Revision Date May 2016

VENDOR MASTER APPLICATION FORM

THIS BLOCK - TO BE COMPLETED BY FINANCE AND PURCHASING DEPARTMENT ONLY PAGE 1

(Tick when FNB ONLINE (Tick when SAP BRITS PE RETAIL REGION COMMERCIAL
Loaded) Loaded)

NEW CONTRACTOR ON SITE YES NO Purch. Organisation

New Change

Supplier Code Accounting Group

To be completed by Purchasing

Supplier Name L A S H O C K S A N D L A A L I G N M E N T B A Y
(Legal Entity)

Address

P.O. Box N / A NB NB NB NB NB NB NB NB NB NB

Town R U S T E N B U R G BEE STATUS - COMPULSORY

PLEASE TICK OF APPLICABLE
Region N O R T H W E S T BEE STATUS YES X NO

STATUS IN PROGRESS
Country S O U T H A F R I C A R E P YES NO X

Postal Code 0 2 9 9

IF YOU ARE AN EME, PLEASE PROVIDE LETTER FROM YOUR

Street Name Z E N D L I N G AUDITOR, CONFIRMING TURNOVER IS LESS THAN R10 million.
ALTERNATIVELY PROVIDE COPY OF BBBEE CERTIFICATE.
Town R A s T E N B U R G

Region N O R T H W E S T

Country S O U T H A F R I C A R E P

Postal Code 0 2 9 9

file:///conversion/tmp/activity_task_scratch/674199305.xlsx
 PAGE 2
V.A.T. Registration No/ TAX No 9 1 5 9 1 6 0 2 4 2 (PLEASE INCLUDE COPY OF
VAT REGISTRATION DOCUMENTS
Company Registration Number 2 0 1 8/ 5 6 0 6 1 4/ 0 (PLEASE INCLUDE COPY OF
CK21
Banking Details

Bank Name F N B
COPY OF CANCELLED CHEQUE
Account Nº 6 2 7 9 1 5 0 5 0 3 8 OR OFFICIAL BANK LETTERHEAD

Payment Terms should be negotiated with Bridgestone & Supplier

Bank Key 2 6 0 5 4 6
(Branch Code)

Payment Terms 3 0 DAYS FROM STATEMENT 2.5% SETTLEMENT DISCOUNT EV YA

Correspondence

Sales Person Contact D A V I D B A N D A

Telephone No 2 7 7 8 1 5 4 3 3 5 6

Fax No 2 7 8 6 7 3 7 3 6 3 8

Cell No 2 7 7 6 9 2 1 3 2 6 6

E-Mail Address e x e p t i o n a l c a r s e r v @ g m a i l .c o m

Website / Internet Address N / A

Accounts Person/Contact 2 7 6 7 2 5 6 1 4 8 2

Sales Person / Contact 2 7 7 6 9 2 1 3 2 6 6

Telephone No 2 7 7 6 9 2 1 3 2 6 6

Fax No 2 7 8 6 7 3 7 3 6 3 8

Cell. No. 2 7 7 8 1 5 4 3 3 5 6

file:///conversion/tmp/activity_task_scratch/674199305.xlsx
General PAGE 3

Industry Type A U T O M U T I V E & B R E A K D O W N S

Managing Director D A V I D B A N D A

Order Currency Z A R R A N D

Shipping Details
Incoterms F O B O N R E Q U E S T

Port Of Origin N \ A

Accounting Information (For Office use only)

Accounting Clerk

Payment Method YA EV

Reconciliation Account

Requested by : Date :
Commodity Buyer

Approved by : Date :
Bridgestone / Bridgestone Commercial Procurement Manager (NoMi, MI, and RM)

Entered by : Date :
Bridgestone / Bridgestone Commercial Finance or Acc Payable Manager

Confirmed by : Date :
Bridgestone / Bridgestone Commercial Finance Manager

file:///conversion/tmp/activity_task_scratch/674199305.xlsx
 Supporting documents:
a)     Official and valid BEE Rating Certificate (NOT REQUIRED FOR FOREIGN SUPPLIERS WHO HAVE NO S.A. REPRESENTATION)
b)     A letter from your auditor/accountant confirming the organisations turnover.
c) Copy of VAT registration documents
d) Copy of cancelled cheque or bank details confirmed on an Official Bank letterhead
e) Letter of good standing
f) Public liability insurance if applicable
g) Documentation relevant to quality accreditation and certification

I, D A V I D B A N D A
In my capacity as M______________________________________
A N G E R (Title)

any supporting documents is true and correct, to the best of my

knowledge and belief.

Signature Date

file:///conversion/tmp/activity_task_scratch/674199305.xlsx
 OMNIX

(For Office use only)

a) 'R a) Reason/s for wanting this supplier loaded onto Omnix

b) Please state previous supplier/s you purchased these products/services from
a)

b)

To be completed by Company Associate submitting this form:

To be completed ONLY in the event of this being an Overseas Supplier - this field is compulsory

Country of Origin:
(Name of the Country where supplier on whom the PO was placed operates

Port of Origin:
(Name of the Port closest to where supplier on whom PO was placed operate

Branches to be linked
n whom the PO was placed operates from)

plier on whom PO was placed operates from)