Home Supplier Database Application

Supplier Database Application

Apply to be registered on the PIMHP supplier database for the supply of goods and services. The database gives all prospective suppliers an equal opportunity to submit quotations to PIMHP. Preference will be given to registered suppliers.

Step 2 of 7Company details

Company / registered supplier name *

Trading name of the company *

Company / Close Corporation registration number *

VAT registration number (if applicable)

Income tax reference number *

Web address

E-mail address *

Telephone number *

Fax number *

Compulsory – enter N/A if you have no fax line.

Toll-free number

Number of full-time employees *

Postal address *

Physical address *

Postal address – postal code *

Physical address – postal code *

Tax clearance certificate attached? *

YesNo

Tax clearance expiry date

Step 3 of 7Ownership & contacts

List of directors / owners / partners *

Name

Company position

% Shareholding

Identity number

Nationality

Financial decision making

Provide details of the individuals responsible for the following daily activities in your company. HDI = historically disadvantaged individual.

Activity

Name & surname

HDI

Gender

Years of service

Capacity

Signing of cheques

Signing & co-signing of loans

Acquiring lines of credit

Major acquisition / purchase

Signing of contracts

Main contact person in your organisation

Name *

Position in company *

Cell phone number *

Fax number

E-mail address *

Contact person responsible for sales

Name *

Position in company *

Cell phone number *

Fax number

E-mail address *

Step 4 of 7Commodities & status

Trade names – a maximum of six (6) will be registered

#	Trade name of commodity (e.g. HP or Dell)	Description of commodity (e.g. cartridge)
1
2
3
4
5
6

Sector (for SMME classification) *

SMME status of your enterprise *

View the SMME classification table

Sector	Employees (Med / Small / V.Small / Micro)	Turnover Rm (Med / Small / V.Small / Micro)	Gross assets Rm (Med / Small / V.Small / Micro)
Agriculture	100 / 50 / 10 / 5	4 / 2 / 0.4 / 0.15	4 / 2 / 0.4 / 0.1
Mining and Quarrying	200 / 50 / 20 / 5	30 / 7.5 / 3 / 0.15	18 / 4.5 / 1.8 / 0.1
Manufacturing	200 / 50 / 20 / 5	40 / 10 / 4 / 0.15	15 / 3.75 / 1.5 / 0.1
Construction	200 / 50 / 20 / 5	20 / 5 / 2 / 0.15	4 / 1 / 0.4 / 0.1
Retail and Motor Trade	100 / 50 / 10 / 5	30 / 15 / 3 / 0.15	5 / 2.5 / 0.5 / 0.1
Wholesale Trade	100 / 50 / 10 / 5	50 / 25 / 5 / 0.15	8 / 4 / 0.5 / 0.1
Catering, Accommodation	100 / 50 / 10 / 5	10 / 5 / 1 / 0.15	2 / 1 / 0.2 / 0.1
Transport, Storage	100 / 50 / 10 / 5	20 / 10 / 2 / 0.15	5 / 2.5 / 0.5 / 0.1
Finance & Business Services	100 / 50 / 10 / 5	20 / 10 / 2 / 0.15	4 / 2 / 0.4 / 0.1
Repair / Allied Services	100 / 50 / 10 / 5	30 / 15 / 3 / 0.15	5 / 2.5 / 0.5 / 0.1
Communication	100 / 50 / 10 / 5	20 / 10 / 2 / 0.15	5 / 2.5 / 0.5 / 0.1
Other Trade	100 / 50 / 10 / 5	10 / 5 / 1 / 0.15	2 / 1 / 0.2 / 0.1
Commercial Agents	100 / 50 / 10 / 5	50 / 25 / 5 / 0.15	8 / 4 / 0.5 / 0.1
Community & Social Services	100 / 50 / 10 / 5	10 / 5 / 1 / 0.15	5 / 2.5 / 0.5 / 0.1
Personal Services	100 / 50 / 10 / 5	10 / 5 / 1 / 0.15	5 / 2.5 / 0.5 / 0.1

Upper limits per size class. Enterprises above the “Medium” thresholds are classified as Large.

B-BBEE status level of contribution claimed *

Points on the 80/20 system. Claims must be substantiated by a B-BBEE certificate issued by a SANAS-accredited verification agency, an IRBA-approved registered auditor or an accounting officer.

Will any portion of a contract be sub-contracted? *

YesNo

Percentage to be sub-contracted (%)

Name of the sub-contractor

B-BBEE status level of the sub-contractor

Is the sub-contractor an EME?

EME: an enterprise with annual total revenue of R5 million or less.

If other, please specify

Step 6 of 7Banking details

Attach a stamped letter from your bank or an original cancelled cheque verifying these banking details in the next step. Invoices with details different from those captured here will not be processed.

Bank *

Account holder’s name *

Bank account number *

Account type *

Branch name *

Branch code *

Authorised by – full name *

Capacity *

Step 7 of 7Documents & declaration

Declaration of any conflict of interest *

Are any of your directors / owners / partners employed by PIMHP, or close relatives of PIMHP staff? If so, give details. Otherwise enter “None”.

Supporting documents

Company registration documents * Choose files or drag hereUp to 5 files · max 10 MB each

ID documents of directors / owners / members / shareholders * Choose files or drag hereUp to 6 files · max 10 MB each

Stamped bank letter or cancelled cheque * Choose files or drag hereUp to 2 files · max 10 MB each

Tax clearance certificate Choose files or drag hereUp to 2 files · max 10 MB each

SBD4, SBD8 and SBD9 forms Choose files or drag hereUp to 3 files · max 10 MB each

Financial statements or auditor’s letter Choose files or drag hereUp to 3 files · max 10 MB each

Indicating maximum size or business capability.

B-BBEE certificate (SANAS-accredited) Choose files or drag hereUp to 2 files · max 10 MB each

Industry / regulatory body registration certificates Choose files or drag hereUp to 5 files · max 10 MB each

Company profile Choose files or drag hereUp to 2 files · max 10 MB each

Completion of form (by applicant)

Name *

Designation *

Type your full name as your signature *

* Required

Supplier Database Application

Important notes – please read carefully

Main contact person in your organisation

Contact person responsible for sales

Supporting documents

Completion of form (by applicant)

Thank you – we have received your application.