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PPADB Contractor Registration Form8 Version2 150911
PPADB Contractor Registration Form8 Version2 150911
PPADB Contractor Registration Form8 Version2 150911
(dd-mm-yyyy) (dd-mm-yyyy)
TO:
Executive Chairperson Public Procurement and Asset Disposal Board Private Bag 0058 GABORONE, BOTSWANA
PUBLIC PROCUREMENT AND ASSET DISPOSAL BOARD APPLICATION FOR INCLUSION in Public Procurement and Asset Disposal Boards List of Approved service providers/suppliers/consultants
**NOTE: Applicant is advised to use page18 or attach a separate signed paper if there is need for more space**
1. Primary Contact (Company Director) Middle Name: Date of Birth: Cell Phone Number: Business Phone Number:
Expiry date:
Name of the Company: Is it registered with Botswana Registrar of Companies? Contractor Type: Company Ownership Webpage: Fax Number: 3. Citizen Reservation Scheme (Indicate interest in registration for reservation scheme) Yes No Supplier 100% Citizen Owned Yes Consultant Majority Owned No Service Provider Minority Owned Foreign Owned
Is Company interested in registering for citizen reservation schemes Reservation Scheme: 4. IT Provider Medical Supply
First Name: Surname: Primary Email: Home Phone Number: Nationality: Country / Jurisdiction: Permit Type: 5. Company Contact Details
Permit number:
Primary Physical Address Plot/Unit No: Street: Village/Town/City: Primary Postal Address
P.O. Box/Private Bag
Secondary Secondary Physical Address (Optional) Plot/Unit No: Street: Village/Town/City: Secondary Secondary Postal Address (Optional)
P.O. Box/Private Bag:
Village/Town/City: Country:
Village/Town/City: Country: 1
6.
7. Discipline and Business Type Selection Discipline Name (Tick as appropriate) Business Type (Tick as appropriate) 8. Company Registration ROC Registration Number: Name of the Company: Date of Registration:
Supplies Company
Consultancies Partnership
(dd-mm-yyyy)
(Attach Supporting Documents: Documents: No8.5 & No8.6 as outlined in Appendix B1 attached)
9.
Full Name: Home Phone Number: Business phone Number: Postal Address P.O. Box /Private Bag: Line Address 1: Line Address 2: Village/Town/City: Physical Address Plot/unit No: Street: Village/Town/City: Country:
(Attach Supporting Documents: Documents: No8.2 No8.2 & No8.8 as outlined in Appendix B1 attached) attached)
Account Type
Name of Bank
Branch Name
1. 2. 3.
ID/Passport No
1. 2. 3.
1. 2. 3.
1. 2. 3.
(Attach Supporting Documents: Documents: No1 & No2 as outlined in Appendix B1 attached) )
(Attach Supporting Documents: Documents: No1, No1, No3, No4, No5, No5, No8.3, No8.3, No8.4 & No8.7 as outlined in Appendix B1 attached)
(Attach Supporting Documents: Documents: No1, No8.2 No8.2 & No8.8 No8.8 as outlined in Appendix B1attached) B1attached)
(Attach Supporting Documents: Documents: Letter of Offer and References from above mentioned clients)
14. Details of Employees in Botswana (FOR CONSULTANCIES) Number of Employees in Botswana Botswana Citizens: Other Nationalities: Total Employed: Details for Principal and Senior Permanent Staff of Botswana
Name of the Person ID Number Date of Birth Profession/Trade Position in Firm Technical Qualification Signature
(Attach Supporting Documents fo for all Principal Senior Permanent Staff as outlined in Appendix B4attached)
15. Details of Affiliates Name of the Group Affiliation and Associated Firms Address
16. Codes/Sub Codes for Contractors PPADB REGISTRATION IS REQUESTED IN THE FOLLOWING DISCIPLINE/S: (Applicants should state required activities activities for registration in code(s code(s), sub code( code(s) and description as indicated in Appendix A2, A3, A4. A4. Applicants Applicants should note that the list of codes is not exhaustive and are encouraged to contact the Board for clarifications)
CODE SUB CODE NEW REGISTRATION DESCRIPTION
