SME Supplier Registration Form

{{company_name}}

{{company_address}}

Phone: {{phone}} | Email: {{email}} | Web: {{website}}

SME Supplier Registration Form

SME Supplier Registration Form

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Supplier Information

**Legal Company Name:** {{supplier_legal_name}}

**Trading Name (if different):** {{supplier_trading_name}}

**Company Registration Number:** {{supplier_registration_number}}

**Date of Establishment:** {{supplier_establishment_date}}

**Physical Address:** {{supplier_physical_address}}

**Postal Address:** {{supplier_postal_address}}

**Main Business Activity/Industry:** {{supplier_business_activity}}

Contact Person Details

**Full Name:** {{contact_person_full_name}}

**Job Title:** {{contact_person_job_title}}

**Mobile Number:** {{contact_person_mobile}}

**Email Address:** {{contact_person_email}}

Banking Details

**Bank Name:** {{bank_name}}

**Account Holder Name:** {{account_holder_name}}

**Account Number:** {{account_number}}

**Branch Name:** {{branch_name}}

**Branch Code:** {{branch_code}}

**SWIFT/BIC Code (for international payments):** {{swift_bic_code}}

Tax and Regulatory Compliance

**Tax Identification Number (TIN) / VAT Registration Number:** {{tax_id_vat_number}}

**Are you VAT registered?** {{vat_registered_yes_no}}

**Do you have a valid Tax Compliance Status (TCS) PIN?** {{tcs_pin_yes_no}}

**If yes, please provide PIN:** {{tcs_pin}}

**Black Economic Empowerment (BEE) Level (South Africa specific):** {{bee_level}}

**BEE Certificate Number (South Africa specific):** {{bee_certificate_number}}

Products/Services Offered

**Please list the main products or services your company offers:**

1. {{product_service_1}}

2. {{product_service_2}}

3. {{product_service_3}}

**Relevant Certifications/Accreditations (e.g., ISO, industry-specific):** {{certifications_accreditations}}

References (Optional)

**Please provide details of two trade references who can vouch for your company's service quality and reliability.**

**Reference 1 Company Name:** {{reference_1_company}}

**Reference 1 Contact Person:** {{reference_1_contact}}

**Reference 1 Phone Number:** {{reference_1_phone}}

**Reference 1 Email Address:** {{reference_1_email}}

**Reference 2 Company Name:** {{reference_2_company}}

**Reference 2 Contact Person:** {{reference_2_contact}}

**Reference 2 Phone Number:** {{reference_2_phone}}

**Reference 2 Email Address:** {{reference_2_email}}

Declaration and Consent

I/We, the undersigned, declare that the information provided in this registration form is true, accurate, and complete to the best of my/our knowledge. I/We understand that any false information may lead to the rejection of this application or termination of any future supplier agreement.

I/We also consent to {{company_name}} conducting necessary background checks, credit checks, and contacting the provided references for verification purposes. I/We agree to inform {{company_name}} of any changes to the information provided herein.

**Signature:** __________________________

**Name (Print):** {{declarant_full_name}}

**Job Title:** {{declarant_job_title}}

**Date:** {{declaration_date}}

For Internal Use Only

**Date Received:** {{internal_date_received}}

**Reviewed By:** {{internal_reviewed_by}}

**Approval Status:** {{internal_approval_status}}

**Supplier Code:** {{internal_supplier_code}}

**Notes:** {{internal_notes}}

Signature Block

**Duly authorised by:**

__________________________

**For {{supplier_legal_name}}**

**Date:** {{signature_date}}