SERVICES SETA SUPPLIER REGISTRATION APPLICATION FORM

The Supply Database Administrator (SCM Unit) 1 Sherborne Road Parktown 2193 Telephone: +27(11) 276 9600 Email Address: procurement@servicessetaorgza SERVICES SETA SUPPLIER REGISTRATION APPLICATION FORM Attention: Name of the Applicant: SSETA Physical Address: Closing Date: Closing Time: Description: Procurement Manager 1 Sherborne Road Parktown 2193 INVITATION FROM SERVICES SECTOR EDUCATION AND TRAINING AUTHORTY (Services SETA) TO ALL SERVICES AND PRODUCTS SUPPLIERS TO REGISTER ON ITS DATABASE AS APPROVED VENDORS Delivery Address: SERVICES SECTOR EDUCATION AND TRAINING AUTHORTY The Supply Database Administrator (SCM Unit) 1 Sherborne Road Parktown 2193

DOCUMENT REQUIRED CATEGORY OF SUPPLIER TICK THE RELEVANT BOX INDICATING SUBMISSION OF THE REQUIRED DOCUMENTS Original cancelled cheque or stamped letter from the bank, verifying the banking details of your business All Suppliers Certified copy of your business registration documents if you are incorporated as a partnership, close corporation or a company Certified copies of the ID documents of directors and shareholders / partners / members / sole proprietor A valid and original tax clearance certificate Proof of registration with the UIF (ie reference number issued by the UIF) Proof of professional registration, accreditation or a copy of any other registration certificate pertaining to your relevant industry, eg ECB (Electrical Contractors Board) A copy of the CIDB (Construction Industry Development Board) certificate NB: You can contact the CIDB on +27 12 482 7200 or +27 086 100 CIDB, or visit wwwcidborgza for information and registration You are also required to obtain the document entitled Code of Conduct for all parties engaged in construction procurement from the CIDB Supporting documentation confirming the points scored regarding each element of the applicable scorecard, as used by the relevant verification agency An Affidavit from the Police Confirming disability Latest verified annual financial statements confirming annual turnover, Net Profit Before Tax (NPBT) and total cost of labour NB: Financial statements must be verified by an auditor for a company or a certified accounting officer for a close corporation, partnership or sole proprietorship Letter signed off by an auditor or a certified accounting officer confirming shareholding of the entity The auditor or certified accounting officer must also confirm that the company is a startup or newly formed where the company is unable to produce Financial statements All Suppliers All Suppliers All suppliers All suppliers who are employers in terms of the Unemployment Insurance Act 63 of 2001 as amended All suppliers, where applicable All suppliers whose services constitute construction and /or engineering works in terms of the Construction Industry Development Board Act 38 of 2000 and its Procurement Regulations All suppliers submitting a valid verification certificate in terms of the BBBEE Codes of Good Practice Disabled Shareholders/members All Suppliers All Suppliers Page 2

CONTENTS SECTION 1: NOTE TO THE APPLICANT SECTION 2: SUPPLIER DETAILS SECTION 3: BUSINESS BANKING DETAILS SECTION 4: BROAD BASED BLACK ECONOMIC EMPOWERMENT (BBBEE) COMPLIANCE SECTION : PRODUCTS AND SERVICES (COMMODITIES) SECTION 6: DECLARATION OF INTERESTS Page 3

