Consulting engineering: Interior decorating: Laying of
70030 Electrical 40202 carpets and flooring
Consulting engineering:
70040 Environmental 40210 Land valuation services
70050 Consulting engineering: Civil 40220 Laundry and dry-cleaning services
Consulting engineering: Project
70060 Management 40230 Locksmith services
Consulting engineering: Roads
70070 and Storm water 40231 Liquors and beverages
Consulting engineering:
70080 Sewerage system 40232 Licence fees
Consulting engineering:
70090 Structure, buildings and bridges 40233 Media distributors
Consulting engineering: Water
70100 system 40240 Mailing services
Consulting engineering: Geo-
70110 technical 40241 Mattresses and beds
Consulting engineering: Solid
70120 waste 40250 Mobile facilities
Consulting engineering: Medical services (paramedical/
70121 Property development 40260 ambulances)
70130 Engineering services 40261 Parking meters
70140 Deed registrars 40262 Pharmacies
70141 Debt collectors 40263 Medical and goods supplies
70142 Asset management 40264 Pre-paid vendors
70150 Land surveying 40265 Laboratories tests and equipment
Aerial and photographic
70151 surveying 40270 Personnel services
70160 Legal services: Contracts 40280 Pest control and removal services
Photographic and graphic design
70170 Legal services: Conveyancing 40290 services
70180 Legal services: Litigation 40291 Photocopiers (hiring and leasing)
70190 Legal services: Other 40300 Picture framing
70191 Legal services: Labour law 40301 Plastic products
Consulting engineering:
70200 Mechanical 40302 Plastic garden furniture accessories
70210 Medical services 40303 Plating

7
70211 HIV/ AIDS management 40310 Printing
70212 Injury on duty claims 40311 Paper: Toilet etc
70221 Property valuers 40312 Paper products
70230 Quantity surveyors 40313 Pool maintenance and products
70231 Recruitment 40320 Removal: Rubble and refuse
70232 Marketing 40321 Removal: Bees
70240 Town and regional planning 40322 Removal: Furniture etc
Consulting: Business
70250 development 40330 Real estate services
Specialist sports turf
70251 development 40331 Repair of pianos
70252 Tourism 40332 Recycling
Training: Human resource
70257 management and organisation 40333 Rubber products
70260 Training: Computers 40340 Research services
70261 Training: Skills development 40341 Renovation of sport fields and parks
70262 Training: Education 40350 Security and safety services
Sandblasting of glass and
70263 Training: Outdoor adventure 40351 equipment
70264 Training: Health and first aid 40352 Scrap metal dealers
70265 Training: Fire and health 40353 Safety products
Training: Performance and risk
70266 management 40360 Security guards
Training: Electrical, building and Security: CCTV, alarms and
70267 construction 40361 accessories
70268 Training: Agricultural 40362 Sport facilitators and equipment
Training: Lifting equipment,
70269 cranes and truck mounted 40370 Social facilitations
Training: Chainsaw, brush
70270 cutters etc 40372 Shelving (industrial storage)
70271 Training: Youth development 40375 Stationary
Training: Community
development, sewing and
70272 clothing 40376 Steel containers
70273 Training: Security officers 40377 Scales: Electronic
Training: Traffic and drivers
70274 courses 40380 Storage
70280 Personnel agency 40381 Signs
Consulting services: Health and
70300 safety 40383 Tools and equipment

8
 Consulting services: Economic
70301 development 40384 Tower clock supplies and repairs
Consulting services: Business Translation and interpreting
70302 skills development 40390 services
Consulting services: Criminal
70303 investigation 40400 Transport: Buses
70304 Consulting services: Education 40401 Transport: Mini buses
Consulting services: Labour
70305 dispute adjudication 40402 Transport: General services
Consulting services: Rating
70306 agency 40403 Transport: Tourism
Consulting services: Tender
70307 management 40410 Travel services
Consulting services: Planning Traffic books, equipment and
70308 and records management 40411 repairs
Consulting services: Landscape
70309 and environmental planning 40412 Typists
Consulting services: Home and
70310 organic project management 40430 Vending services
Consulting services: Insurance
70311 brokers and financial services 40431 Ventilation equipment supplies
Consulting services: Health
70312 (Dietician) 40440 Water purification
Consulting services: Legislation Weed killers and fertilizer supply
70313 and management 40450 and spraying
VEHICLE SUPPLY AND Mark
80000 TRANSPORTATION SERVICES with
AND EQUIPMENT “x” 40460 Water treatments
Wendy houses supply and
80010 Alarm and tracking systems 40470 installation
80011 Auto electrical repairs 40551 Music equipment, sound and audio
Construction equipment supply,
80012 repair and testing List any other commodities that are not listed above:
80020 Batteries
80021 Cranes
80022 Canopies
80030 Engine overhauls
80031 Exhaust repairs
Mechanical equipment (small
80032 plant)

