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SECTION HEADING GOES HERE

Combating of Corrupt Activities Act (No 12 of 2004)?

4.2.1

If so, furnish particulars:

4.3

Was any contract between the bidder and Parliament terminated during the past five years on account of failure to perform on or comply with the contract?

4.4

If so, furnish particulars:

CERTIFICATION

I, THE UNDERSIGNED (FULLNAME)…………………………………………………………………

CERTIFY THAT THE INFORMATION FURNISHED ON THIS DECLARATION FORM IS TRUE AND CORRECT.

I ACCEPT THAT, IN ADDITION TO CANCELLATION OF A CONTRACT, ACTION MAY BE TAKEN AGAINST ME SHOULD THIS DECLARATION PROVE TO BE FALSE.

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

Signature                                                                                                  Date

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

Position                                                                                                    Name of Bidder

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

INITIAL: _____________

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