17. Oath by Applicant I certify that to the best of my knowledge and belief that the information given in all sections above and Appendices is correct. Signature: For and on behalf of Capacity SWORN before me at At: On this Day of Name: (Name of Service Provider)
Company Stamp
In the year
AM/PM , the Deponent having acknowledged that he/she knows and understands the contents of this oath is
bound hereby and considers it binding on his/her conscience. Full Name Signature of Commissioner of Oaths::
Code 101
Code 102
Code 103
Code 104
Maintenance Light Vehicles; (Cars, light trucks, minibuses and small trailers)
SubSub-code 01 02 03 04 05
Code 105
Code 106
Code 107
SubSub-code 01 02 03 04
SubSub-code 01 02 03 04
SubSub-code 01 02 03 04
SubSub-code 01 02 03 04 05 06 07 08 09
Code 112
SubSub-code 01 02 03 04 05
Code 113
SubSub-code 01 02 03 04 05
Code 114
SubSub-code 01
Code 115
SubSub-code 01
Code 116
Code 118
Telecommunication Services
SubSub-code 01 02 03 04 05 06
Mobile telecommunications services Fixed Line Service Public telephone services Shared network services Data and Message transmission Radio communication services 6
Code 119
01 02 Code 120
SubSub-code 01 02 03 04
Code 121
Code 122
Code 123
Code 124
Code 125
Internet Services
SubSub-code 01 02
Code 126
Code 127
Code 128
Media Services
SubSub-code 01 02 03 04
Code 129
Code 130
Code 131
Rental Services
SubSub-code 01 02 03 04
Code 132
Cleaning Services
SubSub-code 01 02 03 04 05
Code 133
Public Utilities
SubSub-code 01 02 03 04 05
Code 134
Health Services
SubSub-code 01 02 03 04 05 06
Code 135
Code 136
Auctioneering Services
SubSub-code 01 02 03
Code 137
Miscellaneous Services
SubSub-code 01 02 03 04 05 06 07 08
Code 140
Calibration Services
SubSub-code 01
Domestic Supplies
SubSub-code 01 02 03 04
Industrial Supplies
SubSub-code 01 02 03 04 05
Office Equipment
SubSub-code 01
Code 208
Transport Equipment & Accessories SubDescription Sub-code 01 Motor Vehicles, Spares and Accessories 02 Auto mobile spares and accessories 03 Earthmoving Equipment, Spares and Accessories 04 Tyres, Tubes and Accessories 05 Aircraft, Spares and Accessories 06 Locomotives, Spares and Accessories 07 Trailers, Animal Drawn Vehicles, Spares and Accessories 08 Boats, Spares and Accessories 09 Motorcycles, spares and accessories Building Materials
Code 209
SubSub-code 01
Code 210 Furniture
Description Construction Hardware and Materials Description Office Household School Special Description Cleaning Chemicals & Materials Stationery Art & Crafts Uniform, Protective Clothing & General Clothing Textile, fabrics & related items Plastic products Sports and Recreation Equipment, Spares and Accessories Forestry products Lab equipment, spares and accessories Musical Instruments Toiletry Description Stock Feeds and Supplements Veterinary Drugs and Remedies Veterinary Vaccines Seeds and Seedlings Agricultural Equipment, Instruments, Spares and Accessories Agro-chemicals Animal Products and By-products Plants Live Animals Dairy products Description
Processed Food Beverages Household products Industrial products Handicraft and art supplies Furniture Construction products Hardware products Garments Paper and paperboards Plastic products Drugs Vaccines Printing Services
SubSub-code 01 02 03 04
Code 211
General Supplies
SubSub-code 01 02 03 04 05 06 07 08 09 10 11
Code 212
Code 213
Code 214
Petroleum Products
SubSub-code
01 02 03
Description
Fuel Oil, Lubricants & Oil based products Coal and Coal Related Products
10
Description
Chemicals Agro-chemical products Paints, vanishes, printing ink and mastics Hazardous Chemicals/Waste Materials
Gases
SubSub-code 01 02 03
Description
Domestic Industrial Medical
11
Code 302
01
Code 303
Civil Engineering
SubSub-code 01 02 03 04 05 06 07 08 09 10 11