9
80040 Fuel, oils and lubrication
80041 Gearbox repairs
80042 Fleet management
80050 Hydraulics
80051 Mechanical workshops
80052 Mowers
80053 Motor cycles
Manufacturing and respraying of
80054 trailers
80060 Panel beating
80070 Radiator repairs
80080 Spares and parts
80090 Towing services
80091 Testing equipment
Toolboxes, ladder racks, ropes,
80092 wooden panels etc
80100 Transmissions
80101 Supply and repair of trucks
80110 Tyres and tubes
80120 Upholstery
80130 Vehicle fleet management
80140 Vehicle supply
Hiring of vehicle and mechanical
80145 plant
80150 Windscreens
80160 Waste oil collectors

10
SECTION 3: BANKING INFORMATION

Attach a valid Bank Confirmation letter, not older than 3 months, registered in the Company Name.

SECTION 4: COMPANY, TAX AND B-BBEE INFORMATION

(Attach a valid Tax Compliance Status PIN and certified copy of B-BBBE certificate)

Income tax
VAT registration number
number
Expiry date of tax compliance status Tax Compliance
pin Status PIN
Business registration number
Central Supplier Database Registration
Number (CSD)
B-BBEE status level of contribution
Issue date of B-BBEE certificate or Expiry date
Affidavit

SECTION 5: CONTACT DETAILS

Contact person Tel Fax
Sales person no
Tel no
Fax
no
Tel no
Fax
Accounts person
Email address no no

Web address

SECTION 6: DECLARATION OF BIDDER’S PAST SUPPLY CHAIN MANAGEMENT PRACTICES

1. This serves as a declaration to be used by municipalities and municipal entities in ensuring that
when goods and services are being procured, all reasonable steps are taken to combat the abuse
of the supply chain management system.

2. The bid of any bidder may be rejected if that bidder, or any of its directors have:
a. abused the municipality’s / municipal entity’s supply chain management system or
committed any improper conduct in relation to such system;
b. been convicted for fraud or corruption during the past five years;

11
 c. willfully neglected, reneged on or failed to comply with any government, municipal or
other public sector contract during the past five years; or
d. been listed in the Register for Tender Defaulters in terms of section 29 of the Prevention
and Combating of Corrupt Activities Act (No 12 of 2004).

3. In order to give effect to the above, the following questionnaire must be completed and
submitted:
3.1 Is the bidder or any of its directors listed on the National Treasury’s Database of Yes No
Restricted Suppliers as companies or persons prohibited from doing business with the
public sector?
(Companies or persons who are listed on this Database were informed in writing of this
restriction by the Accounting Officer/Authority of the institution that imposed the
restriction after the audi alteram partem rule was applied). The Database of Restricted
Suppliers now resides on the National Treasury’s website (www.treasury.gov.za) and can
be accessed by clicking on its link at the bottom of the home page.
3.1.1 If so, furnish particulars:

3.2 Is the bidder or any of its directors listed on the Register for Tender Defaulters in terms Yes No
of section 29 of the Prevention and Combating of Corrupt Activities Act (No 12 of 2004)?
The Register for Tender Defaulters can be accessed on the National Treasury’s website
(www.treasury.gov.za) by clicking on its link at the bottom of the home page.
3.2.1 If so, furnish particulars:

3.3 Was the bidder or any of its directors convicted by a court of law (including a court of Yes No
law outside the Republic of South Africa) for fraud or corruption during the past five
years?
3.3.1 If so, furnish particulars:

3.4 Does the bidder or any of its directors owe any municipal rates and taxes or municipal Yes No
charges to the municipality / municipal entity, or to any other municipality / municipal
entity, that is in arrears for more than 90 days?
3.4.1 If so, furnish particulars:

3.5 Was any contract between the bidder and the municipality / municipal entity or any Yes No
other organ of state terminated during the past five years on account of failure to
perform on or comply with the contract?
3.5.1 If so, furnish particulars:

12
SECTION 7: DISCLOSURE OF STATE AND MUNICIPAL INTERESTS

(a) This document serves as a declaration to be used by the municipality in ensuring that when
goods and services are being procured, all reasonable steps are taken to combat the abuse of
the supply chain management system. No Registration will be accepted from persons in the
service of the state*.

