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.

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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

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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

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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 (<12 Months in Yes operation) Exempted Micro Enterprise (EME) Yes No Qualifying Small Enterprise (QSE) Yes No Large Enterprise (LE) Yes No Other (Please Specify) Liquidity and Capacity Check Current Ratio Trade References Supplier Name Contact Name

Past Service Delivery References Supplier Name Delivery Description

Declaration by the Supplier

5

Contact Name

i.e. Entity registered as a vendor under the Value-Added Tax of 1991, whose net profit before tax summed with its total labour cost exceeds 25% of the value of its total revenue.

No

No Annual Turnover Annual Turnover Annual Turnover

Contact Number

Contact Number

I, the undersigned, hereby: Declare that:  I am duly authorized to sign this application on behalf of the enterprise.  The information furnished, as well as all documentation submitted in support of this application, is true and correct in every respect; and have been lawfully obtained;  The enterprise will abide by the Companies amendment Act, 2011 for trading in South Africa http://www.info.gov.za/view/DownloadFileAction?id=145779.  A partner, member, director, manager or other person, who wholly or partly exercises, or may exercise, control over the enterprise, has not within the last five years been convicted of fraud or corruption. Understand that:  Registration is subject to the conditions referred to on the front cover of this form;  Incomplete applications result in delays in processing.  Applications without relevant supporting documentation will not be processed.  False information provided or a false declaration is a fraudulent and punishable offence. By signing below, you as a Supplier applicant and Authorized Signatory agree that the information you have provided herein is true and correct. UJ reserves the right to act against the undersigned, should this declaration be proven wrong. Supplier Applicant Name Signature Date Company Director or Authorized Signatory Name Signature Date Company stamp

DECLARATION OF INTEREST

A member of staff or any relative of a staff member wishing to supply goods or services to the UJ and who responds to a request for quotation/tender must declare his/her interest in writing and may only participate once the Executive Director: Finance has approved the application of the prospective supplier. Any staff member with a declared interest is excluded from the decision-making process. The supplier herewith declares the following interest:

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1

If the supplier or any person connected with the supplier is employed by the UJ, please furnish the following details of the UJ employee: Name:

………………………………………………...

Address:

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

Contact Details:

2

………………………………………………...

If the supplier has any relationship (family, friend, other) with a person employed by the UJ or its administration and who may be involved with the procurement of goods/services, please furnish the following details of the UJ employee: Name:

………………………………………………...

Address:

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

Contact Details:

………………………………………………...

To be signed even if no interest is declared

_________________________

_____________________________________

SIGNATURE OF DECLARANT

NAME AND SURNAME IN BLOCK LETTERS

______________________

_____________________________________

POSITION OF DECLARANT

NAME OF SUPPLIER

____________ DATE

For University of Johannesburg Internal Use End User’s Name: Once – Off Supplier

Yes

Signature: End User’s Manager Approval:

Date:

Signature: Supplier Evaluator: Procurement Services

Date:

Signature:

Date: 7

No

Supplier Evaluation completed by Supplier Evaluator/ Supplier Evaluator Assistant (Please tick applicable box) Supplier Evaluation was conducted by Signature:

Name: Date:

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Yes

No

1. The University of Johannesburg payment terms is 30 days after the receipt of the statement. Any other payment terms must be agreed by the University in writing beforehand. 2. A supplier will not be paid without an official UJ order number (NO ORDER NUMBER NO PAYMENT) 3. Supplier Vat number, banking details and supplier contact information as well as UJ VAT number must be on the invoice, without this information the invoice will be sent back to the supplier. 4. Suppliers that are on the system are required to submit an original Tax clearance and B-BBEE certificate yearly failure to that a supplier will be automatically end dated and cannot be used. 5. An invoice will only be paid if it has been signed off by the respective UJ employee as per the delegation of authority. 6. University of Johannesburg is only allowed to do business with approved suppliers in the UJ database. For more information please refer to supplier application forms. 7. A UJ order is regarded as an official agreement that the goods or services can be rendered to UJ and payment will be done as paragraph no (1). 8. The University of Johannesburg reserves the right to cancel any order in the event where the goods or services are not delivered by the agreed date. 9. Deliveries will only be accepted between 08:00 and 15:30 from Monday to Friday unless prior arrangement has been made. 10. All complaints regarding the non-compliance of the above must be forwarded to the Supplier Evaluator at 011 559 6824/6702 or [email protected] 11. The University of Johannesburg may update the content of the above information at any time.

Signed at --------------------------------------On-----------the-----------Day---------20---------Supplier Company Name: -------------------------------------------------------------------------Full Name of the Applicant: -----------------------------------------------------------------------Signature: -----------------------------------------Date: ------------------------------------------------

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