SECTION 1: NOTE TO THE APPLICANT RE: REQUEST FOR REGISTRATION AS AN APPROVED SUPPLIER ON THE SUPPLIER DATABASE OF THE SERVICES SETA Prospective suppliers are herewith invited to register as approved suppliers on the official Supplier Database of the Services Seta In order to comply with the processes and procedures set out in the Supply Chain Management Policy; Services Seta developed a Supplier database to register all suppliers providing goods, works and services to the organization The purpose of the database is to give all prospective suppliers a fair and equal opportunity to submit quotations for goods, works and services to Services Seta Preference will be given to the registered suppliers However, it does not necessarily follow that those potential suppliers which are not yet registered will be totally exempt from quoting for the goods or services to Services Seta It is imagined that the Supplier Database will contribute to efficient administration and compliance with the Preferential Finance Management Act (PFMA) Attached please find an official request for registration, to be completed in full by prospective service providers It is imperative that suppliers read the registration form carefully, complete all sections in full, sign and date the form Please note that minimum requirements required are an original and valid/ current Tax Clearance Certificate, original or certified copy of BEE certificate with the BEE agency accredited by SANAS, registration certificate with any regulatory body eg Electrical Contractors Board (ECB) etc If the supplier or training service provider is accredited with any SETA the accreditation must be submitted, registered companies with (CIPRO) - certified copies CK 1&2 or CM 2 & 29 documents must be submitted and certified ID copies of company owners Failure to submit the above documents and the incomplete registration forms will invalidate your application The company must attach a separate detailed price list for all commodities and services that have been listed on this application form SUPPLIER DATABASE REGISTRATION FORM IMPORTANT NOTES Please read carefully To be completed by all vendors seeking registration on Services Seta Prospective Supplier Database The questionnaire must be completed in full and be signed; A company profile may accompany the registration form but will not be accepted as substitute for the application form- all fields on application form MUST be completed by the applicant; Suppliers will be informed of the outcome and will be provided with a supplier registration number Supplier must comply with all the registration-criteria for registration to be finalised failure to do so may result in the application being declined The completed application for registration can be hand delivered or posted to: Or Alternatively posted to: For attention: The Supply Database Administrator (SCM Unit) 1 Sherborne Road, Parktown, 2193 P O Box 3322, Parktown, JHB, 2041 Page 4

SECTION 2: SUPPLIER DETAILS Supplier Grouping Details Type of Firm: (please tick the relevant box) 1 Public Company(Ltd) 7 Sole Proprietor 2 Private Company(Pty)Ltd 8 Foreign Company 3 Closed Corporation(cc) 9 Partnership 4 Other (specify) 10 Trust Joint Venture 11 Section 21 Company 6 Consortium 12 Government/Parastatal Company / Supplier Name Trading As Name Of Business Full Names And Surname of Sole Proprietor Company / Close Corporation Registration Number Sole Proprietor/Partnership/Trust Id Number VAT registration number (if applicable) Skills Development Levy Registration number Company UIF number: Company PAYE number: Income tax reference number Web Address E- Mail Address Telephone Number Fax Number Toll-Free Number Number of full-time employees Postal Address: (compulsory) Physical Address: Postal code Page

Company/Supplier Classification: (Please tick the relevant box or boxes) ISO Listed Importer Services Manufacture Sales Repairer Black-owned Distributor Exporter Tax Clearance Certificate: (please tick the relevant box) Attached Not attached Tax Clearance Certificate (please attach to application) Tax Clearance Certificate Expiry date Geographical Coverage (Please tick the province/s where you conduct your business provide proof of physical presence eg Rental or Lease agreement/municipal statement if building is owned) Gauteng Free State West Cape Northern Cape KwaZulu-Natal Limpopo Eastern Cape Mpumalanga North West Main contact person in your company: Name Company position Cell phone number Identity (ID) number E-mail address Contact person (Sales) in your company: Name Position in company Cell phone number ID number E-mail address Page 6

List all partners, proprietors and shareholders (Compulsory) Initials Surname and Position occupied in the company Citizenship ID number Physical address Note: Where owner are themselves a company or partnership, owners of the holding firm must be identified Page 7

SECTION 3: BUSINESS BANKING DETAILS Name of Account Holder Bank Name Branch Name Branch Code Account Number Account Type Cheque Savings Transmission Authorisation of electronic transfer of Funds (EFT) to supplier s bank account I, the undersigned, hereby authorise Services SETA to credit my business account via Electronic Fund Transfer as aforementioned with the amount payable / due to specified beneficiary for goods and services rendered Signature Name Capacity Date For Completion by your Bank Bank Stamp I certify that I am duly authorised by (Bank Name) to give such information and that such information is correct Signature Name of Authorised Official Date Page 8