(b) In view of possible allegations of favouritism, should a resulting bid, or part thereof, be awarded
to suppliers connected with or related to persons in the service of the state, it is required that
the supplier or his/her authorised representative declare their position in relation to the
evaluating/adjudicating authority and/or take an oath declaring his/her interest.

(c) The request for registration on the municipality’s database may be rejected if the supplier, or
any of its directors/members/partners have:
(i) abused the municipality’s supply chain management system or committed any improper
conduct in relation to such system;
(ii) been convicted for fraud or corruption during the past five years;
(iii) wilfully neglected, reneged on or failed to comply with any government, municipal or other
public sector contract during the past five years;
(iv) being a person whose tax matters are not cleared by the South African Revenue Services; or
(v) been listed in the Register for Tender Defaulters in terms of section 29 of the Prevention and
Combating of Corrupt Activities Act (No 12 of 2004).
-----------------------------------------------------------------------------------------------------------------------------------
¹MSCM Regulations: “in the service of the state” means to be –
(a) a member of –
(i) any municipal council;
(ii) any provincial legislature; or
(iii) the national Assembly or the national Council of provinces;
(b) a member of the board of directors of any municipal entity;
(c) an official of any municipality or municipal entity;
(d) an employee of any national or provincial department, national or provincial public entity or
constitutional institution within the meaning of the Public Finance Management Act, 1999 (Act
No.1 of 1999);
(e) a member of the accounting authority of any national or provincial public entity; or
(f) an employee of Parliament or a provincial legislature.
² Shareholder” means a person who owns shares in the company and is actively involved in the
management of the company or business and exercises control over the company.

13
(d) In order to give effect to the above, the following questionnaire must be completed and
submitted:
i. Full name of supplier’s representative:……………………..………………………………..

ii. Identity Number: ………………………………………………………………………………….

iii. Position occupied in the Company (director, trustee, shareholder²):………………………..

iv. Company Registration Number: ……………………………………………………………….

Name of director / trustees / Identity number of director / trustees Person’s current place of
members / shareholders in the / members / shareholders in the employment
company company

v. Tax Reference Number:…………………………………………………………………………

vi. VAT Registration Number: ……………………………………………………………………

vii. The names of all directors / trustees / shareholders members, their individual identity numbers
and state employee numbers must be indicated in paragraph (d) below
viii. Is any of the enterprise’s directors, managers, or principal shareholders presently in the service
of the State? YES □ / NO □
If yes, please complete the following table:

Name of person currently in the Identity number of person Person’s current position
service of the state currently in the service of the state within the enterprise

ix. Has a director, manager, principal shareholder of your enterprise been in the service of the state,
during the previous twelve months? YES □ / NO □

14
 If yes, please complete the following table:

Name of person who was Name of state employer of Job title of person who State
in the service of the state person who was in the service of was in the service of the employee
during the past 12 months the state during the past 12 state during the past 12 number
months months

x. Do you have any relationship (family, friend, other) with persons in the service of the state and
who may be involved with the evaluation and or adjudication of bids/ quotations? YES □ / NO □
If yes, furnish particulars: …………………………………….……..………………………………………………………
………………………………………………………..……………………………….……………….…………………………………

xi. Are you, aware of any relationship (family, friend, other) between any other bidder and any
persons in the service of the state who may be involved with the evaluation and or adjudication
of bids/ quotations? YES □ / NO □
If yes, furnish particulars……………………………………………………………………………………………….……
……………………..……………………………….……..................................................................................

xii. Are any of the company’s directors, trustees, managers, principle shareholders or stakeholders
in service of the state? YES □ / NO □
If yes, furnish particulars: ………………………………………………………………………..…………………………...
…………………………………………………………………………………………………………………..………………………….
xiii. Are any spouse/ domestic partner, child/grandchild/dependent or
parent/grandparents/parents-in-law or brother/sister/brother-in-law/sister-in-law of the
company’s directors, trustees, managers, principle shareholders or stakeholders in service
of the state? YES □ / NO □

d) Full details of directors / trustees / members / shareholders.

