ANNEXURE 10 - BASIC INFORMATION FORM PROSPECTIVE BIDDER INFORMATION: Name: Type: (Corporation, Partnership, etc.) Company/Entity incorporation/registration no: Domicile: Address of principal office: Telephone number: Fax number: E-mail address: Primary areas of business: Shareholder/Member certificate (attach separately) CONSORTIUM MEMBERS INFORMATION: (IF APPLICABLE, FILL IN DETAILS FOR ALL MEMBERS, IDENTIFYING THE LEAD MEMBER AND/OR THE MEMBER(S) TO BE EVALUATED FOR EACH OF THE ELIGIBILITY CRITERIA SET FORTH IN SECTION 4.3 PART I) Name: Type: (Corporation, Partnership, etc.) Company/Entity incorporation/registration no: Domicile: Address of principal office: Telephone number: Fax number: E-mail address: Primary areas of business: Shareholder/Member certificate (attach separately)
ANNEXURE 10 - BASIC INFORMATION FORM PROSPECTIVE BIDDER INFORMATION: Name: Type: (Corporation, Partnership, etc.) Company/Entity incorporation/registration no: Domicile: Address of principal office: Telephone number: Fax number: E-mail address: Primary areas of business: Shareholder/Member certificate (attach separately) CONSORTIUM MEMBERS INFORMATION: (IF APPLICABLE, FILL IN DETAILS FOR ALL MEMBERS, IDENTIFYING THE LEAD MEMBER AND/OR THE MEMBER(S) TO BE EVALUATED FOR EACH OF THE ELIGIBILITY CRITERIA SET FORTH IN SECTION 4.3 PART I) Name: Type: (Corporation, Partnership, etc.) Company/Entity incorporation/registration no: Domicile: Address of principal office: Telephone number: Fax number: E-mail address: Primary areas of business: Shareholder/Member certificate (attach separately)
EMS%20-%20RFP.docx