SECTION 4: BROAD BASED BLACK ECONOMIC EMPOWERMENT (BBBEE) COMPLIANCE Please attach the B-BBEE certificate issued by Verification Agency accredited by SANAS: (Kindly ignore if valid and current or certified copy of the certificate were already submitted and in SSETA possession) In terms of Regulation (2) and 6 (2) of the Preferential Procurement Regulations, preference points must be awarded to a bidder for attaining the B-BBEE status level of contribution in accordance with the table below: Tick Box Your B- BBEE Status B-BBEE Status Level of Contributor Number of points (80/20 system) Number of points (90/10 system) 1 20 10 2 18 9 3 16 8 4 12 8 4 6 6 3 7 4 2 8 2 1 Non-compliant contributor 0 0 Please attach the B-BBEE certificate issued by Verification Agency accredited by SANAS: (Kindly ignore if valid and current or certified copy of the certificate were already submitted and in SSETA possession) Bidders who qualify as EMEs in terms of the B-BBEE Act must submit a certificate issued by an Accounting Officer as contemplated in the Close Corporation Act (CCA) or a Verification Agency accredited by SANAS or a Registered Auditor Registered auditors do not need to meet the prerequisite for IRBA s approval for the purpose of conducting verification and issuing EMEs with B-BBEE Status Level Certificates Page 9

Small, Medium and Micro Enterprise (SMME) status of your enterprise: Please use this table to determine the SMME status of your enterprise (Please tick the relevant box in each column) A Sector B Full-time paid employees C Annual Turn-over(millions D Total Gross Asset value (property excluded) (millions) Medi um Small Very small Mi cro Medium Small Very small Micro Medi um Small Very small micro Agriculture 100 0 10 4 2 04 01 4 2 04 01 Mining quarrying and 200 0 20 30 7 3 01 1 8 4 18 01 Manufacturing 200 0 20 40 10 4 01 1 3 7 1 01 Construction 200 0 20 20 2 01 4 1 04 01 Retail and motor trade 100 0 10 30 1 3 01 2 0 01 Wholesale trade Caretering and accomodation 100 0 10 0 2 01 8 4 0 01 100 0 10 10 1 01 2 1 02 01 Transport storage and 100 0 10 20 10 2 01 2 0 01 Finances business services and 100 0 10 20 10 2 01 4 2 04 01 Repair/allied services 100 0 10 30 1 3 01 2 0 01 Communication 100 0 10 20 10 2 01 2 0 01 Other trade 100 0 10 10 1 01 2 1 02 01 Commercial agents 100 0 10 0 2 01 8 4 0 01 Community and social services 100 0 10 10 1 01 2 0 01 Personal services 100 0 10 10 1 01 2 SMME status of your enterprise (Compulsory) (according to SMME table above) Please tick the relevant box Micro Very small Small Medium Large 0 01 Page 10

