REGISTRATION FORM

(Please tick () and fill in where appropriate)

1.  Status

Select one of the Following

(i)  Individual       

(ii) Company                                                                               

(iii) Partnership  

     Registered Small and Medium Enterprise (SME) - (Yes/No): .................................

                

2. Details

(i)   Name of Enterprise: ………………………………………………………....................….…..…….....

(ii)  Business address:   ………………………………………………………......................….................

                                     ……………………………………………………………….......................………..

(iii) Telephone Number:…………………        Mobile Phone Number: …………………...…….    

   
                 Fax Number:………..........................…… Email Address:………………………………......

 

(iv)    (a)     Name of representative (in case of company, partnership or joint venture):

                  …………………………………………………………….…………….........................................

(b)  Position Held: ………………………….........……………………………….............................

(c)   Identity Card no: ………………………………...........……………………….........................

(d)  Address of representative:………………........……………………………..........................

        ...………………………………………………………..........……………………............…………

 

(e)   Telephone Number ………………     Mobile Phone Number ……………………….

       Fax Number …………………….....      Email Address ……………………....…………

(v)      Category (Supplier, Contractor, Service provider or Consultant):

           .........................................        ........................................................        ………………………………….

(vi)   No. of Years in Business:……………………….

(vii)  Types of Contracts executed and Name of Client(s): ........................................................................................

         ……………………………………………………………..................................................…………………………………......

          ………………………………………………………………………….................................................……………………......

(please attach sheet if space is insufficient)

 

3. Eligibility Requirements 

(i)   Business Registration Number:………………………………………............................          

(ii)  VAT Registration Number:…………………………………………................................           

(iii) Tax Account Number (TAN):…………………....…………………….............................

(iv) Tax Status (tax clearance certificate): ……...........................................................(please attach)

(v)   SME Registration Number:...................................................................................

       (please attach copy of certificate)

4. Documents to be submitted

Copy of the following documents should be attached with the Registration Form

(i)          Certificate of Incorporation for business

(ii)         Business Registration Certificate 

(iii)       Trade License/Job Contractor’s Permit               

(iv)       Photocopy of tax clearance certificate for last financial year

(v)         Trade Fee Receipt for current year

(vi)       Valid Operating License from relevant Regulatory Body (if applicable)

(vii)       For Consultancy Service:

(a) A profile of the company, its organisation and staffing (in the case of associations between two or more firms, the name, address and profile of the participating firm(s), and nature of the association (e.g., joint venture, subcontract and the like). The lead firm must be clearly identified)

(b)  Details of experience or similar assignments undertaken in the previous five years, including their locations; focus on the firms’ role in similar assignments in the region or elsewhere; and

(c)   CVs of staff who could be available to work

(d) CV in the case of individual consultant.
 

5. Disclosure

(i) Whether debarred by competent authority to participate in any bidding exercise

    YES                NO       

     (if yes please specify period):  From: …………………….. To: ……………………..

       Give Details:   …………………………………………………………………………....

                             ………………………………………...………………………………….

     

(ii) Whether convicted for any offence including fraud, corruption or dishonesty                   

               YES                NO  

       Give Details:   ………………………………………………………………………….

                             ………………………………………………………………………….

 

6. List of items for Registration

    Please (√ ) your choice of items of Goods/Services/Works for registration as per:

·       Annex 1 – GOODS     

·      Annex 2 – SERVICES  

·      Annex 3 - WORKS      

N.B.: The attention of all Suppliers/Services Providers/Contractors is hereby drawn to the following: Failure to provide the required information may entail your non-registration as a Supplier/Service Provider/Contractor with the Open University of Mauritius. Registration does not mean that the Open University of Mauritius has any contractual obligation towards them, nor will they become exclusive Suppliers for Goods, Service Providers and Contractors for Works.

     

 

Recourse to any other alternative Suppliers/Service Providers/Contractors/Consultants may be envisaged whenever this is considered necessary by the Open University of Mauritius.

I/We undertake to provide credit facilities to the Open University of Mauritius and to abide to procurement legislations.

I/We ........................................................................................................................ declare that the above information provided in this form including those

provided if any in the attachment is correct at the time this form is being filled.

Authorised Signatory

Signature      :  …………………….......……….

Name            : …………………………………..

Position        : …………………………………..(capacity in which signing)

Date             : ………………………….............…               Seal:…………………………………….

 

Issue: 01                                Supplier’s Registration Form         Identifier: OU-ICT003
Revision: 01

PA23.04.15