Name of person Your relation to the Name of employer of Job title of person State
currently in the person in the person in the service in the service of the employee
service of the state service of the state of the state state number

15
SECTION 8: CERTIFICATE FOR MUNICIPAL SERVICES AND PAYMENTS TO SERVICE PROVIDERS

PLEASE SELECT ONE OF THE FOLLOWING OPTIONS THAT ARE APPLICABLE TO YOUR MARK
ENTERPRISE AND FOLLOW FURTHER INSTRUCTIONS AS INDICATED BELOW WITH “X”
Part A: Property owned by enterprise or directors
Part B: Property leased by enterprise or directors
Part C: Where property is not owned or leased by enterprise or directors

PART A: PROPERTY OWNED BY ENTERPRISE OR DIRECTORS

ATTACH COPY OF MUNICIPAL ACCOUNT(S) NOT OLDER THAN 90 DAYS

PART B: PROPERTY LEASED BY ENTERPRISE OR DIRECTORS

Please attach a sworn affidavit or a copy of your lease agreement if the property is leased by the enterprise
or the proprietors or directors in their personal capacity, for which the aforementioned is not responsible
for payment of municipal rates and taxes.

PART C: WHERE PROPERTY IS NOT OWNED OR LEASED BY ENTERPRISE OR DIRECTORS

Please attach a sworn affidavit from the proprietor or director of the enterprise confirming the locality of the
business enterprise and that the enterprise does not own or lease any property and that the aforementioned
is not responsible for payment of any municipal rates and taxes.

I,……………………………………………………………………………………., the undersigned, certify that the information

furnished on this declaration form is correct and that I/we have no undisputed commitments for municipal
services towards a municipality or other service provider in respect of which payment is overdue for more than
90 days.

.......................................................... ……………………………
Signature for and on behalf of supplier Date

16
SECTION 9: BUSINESS TYPE (Attach proof where applicable)
Type Required documentation to be attached for each business Tick
type
Attach certified copy of company registration documents box
Public Company Ltd
Attach certified copies of identity documents of all directors
Business Attach certified copy of company registration documents
Private Company (Pty) Ltd
type Attach certified copies of identity documents of all directors
(tick the Close Corporation Attach certified copy of CC’s registration documents
appropriate Attach certified copies of identity documents of all members
box and Sole Proprietor Attach certified copy of ID Document
attach the Partnership Attach certified copy of partnership agreement
required Attach certified copies of identity documents of all partners
Attach certified copy of trust document
documents) Trust
Attach certified copies of identity documents of all trustees
NGO’s/ NPO’s Attach certified copy of Constitution

SECTION 10: OTHER REGISTATION PARTICULARS (Attach proof as indicated below)

Construction Industry Development Board
(CIDB) registration number
Building Industry Bargaining Council (BIBC)
(Attach certificate or letter of good
standing)
Caterers (Attach a copy of food handling Halaal caterers (Attach a copy of
certificate as issued by Cape Winelands Yes No Halaal certificate as issued by the Yes No
District Municipality) Muslim Judicial Council)
Training providers (attach
ASATA registration number
accreditation documents as training Yes No
(for travel industry)
providers)
PSIRA registration number CESA registration number (for
(for security related industry) consulting engineering industry)

SECTION 11: DECLARATION OF CORRECTNESS OF INFORMATION PROVIDED

I / we the undersigned, warrant that I am/we are duly authorised to do so and on behalf of
_________________________________________________________________ (name of business)

declare that:

1. The information contained in this document and all attached hereto is correct;
2. No municipal rates and taxes or municipal service charges owed by the supplier or any of its
directors to any municipality/ municipal entity, are in arrears for more than three (3) months;

17
 3. It is noted that Drakenstein Municipality may utilise tools at its disposal to verify all information
contained and attached hereto;
4. All copies of relevant documentation are attached as indicated under each section;
5. If there are any changes to the information supplied on this document, that I/we will inform the
Supply Chain Unit of Drakenstein Municipality in writing within ten (10) working days of any
changes; and
6. Should any information as provided prove to be false, that Drakenstein Municipality will act
against me/us.
7. Consent is given to Drakenstein Municipality to use any personal information, as provided within
the supplier database registration form, by you and contained herein for the purpose of
registering your business on the Drakenstein Municipality’ supplier database as an accredited
prospective provider.

If the information supplied is found to be incorrect then the Drakenstein Municipality in addition to any
remedies it may have, may:
1. disqualify the supplier/applicant for a particular bid/contract/project it may be considered for,
or which had been awarded to the supplier/applicant;
2. recover from the supplier all costs, losses or damages incurred or sustained by the municipality
as a result of the award of the contract, and/or;
3. cancel the contract and claim any damages which the municipality may suffer by having to make
favourable arrangements after such cancellations, and/or;
4. de-register the supplier from the supplier database and/or;
5. list the supplier on National Treasury’s database of restricted suppliers; and/or;
6. take any other action as may be deemed necessary.

