Request For Supplier Information

IMPORTANT: Please complete and return asap

INFORMATION IS NEEDED EITHER FOR: Payment pending; Routine database maintenance; You may have done work for Hollard in the
past; or belong to an association that Hollard interacts with and we are adding/updating their members on our database; or we are building up a
database (network) of suppliers with specific goods and services nationally

COMPLETION & SUBMISSION PLEASE ATTACH MANDATORY DOCUMENTATION

• Hollard is under no contractual obligation or guarantee that a relationship will be • The SARS Tax Clearance Certificate – current
entered into with the company herein financial year**
• Hollard reserves the right to request proof or more info • Registered business – the CIPRO certificate
• Please advise Group Procurement of any changes to your company • Manufacturer Accredited Certificates - if
relevant
VAT REQUIREMENTS • Proof of Bank Details – either a cancelled
• Use the correct VAT company name & numbers under which you trade & issue invoices cheque or bank statement or a letter from
• Hollards vat nrs must also appear on your invoices. Please use the correct one your bank
o Hollard Insurance 4450117405 • BEE Certificate – current & valid
o Hollard Life 4890176532

RETURN ALL SUPPORTING DOCUMENTATION WITH THIS FORM TO

Group Procurement - Email: [email protected] OR Fax: (011) 351-0899
DIRECT ALL QUERIES REGARDING THIS DOCUMENT TO
Mavis Lubambo on Tel: (011) 351-1411

GENERAL INFORMATION
COMPANY'S REGISTERED NAMES
Full trading name

Full registered name (CIPRO) Registration Number

VAT registered name (SARS) VAT Number

PHYSICAL ADDRESS (Physical address is mandatory)

Street nr Street name Suburb City Postal code Province

PO Box Number P/Bag Number Suburb City Postal Code Province

If not in South Africa, please state which country

GENERAL OFFICE DETAILS
Accounting Contact Name Tel Nr Fax Nr Email address

Switchboard: D/C, Tel (1) Tel (2)

Switchboard: D/C, Fax (1) Fax (2)
Switchboard email
CONTACT DETAILS OF OWNER – TO BE USED FOR OFFICIALBUSINESS / LEGAL MATTERS
Owner Name ID Cell number Email

HOLLARD LIFE ASSURANCE Hollard Villa Arcadia, 22 Oxford Road Directors: RH Enthoven* (Chairman),
COMPANY LIMITED Parktown, Gauteng, 2193 NG Kohler (Group CEO),
(Reg. No. 1993/001405/06) PO Box 87428, Houghton, 2041 TBT Mparutsa (Group CFO),
Tel: 011 351 5000 B Ngonyama,
Hollard is an authorised Fax: 011 351 5001 BF Mohale, AR Munro, H Masondo,
Financial Services Provider www.hollard.co.za R Fihrer (*British)
NL Shirilele (Company Secretary)
 Group Procurement : Request for Supplier Information
Email: [email protected], Fax: (011) 351-0899; Tel: (011) 351-1411
Aug 2012 Page 2 of 2

BANK DETAILS & PAYMENT TERMS (PLEASE SUBMIT A COPY OF A CANCELLED CHEQUE)
Account holder’s name (as printed on company cheques)
Account number Bank name Branch code Branch name Type of account

Payment terms Payment term days State % early settlement Currency

SERVICES CATERGORIES
FOOTPRINT (geographical coverage) MEMBERSHIP WITH RELEVANT ASSOCIATIONS

GOODS OR SERVICE SPECIALISE IN OR PROVIDE

OFFICE EXPENSES AUTOMOTIVE GENERAL SPECIALIST SERVICES BUILDING AND CONTENT

� Building Services (cleaning, Auto Services � 24/7/365 Contact Services Building Construction & General
alterations to building, etc) � Accident Reconstruction Specialists Services
� Business Delivery Services (mail � Assessors (assessments and On-Line Systems & Services � Awnings
services, courier services) estimates for damages to vehicles; � E-dealer Guide; Tenders; Vouchers; � Carpentry & Joinery
� Training (courses, seminars) 2nd level assessments; work-in- Credit Checks; Weather Reports � Carpets
� Business Infrastructure (equipment progress and compliance � Transunion Credit Bureau / ITC � Carports
rental, furniture, office machines, management) � Weather Bureau � Ceilings & Partitioning
security, vehicles) � Auto Dealer Guide � Claims Card � Demolition
� Marketing (advertising, promotion � Car Hire � Value Card � Electrical Fencing
items, merchandising) � Salvage Contractors � Electrical Incident Managers
� Information Technology (computer � Towing Professional Services � Electrical Repairs
software & maintenance, � Vehicle Pre-Inspection Services � Accident Reconstruction � Excavation & Filling
networking) (Inspections are done to confirm the � Appraisers � Fencing & Walling
� Offices Services & Supplies vehicle; its details; condition; security � Attorneys � Flooring, Tiling, Paving
(stationery, catering, food services, systems and driver details. � Auditors � Gate & Garage Motors
flowers) � Vehicle Tracking Equipment & � BEE Verification Agency & � Geysers
� Telecommunications (telephone Services Consultants � Glazing
systems, data lines) � Investigators � Gutters & Down pipes
� Professional Services (accounting, Automotive Specialist - Fitment, � Loss Adjusters (Building & Content � Ironmongery
consulting, legal services, staff Repair & Replace Assessors) � Plastering
recruitment) � Agricultural � Motor Assessors � Plumbing
� Travel & Accommodation � Air Conditioning � Specialised Service Providers (State) � Pools & Spa's
� Body Customisation � Surveyors � Roof Repair
� Canopies � Third Party Recoveries & Defence � Security & Alarms
� Caravans / Motor Homes Matters � Thatching
WATERCRAFT
� Electricians � Tracing Solutions & Agents � Tree felling
� List all
� Engine Modifications � Upliftment Agents � Waterproofing
� Glass
� Mechanical General Retailers / Dealers
MOTOR BIKES
� Motorcycles & Quads � Audio Visual Equipment
� List all
� Panelbeaters � Clothing & Accessories
� Racing Vehicles � Information Technology
� Save-a-Car Programme � Jewellery
SPORT / RACING
� Service & Maintenance � Kitchen & Household Appliances &
� List all
� Sound & Security Furniture
� Specialist Repairs � Outdoor & Camping Equipment
� Trailers � Peripherals & Accessories.
� Trucks & Trailers � Photography Equipment
� Tyres & Mags � Sport Equipment & Accessories

Automotive Suppliers Specialist Fitment, Repair & Replace

� Accessories � List All
� Parts Procurement
� Vehicle Dealers Used & New