Roads Bridges Infrastructure Public health Dams Railways Airports Irrigation Water supply Sanitation Civil/Structural Engineering Description Electrical design-general Airfield lighting Lifts, hoists and escalators Description Mechanical design- general Steam boiler systems Description Groundwater mapping Water resource planning Borehole siting Borehole logging Description Mining Engineering Services Description Clerk of works services Wet services Description Soils/rocks Bitumen Concrete Steel Pavement investigation Sub-surface investigation Land Topographical Road alignment Geological Road materials
Code 304
Electrical Engineering
SubSub-code
01 02 03
Code 305
Mechanical Engineering
SubSub-code 01 02
Code 306
Code 307
Code 308
Building Engineering
SubSub-code
01 02
Code 31 3 10
Surveying Services
01 02 03 04 05
12
Code 31 3 11
Code 31 312
01 02
Code 31 3 13
Environmental Services
SubSub-code 01 02 03 04 05 06
Environmental assessments Archaeological services Environmental engineering and monitoring services Environmental management systems Natural resource planning and management Environmental policy and legislation Description Finance management Banking management Accounting and auditing services Economic consulting services Payroll management services Description Organisation design and change management Job evaluation, compensation & reward management Recruitment & placement Student placement & management Training & development Human resources policy Description Property management Estate agency Valuations Property consultancies Facilities management Dispute resolution Property development financing Conveyancing Description Management consultancy services Strategy development and implementation services Supply chain management services Description Legal services Arbitration services Description ICT System Development Network and Facilities Management ICT Security Management ICT Risk Management
Code 31 3 14
Code 31 3 15
Human Resource
SubSub-code 01 02 03 04 05 06
Code 31 3 16
Code 31 3 17
Code 31 3 18
ICT Consultancy
SubSub-code
01 02 03 04
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Appendix B1
COMMON REQUIREMENTS FOR REGISTRATION (Applicable to ALL Consultants, Service Providers, Suppliers and Works Contractors) No 1 2 3 4 5 6 7 8 REQUIREMENT FOR REGISTRATION
REGISTRATION CHARGES applicable to ALL Suppliers, Consultants & Service Providers Fee Application Form Submission Certificate P50.00 P100.00 P100.00 Category 100% Citizen Majority Citizen Minority Citizen 100% Foreign Certified Copy P20.00 Fee per Sub Code P100.00 P200.00 P500.00 P1000.00
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Appendix B2
Minimum Requirements for Registration of Service Providers (Code 100- Code 199)
Code Code 100 up to Code 199 Code 100 Code 100 Code 101 Code 102 Code 102 Code 103 Sub code ALL sub codes ALL sub codes Sub Codes 09, 10 Sub Code 01 Sub Code 02, 04, 05 Sub Code 03 ALL sub codes Other Mandatory Requirements Submit Licence from relevant authority Submit Licence from Ministry of Defence, Justice and Security Submit Accreditation Certificate from BOTA Submit Authorisation from the Botswana Tourism Board Submit Authorisation from the Botswana Tourism Board Submit Authorisation from Department of Wildlife & National Parks Submit Licence from Department of Waste Management and Pollution Control Submit Trade Licence (Workshop Licence) from Ministry of Trade Submit Radiation Licence from Department of Radiation, Ministry of Infrastructure, Science and Technology Submit Aircraft Maintenance Organisation Licence from Civil Aviation Authority of Botswana Submit Broadcasting Licence from Botswana Telecommunications Authority Submit Licence from Botswana Postal Services Submit Broadcasting Licence from Botswana Telecommunications Authority Submit Licence from Non Banking Financial Institutions Regulatory Authority Submit Broadcasting Licence from National Broadcasting Board of Botswana Submit Air Operator Licence from Civil Aviation Authority of Botswana Submit Road Transport Permit from Department of