Ministry of Justice, Law and Parliamentary Affairs

Supplier Registration Form

1. SUPPLIER DETAIL

Full Registerd Name:                           

Trading Name:                                    

Registration Number:                           

Date Established:                                

IBR Number:                                        

Name of holding company (if any):          

Name of Subsidiary companies  (if any):  

                              Type of Entity: (Please mark appropriate box with X)

  Public company

  Private company

  Close Corporation

  Partnership

Other (please specify):  

Physical Address:       

Postal Address:          

Registered Office:       

Telephone Number:     

E-mail Address:          

Address:                    

2. IF AN INDIVIDUAL

Full Names:                                    

ID Number:                                     

Physical Address:                           

Telephone Number:                          

Cellphone Number:                           

Occupation:                                     

In the present line of business since:  

3. PRODUCTS / PARTS/ SERVICES

Nature of Business:  

Product Range:        

4. DOCUMENTATION TO BE ATTACHED

-Bank account details Upload Bank Account details

-Tax Clearance Cerificate Upload Tax Clearance Certificate

-Trader's License Upload Trader's License

I declare that the information provided is accurate  Yes   No

Name:          

Date:            

Designation:  

Signature:      

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