SECTION : PRODUCTS AND SERVICES Services Seta will only register a maximum of three (3) commodities and services per application (Note that Services Seta will not consider any extra additional commodities/ services but ONLY be limited to three) If your organisation does provide more than three categories please provide proof (Example: previous work done in a form of Official Order or Certificate of Work Done) ABET TRAINING ADVANCE IT SUPPORT HEADOFFICE AND REGIONAL OFFICES ADVERTISING AND RECRUITMENT OR PLACEMENT AGENCY AIR CONDITIONER INSTALLATION & MAINTENANCE ANNUAL REPORT ANTI VIRUS SOFTWARE APPLIANCES AND VENDING EQUIPMENT AUDITORS AND ACCOUNTING SERVICES BANK PROVIDERS AND INSURANCE BOOKS PROVIDERS BUILDING MAINTENANCE & RENOVATIONS CATERING SERVICES CCTV INSTALLATION AND REPAIRS CHAMBER / INDUSTRY SERVICESS AND PROJECTS CLEANING SERVICES COMPUTER CONSUMABLES CONSTITUENCY MODERATORS AND ASSESSORS CONSULTING: BUSINESS CONSULTANTS & BUSINESS ANALYSTS CONSULTING: COMPLIANCE SERVICES CONSULTING: FINANCIAL SERVICES CONSULTING: HUMAN RESOURCE CONSULTING: LEGAL SERVICES CONSULTING: MANAGEMENT / BUSINESS CONSULTING: RESEARCH DEVELOPMENT CONSULTING: RISK MANAGEMENT SERVICES CONSULTING: SKILLS DEVELOPMENT CONSULTING: SUPPLY CHAIN MANAGEMENT SERVICES CONTRACTOR: WASTE COLLECTION AND RECYCLING CONTRACTORS: AUCTIONEERS CONTRACTORS: CARPET CLEANING SERVICES CONTRACTORS: LANDSCAPING TREE FELLING, PLANTS, FLOWERS AND DECO LIST OF COMMODITIES (PRODUCTS AND SERVICES) HANDYMAN SERVICES HEADOFFICE AND REGIONAL OFFICES IT SUPPORT HET PROGRAMMES HIV PROJECTS AND HIV / AIDS TRAINING SERVICE PROVIDERS HOW TO TENDER (SPECIAL PROJECTS) INDUSTRIAL RELATIONS (IR) INSTALLATION AND SERVICING OF FIRE EXTINGUISHES INTERNAL & EXTERNAL NEWSLETTERS INTERPRETERS FOR THE FACILITATION FOR DEAF LEARNERS IT HARDWARE AND SOFTWARE IT PABX AND TELEPHONY EQUIPMENT AND NETWORK CABLING IT WEBSITE DESIGN, DEVELOPMENT AND MAINTENANCE LABOUR RELATION SERVICES LEADERSHIP SERVICES AND PROJECTS LEARNERSHIPS SERVICES AND PROJECTS LOCKSMITH SERVICES MEDICAL AID HEALTH SERVICES NAVISION SYSTEM CONSULTING NEW VENTURE CREATION SSETA ACCREDITED SERVICE PROVIDERS NGO, NPO & CBO CAPACITY BUILDING OCCUPATIONAL HEALTH & SAFETY TRAINING OFFICE EQUIUPMENT AND MAINTENANCE, PHOTOCOPIERS, SCANNERS AND PRINTERS ETC OFFICE FURNITURE, EQUIPMENT & MACHINES OFFICE FURNIURE REMOVAL SERVICES OFFICE RENTAL / SPACE ORACLE DATABASE DESIGN, DEVELOPMENT AND MAINTENANCE PASSENGER VEHICLE HIRE (MINI BUSES, BUSES, CARS AND TOLLGATE CARDS) PEST CONTROL SERVICES PHOTOGRAPHY-VIDEOGRAPHER, EVENTS, CORPORATE, CONFERENCE, AWARDS PR & MEDIA SERVICES, MEDIA MOTORING SERVICES PRINTING PAPER & PRINTING SERVICES Page 11

CONTRACTORS: PAVING CONTRACTORS: PLUMBING CONTRACTORS: WATERPROOFING CORPORATE GIFTS CORPORATE SIGNAGE INDOOR / OUTDOOR COURIER SERVICES: BULK POSTING, BULK FAXING & BULK E MAILING DATA LINES DESIGN AND LAYOUT OF PROMOTIONAL MATERIAL / PUBLICATIONS DEVELOPMENT OF QUALIFICATION PROFESSIONALS AND CPD, CURRICULUM DEVELOPMENT, REGISTRATION OF QUALIFICATION AND TRAINING MATERIAL DISABILITY CONTENT EDITOR, PORTAL AND MAINTENANCE DIVERSITY MANAGEMENT DOCUMENTS ACHIEVING DRIVER TRAINING K3 ELECTRICAL INSTALLATION AND MAINTENANCE PLUGS, LIGHT BULBS ELEVATORS CONVEYERS AND MAINTENANCE EMPLOYMENT EQUITY PLANNING ETQA DEVELOPMENT TOOL ETQA SITE VISITS FOR ACCREDITATION AND LEARNING PROGRAMME EVENTS, CONFERENCE AND MANAGEMENT FET COLLEGE PROGRAMMES FINGER PRINT READER INSTALLATION AND REPAIR FURNITURE AND FITTINGS GENERATORS AND UPS MAINTENANCE PROJECTS INFORMATION SYSTEM QUALITY MANAGEMENT TRAINING SERVICE PROVIDERS REFRESHMENTS RURAL DEVELOPMENT SERVICE PROJECTS SCHOOL FEEDER PROJECTS SDF AUDITORS SDF TRAINING SECURITY PRODUCTS AND SERVICES SME TRAINING, WORKSHOPS, CONFERENCES SOUND SYSTEM HIRE STAFF TRAINING PROVIDERS STATIONERY & PRINTING SERVICES SYSTEMS DEVELOPMENTS, MAINTENANCE AND PORTALS TAX CONSULTING SERVICES TRADE SHOWS TRAINING TRAINERS FOR VARIOUS INDUSTRY TOPICS AND SPECIALISED CONSULTANT PER INDUSTRY TRAINING FACILITIES, DATA PROJECTOR, SCREENS, VIDEO CONFERENCING TRAINING OF CONSTITUENCIES INDUSTRY QCTO FACILITATORS UNIVERSITY PROGRAMMES UOT PROGRAMMES VEHICLE TRACKER VENUE HIRE AND DECO, ACCOMMODATION WINDOW CLEANING SERVICES IF THE PRODUCTS & SERVICES THAT YOUR ORGANISATION IS OFFERING IS NOT LISTED ABOVE PLEASE LIST YOUR CATEGORIES BELOW Page 12