PLEASE ENSURE THAT ALL SUPPORTING DOCUMENTATION AS INDICATED PER SECTION IS ATTACHED
HERETO
Full name of duly authorised representative: _________________________________

Signature: ___________________________________________________________

Capacity: ___________________________________________________________

Date: _______________________________________________________________

18
COMMISSIONER OF OATHS

Signed and sworn to before me at …………………………………………..…………. on this ……………………………………….. day

of …………………………………. 20….. by the deponent, who has acknowledge that he/she knows and understands
the contents of this affidavit, that all content contained herein and attached hereto is true and correct to the
best of his/her knowledge and that he/she has no objection to taking the prescribed oath, and that the
prescribed oath will be binding on his/her conscience.

……………………………………………………..
COMMISSIONER OF OATHS

Position:
………………………………………………………………………………………….

STAMP OF COMMISIONER
OF OATHS

Address:.………………………………………………………………………………………………………………………….…………

………………………………………………………………………………………..……………………………………………….…………

Tel:…………………………………………………………………………/……………………………………………………….…………

19
 SWORN AFFIDAVIT – B- BBEE EXEMPTED ENTERPRISE

I, the undersigned,
Full name & Surname
Identity number

Hereby declare under oath as follows:

1. The contents of this statement are to the best of my knowledge a true reflection of the facts.
2. I am a member / director / owner of the following enterprise and am duly authorised to act on its
behalf:
Enterprise Name
Trading Name
Registration Number
Enterprise Address

3. I hereby declare under oath that:

• The enterprise is ______________% black owned;
• The enterprise is ______________% black woman owned;
• Based on the management accounts and other information available on the _______financial
year, the income did not exceed R10,000,000.00 (ten million rands);
• Please confirm on the table below the B-BBEE level contributor, by ticking the applicable box.
100% black owned Level One (135% B-BBEE procurement recognition)

More than 51% black Level Two (125% B-BBEE procurement recognition)
owned
Less than 51% black Level Four (100% B-BBEE procurement
owned recognition)

4. The entity is an empowering supplier in terms of the dti Codes of Good Practice.
5. I know and understand the contents of this affidavit and I have no objection to take the
prescribed oath and consider the oath binding on my conscience and on the owners of the
enterprise which I represent in this matter.
6. The sworn affidavit will be valid for a period of 12 months from the date signed by
commissioner.
Deponent Signature: ____________________________

Date: ______________
________________________________
Commissioner of Oaths
Signature & stamp

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 SWORN AFFIDAVIT – B- BBEE QUALIFYING SMALL ENTERPRISE
I, the undersigned,
Full name & Surname
Identity number

Hereby declare under oath as follows:

1. The contents of this statement are to the best of my knowledge a true reflection of the facts.
2. I am a member / director / owner of the following enterprise and am duly authorised to act on its
behalf:
Enterprise Name
Trading Name
Registration Number
Enterprise Address

3. I hereby declare under oath that:

• The enterprise is ______________% black owned;
• The enterprise is ______________% black woman owned;
• Based on the management accounts and other information available on the _______financial
year, the income did not exceed R50,000,000.00 (fifty million rands);
• The entity is an Empowering Supplier in terms of Clause 3.3 (a) or (b) or (c) or (d) or as
amended 3.3 (e) (select one) ________ of the dti Codes of Good Practice.
• Please confirm on the table below the B-BBEE level contributor, by ticking the applicable
box.
100% black owned Level One (135% B-BBEE procurement
recognition)
More than 51% black Level Two (125% B-BBEE procurement
owned recognition)

(a) At least 25% of cost of sales, (excluding (b) Job Creation – 50% of jobs created are
labour costs and depreciation) must be for black people, provided that the number
procured from local producers or suppliers in of black employees in the immediate prior
South Africa; for the services industry verified B-BBEE measurement is maintained
include labour costs but capped at 15%
(c) At least 25% transformation of raw (d) At least 12 days per annum of
material / beneficiation which include local productivity deployed in assisting QSE and
manufacturing, production and / or EME beneficiaries to increase their
assembly, and / or packaging. operation or financial capacity
(e) At least 85% of labour costs should be paid to South African employees by service industry
entities.

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 4. I know and understand the contents of this affidavit and I have no objection to take the
prescribed oath and consider the oath binding on my conscience and on the owners of the
enterprise which I represent in this matter.
5. The sworn affidavit will be valid for a period of 12 months from the date signed by
commissioner.

Deponent Signature: ____________________________

Date: ______________

________________________________
Commissioner of Oaths
Signature & stamp

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