VWSA BLACK-OWNED SUPPLIER'S DAY APPLICATION FORM

VWSA BLACK-OWNED SUPPLIER'S DAY

APPLICATION FORM

1

1 *

Business Details

First name:
Surname:
Cell Number:
Office Telephone Number:
Email Address:
Business Name:
Business Telephone Number:
Physical Business Address:
Website Address (if available):
DUNNS Number (if available):
Company Registration Number:
What is your annual turnover?

2

2 *

What is your organisation's B-BBEE level?

3

3 *

Are you an EME (turnover less than R 10 million P/A or less than 1 year old)?

Turnover less than R 10 million
Less than 1 year old
N/A

4

4 *

Are you a QSE (turnover between R 10 million and R 50 million P?A)?

Annual turnover between R 10 million and R50 million
N/A

5

5 *

Ownership

	0%	<10%	<20%	<30%	<40%	<50%	<60%	<70%	<80%	<90%	<100%
What is your organisation's % black ownership? (Includes Coloured, Indian and Chinese as per codes.)	0%	<10%	<20%	<30%	<40%	<50%	<60%	<70%	<80%	<90%	<100%
What is your organisation's % black female ownership?	0%	<10%	<20%	<30%	<40%	<50%	<60%	<70%	<80%	<90%	<100%
What is your organisation's % disability ownership?	0%	<10%	<20%	<30%	<40%	<50%	<60%	<70%	<80%	<90%	<100%
What is your organisation's % war veteran ownership?	0%	<10%	<20%	<30%	<40%	<50%	<60%	<70%	<80%	<90%	<100%

6

6 *

Products and Services

	Yes	No	I previously did
Do you currently supply products or services to VWSA?	Yes	No	I previously did
Do you currently supply products or services to a VWSA supplier?	Yes	No	I previously did
Do you currently supply products or services to any local OEM?	Yes	No	I previously did

*

What products or services do you offer?

1)
2)
3)
4)
5)

*

What business sector do you operate in?

Automotive
Mining
Defence/Military
Agricultural
Service Industry
IT
Other (please specify)

*

Please describe your product/service in 100 words.

7

7 *

Do you have any quality standards certifications?

SABS
ISO
N/A
Other (please specify)

8

8 *

Do you export?

Yes
No
I previously did

9

9 *

How many people do you employ?

10

10 *

Should you be successful in your application to participate in the inaugural VWSA Black-Owned Supplier's Day on May 5, how many representatives from your organisation would attend (max 5)?

1
2
3
4
5

11

11 *

Please confirm that you understand after the initial round of screening, that VWSA will request you to provide documentary proof of your B-BBEE status, ownership, turnover, certifications et al, afterwhich you will be notified of the status of your application.

I accept this term

12

12 *

Please tick this box to confirm your acceptance of the terms and conditions, which include: Liability: VWSA reserves the right to retract this invitation (attached to the expression of interest) at its own discretion and is under no obligation to establish contracts with applicants, who apply and participate in the VWSA Black-Owned Supplier's Day at own risk.

I accept the terms and conditions

*Please make sure that every field is answered. If the field does not apply to you, please fill in NA.