Road Transport and Safety Submit Air Operator Licence from Civil Aviation Authority of Botswana Submit Road Transport Permit from Department of Road Transport and Safety Submit Air Operator Licence from Civil Aviation Authority of Botswana Submit Trade Licence (Hire Services Licence) from Ministry of Trade Submit Licence from Ministry of Health Submit Air Operator Licence from Civil Aviation Authority of Botswana Submit a Licence from Botswana Health Professions Council Submit Vet Licence from Ministry of Agriculture Submit Customs Clearing Licence from Botswana Unified Revenue Service Submit Trade Licence (Auctioneering Licence) from Ministry of Trade Submit Auctioneering Authorisation from Real Estate Board
Codes 104 112 All sub codes Codes 114 117 Code 112 Code 113 Code 118 Code 119 Code 125 Code 127 Code 128 Code 129 Code 129 Code 130 Code 130 Code 131 Code 131 Code 134 Code 134 Code 134 Code 134 Code 135 Code 136 Sub code 05 ALL sub codes ALL sub codes Sub code 01 ALL sub codes ALL sub codes ALL sub codes Sub code 01 sub code 02 Sub code 01 sub code 02 Sub code 01 Sub codes 03 & 04 Sub codes 01, 02, 03, & 04 Sub codes 01 Sub codes 01 Sub code 06 Sub code 04 Sub code 01
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Appendix B3
Minimum Requirements for Registration of Suppliers (Code 200 - Code 299) Code Code 200 up to Code 299 Code 200 Code 202 Code 202 Code 208 Code 212 Code 212 Code 212 Code 213 Code 213 Code 215 Subcode ALL sub codes Sub code 02 & sub code 03 Sub code 01 & sub code 02 Sub code 08 Sub code 05 ALL sub codes Sub code 02 & sub code 03 Sub code 06 ALL sub codes Sub code 12 & sub code 13 Sub code 02 Other Mandatory Requirements Submit Trade Licence from relevant authority Submit Department of Veterinary Service Director's Authority Submit pharmaceutical supply licence from Ministry of Health Submit Radiation Licence from Department of Radiation, Ministry of Infrastructure, Science and Technology Submit Aircraft Maintenance Organisation Licence from Civil Aviation Authority of Botswana Submit manufacturers licence from Department of Industrial Affairs, Ministry of Trade and Industry Submit Department of Veterinary Service Director's Authority Submit Agrochemicals licence from Ministry of Agriculture Submit manufacturers licence from Department of Industrial Affairs, Ministry of Trade and Industry Submit pharmaceutical supply licence from Ministry of Health Submit Agrochemicals licence from Ministry of Agriculture
16
Appendix B4 B4
Minimum Requirements for Registration of Consultants (Code 300- Code 399)
Qualification of Key Staff Code Sub Code Other Mandatory Requirements Software requirement
Academic Academic Qualification No. of Key Staff Required Key staff Experience
Experience of Company
ALL
Applicant should have an Office with furniture, telephone line, fax machine, computer, printer Applicant should submit a practicing license/accreditation from relevant authority where applicable Applicant should submit signed copies of Curriculum Vitae of Key staff Applicant should submit certified copies of National Identification Card (Omang) for citizen key staff and/or Certified copies of passports for Non citizen key staff. Applicant should submit proof of permanent employment of key staff Submission of certified copies of academic certificates for key staff Submission of BOTA Accreditation where applicable Applicant is required to have a laboratory and relevant equipment to carry out the tests Applicants is required to have relevant surveying equipment Practicing & Fidelity Certificate from Law Society of Botswana
5 years
None
ALL
ALL
ALL
Code 301 up to Code 399 Code 301 up to Code 399 Code 301 up to Code 399
ALL
ALL
ALL
Code 309
ALL
Code 310
ALL
Code 318
01
17
***The space provided below can be used for continuation should there be need for extra space**
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