TCS PIN: OR CSD No: B-BBEE STATUS LEVEL B-BBEE VERIFICATION Yes STATUS LEVEL Yes CERTIFICATE SWORN [TICK APPLICABLE BOX] No AFFIDAVIT No IF YES, WHO WAS THE CERTIFICATE ISSUED BY? AN ACCOUNTING OFFICER AS CONTEMPLATED IN AN ACCOUNTING OFFICER THE CLOSE CORPORATION ACT (CCA) AS CONTEMPLATED IN A VERIFICATION AGENCY ACCREDITED BY THE THE CLOSE SOUTH AFRICAN ACCREDITATION SYSTEM CORPORATION ACT (CCA) (SANAS) AND NAME THE A REGISTERED AUDITOR APPLICABLE IN THE TICK BOX NAME: [A B-BBEE STATUS LEVEL VERIFICATION CERTIFICATE/SWORN AFFIDAVIT(FOR EMEs& QSEs) MUST BE SUBMITTED IN ORDER TO QUALIFY FOR PREFERENCE POINTS FOR ARE YOU A ARE YOU THE FOREIGN BASED ACCREDITED SUPPLIER FOR Yes No REPRESENTATIVE IN Yes No THE GOODS [IF YES SOUTH AFRICA FOR /SERVICES ANSWER THE GOODS /SERVICES /WORKS PART B:3 /WORKS OFFERED? [IF YES ENCLOSE OFFERED? BELOW ] SIGNATURE OF BIDDER DATE ……………………………… CAPACITY WHICH THIS BID IS SIGNED (Attach proof of authority to sign this bid; e.g. resolution of directors, etc.) TOTAL BID TOTAL NUMBER OF PRICE (ALL ITEMS OFFERED INCLUSIVE) BIDDING PROCEDURE ENQUIRIES MAY BE TECHNICAL INFORMATION MAY BE DIRECTED TO: DIRECTED TO: DEPARTMENT/ PUBLIC ENTITY CONTACT PERSON CONTACT PERSON TELEPHONE NUMBER TELEPHONE NUMBER FACSIMILE NUMBER FACSIMILE NUMBER E-MAIL ADDRESS E-MAIL ADDRESS
TCS PIN: OR CSD No: B-BBEE STATUS LEVEL VERIFICATION CERTIFICATE [TICK APPLICABLE BOX] Yes No B-BBEE STATUS LEVEL SWORN AFFIDAVIT Yes No IF YES, WHO WAS THE CERTIFICATE ISSUED BY? AN ACCOUNTING OFFICER AS CONTEMPLATED IN THE CLOSE CORPORATION ACT (CCA) AND NAME THE APPLICABLE IN THE TICK BOX AN ACCOUNTING OFFICER AS CONTEMPLATED IN THE CLOSE CORPORATION ACT (CCA) A VERIFICATION AGENCY ACCREDITED BY THE SOUTH AFRICAN ACCREDITATION SYSTEM (SANAS) A REGISTERED AUDITOR NAME: [A B-BBEE STATUS LEVEL VERIFICATION CERTIFICATE/SWORN AFFIDAVIT(FOR EMEs& QSEs) MUST BE SUBMITTED IN ORDER TO QUALIFY FOR PREFERENCE POINTS FOR ARE YOU THE ACCREDITED REPRESENTATIVE IN SOUTH AFRICA FOR THE GOODS /SERVICES /WORKS OFFERED? Yes No [IF YES ENCLOSE ARE YOU A FOREIGN BASED SUPPLIER FOR THE GOODS /SERVICES /WORKS OFFERED? Yes No [IF YES ANSWER PART B:3 BELOW ] SIGNATURE OF BIDDER ……………………………… DATE CAPACITY WHICH THIS BID IS SIGNED (Attach proof of authority to sign this bid; e.g. resolution of directors, etc.) TOTAL NUMBER OF ITEMS OFFERED TOTAL BID PRICE (ALL INCLUSIVE) BIDDING PROCEDURE ENQUIRIES MAY BE DIRECTED TO: TECHNICAL INFORMATION MAY BE DIRECTED TO: DEPARTMENT/ PUBLIC ENTITY CONTACT PERSON CONTACT PERSON TELEPHONE NUMBER TELEPHONE NUMBER FACSIMILE NUMBER FACSIMILE NUMBER E-MAIL ADDRESS E-MAIL ADDRESS