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SECTION HEADING GOES HERE

ANNEXURE H: SUPPLIER ACCREDITATION FORM (SAF 2/2004)

Information declared hereunder will be subjected to verification and where it is found to have been falsified, or misrepresented, Parliament of RSA reserves the right to terminate any resultant agreement and/or recover losses incurred as a result of such misrepresentation.

A.  ENTITY INFORMATION

1.  Registered Name

2.  Registration number under which entity is incorporated/registered

3.  Registered address

4.  Trading name of entity

5.  Address from which entity operates within RSA

Physical address:

6.  Do you share any facilities? Yes /  No

Procurement of Catering Services forTaking Parliament to the People: T9/2/2010

INITIAL: _____________

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