Attach a separate Detailed Price Listing for the commodities and services listed above -Provide trade references on table below for each commodity/ service your company have applied for (refer list above): Contact person Contact details Company Name Description of Product/Services rendered Start date End Date NOTE WORTH TAKING: Your company Nature of Business will be considered when assessing your company database registration documents whether it is aligned to the commodities or services listed by your company -State your company Nature of Business (Example- Landscaping, Training and Monitoring etc) below: Aligned For Internal Use Only (PLEASE CIRCLE THE RELEVANT STATUS) Not Aligned Page 13

SECTION 6: DECLARATION OF INTERESTS 1 Are you or any other person who holds an interest in your business (ie a shareholder, a director, or a member or partner, a line manager, or a fellow employee), employed by Services SETA or serves as a director at Services SETA, or was previously employed by Services SETA or served as a director at Services SETA? Yes No If yes, state particulars 2 Are you, or any other person who holds an interest in your business, a close family member (ie related by birth, marriage, domestic partnership, adoption, guardianship or the like) to or an associate (ie a friend, rival, business partner, neighbour, etc) of an Services SETA employee and/or director? Yes No If yes, state particulars 3 Have you, or any other person who holds an interest in your business, given a business courtesy to or received a business courtesy from a Services SETA employee and/or director over the last 12 (twelve) months? Yes No If yes, state particulars 4 Have you, or any other person who holds an interest in your business undergone Services SETA supplier disciplinary process and / or has been suspended from the Services SETA supplier database over the last (five) years? Yes No If yes, state particulars Is your business currently engaged in defending any legal proceedings which have been instituted against it (including against any of its directors / members / partners), or has your business (including any directors / members / partners) either been charged with or been convicted of any criminal act, or has any judgment or decision been made against it by any administrative or regulatory body? Yes No Page 14

If yes, state particulars DECLARATION: I, the undersigned [insert full name of signatory], duly authorised to complete this application form in my capacity as [insert capacity, ie, member, director, partner, etc] on behalf of the applicant [insert full name of the business entity] certify that, to the best of my knowledge, the information furnished herein is true and correct I accept that SERVICES SETA reserves its right to act against the applicant or me personally in terms hereof, should this declaration prove to be false I am aware that, in addition and without prejudice to any other remedy provided to combat any restrictive practices related to bids and contracts, bids that are suspicious will be reported to the Competition Commission for investigation and possible imposition of administrative penalties in terms of section 9 of the Competition Act No 89 of 1998 and or may be reported to the National Prosecuting Authority (NPA) for criminal investigation and or may be restricted from conducting business with the public sector for a period not exceeding ten (10) years in terms of the Prevention and Combating of Corrupt Activities Act No 12 of 2004 or any other applicable legislation Declaration Applicant's Signature: I hereby declare that the above information is correct at the time of completion I hereby pledge to inform the SSETA in writing, of any changes of any details that appears on this document I certify that I have the appropriate authority to furnish the above-mentioned information on behalf of my employer On behalf of: (Company s name) Date: Applicant s Title /Position and Name of director/member that appears on CIPRO documents Title: Position: Full Names: Page 1