Request For Registration As An Approved Supplier On The Supplier Database Of The Department Trade And Industry Page 9
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11Supplier Account Details
(Please note that this account MUST be in the name of the supplier. No 3rd party payments allowed).
Account Name
Account Number
Branch Name
Branch Number
Account Type
Cheque Account
Savings Account
Transmission Account
Bond Account
Other (Please Specify)
ID Number
Passport Number
Company Registration Number
/
/
*CC Registration
*Please include CC/CK where applicable
Practise Number
Bank stamp
It is hereby confirmed that these details have been verified
against the following screens
ABSA-CIF screen
FNB-Hogans system on the CIS4
STD Bank-Look-up-screen
Nedbank- Banking Platform under the Client Details Tab
Contact Details
Business
Area Code
Telephone Number
Extension
Home
Area Code
Telephone Number
Extension
Fax
Area Code
Fax Number
Cell
Cell Code
Cell Number
E-mail Address
Contact Person:
Supplier Signature
Regional Office Sender
Print Name
Print Name
Rank
/
/
/
/
Date (dd/mm/yyyy)
Date (dd/mm/yyyy)
NB: All relevant fields must be completed
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Parent category: Legal