Supplier Database Registration Form

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

Supplier Database Registration Form

Date: {{date}}

Section 1: Supplier Details

Supplier Legal Name: {{supplier_legal_name}}

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

Company Registration Number: {{company_registration_number}}

VAT Registration Number (if applicable): {{vat_registration_number}}

Registered Address: {{registered_address}}

Physical Address (if different): {{physical_address}}

Postal Address (if different): {{postal_address}}

Primary Contact Person: {{primary_contact_person_name}}

Contact Person's Title: {{primary_contact_person_title}}

Contact Number: {{primary_contact_number}}

Email Address: {{primary_contact_email}}

Website: {{supplier_website}}

Section 2: Business Information

Type of Business (e.g., Sole Proprietor, Partnership, Pty Ltd): {{business_type}}

Industry Sector: {{industry_sector}}

Description of Goods/Services Provided: {{description_of_goods_services}}

Key Products/Services: {{key_products_services}}

Years in Business: {{years_in_business}}

Section 3: 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, if applicable): {{swift_bic_code}}

Section 4: Compliance and Documentation

Please attach certified copies of the following documents:

1. Company Registration Certificate (e.g., CIPC Certificate in South Africa): {{company_registration_certificate_attached_yes_no}}

2. Tax Clearance Certificate (e.g., SARS B-BBEE Certificate in South Africa): {{tax_clearance_certificate_attached_yes_no}}

3. VAT Registration Certificate (if applicable): {{vat_registration_certificate_attached_yes_no}}

4. Proof of Bank Account (e.g., cancelled cheque or bank statement): {{proof_of_bank_account_attached_yes_no}}

5. B-BBEE Certificate/Sworn Affidavit (e.g., for South African entities): {{bbbee_certificate_attached_yes_no}}

6. Valid Business License/Permit (if applicable): {{business_license_attached_yes_no}}

Section 5: References (Optional)

Please provide details of two business references:

Reference 1 Name: {{reference_1_name}}

Reference 1 Company: {{reference_1_company}}

Reference 1 Contact Number: {{reference_1_contact_number}}

Reference 1 Email: {{reference_1_email}}

Reference 2 Name: {{reference_2_name}}

Reference 2 Company: {{reference_2_company}}

Reference 2 Contact Number: {{reference_2_contact_number}}

Reference 2 Email: {{reference_2_email}}

Section 6: Declaration

I/We, the undersigned, hereby declare that the information provided in this form is true and correct to the best of my/our knowledge and belief. I/We understand that any false information supplied could lead to the rejection of this application or termination of any future business relationship.

I/We give {{company_name}} permission to verify the information provided and to conduct any necessary background checks.

Signature Block

_________________________

Name: {{signer_name}}

Title: {{signer_title}}

Date: {{signature_date}}

On behalf of: {{supplier_legal_name}}