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Suppliers Accreditation Form
Suppliers Accreditation Form
FORM SUBMISSION ISSUES:
Please be patient when submitting the form, we apologize for any inconveniences caused.
Section A - Business Info
Company Name
Contact Person
First Name
Last Name
Contact Number
Area Code
Phone Number
Email Address
Service / Product Description
Section B - Questionnaire
If your company’s turnover is greater than R1 million in any 12 month consecutive period, is your company registered for VAT, OR, is your company’s turnover less than R1 million in any 12-month consecutive period?
Yes
No
Is your company's turnover less than R10 million in any 12-month consecutive period?
Yes
No
Do you have a valid B-BBEE rating as issued by an accredited agency or, in the case of an EME or >=51% Black Owned QSE, a valid affidavit?
Yes
No
Does your company have a valid tax clearance certificate?
Yes
No
Would you be prepared to supply a bank reference on your main account to Netcare?
Yes
No
Are there material outstanding/unresolved judgements against your company?
Yes
No
Has your company had judgements issued against it in the last three years?
Yes
No
Section C - Business Questionnaire
Netcare Procurement Category
Catering
Indirect
Furniture and Fittings
Medical
Property
Technical
Pharmacy
IT
Please Select Category
Does your company accept Netcare's conditions of Purchase?
Yes
No
Is your company prepared to limit annual price escalation to less than or equal to the published Production Price Index (PPI) / Consumer Price Index (CPI)?
Yes
No
Is your company willing to enter into a service level agreement (SLA) with Netcare?
Yes
No
Have you got a valid B-BBEE rating as issued by an accredited agency / or the evidence of being an EME (Exempt Micro Enterprise)?
Yes
No
Does your company have a documented waste disposal policy/procedure?
Yes
No
Has your company ever been served with any environmental contravention/improvement notices by a government authority?
Yes
No
Does your company have a published Environmental / Sustainability Policy?
Yes
No
Would you be prepared to release your last three years of annual financial statements to Netcare?
Yes
No
Has your company's turnover decreased in the past five years?
Yes
No
Does your company have a sound credit history?
Yes
No
Has your company been consecutively profitable in the past five financial years?
Yes
No
Have your company's assets always been greater than its liabilities in the past five years?
Yes
No
Is there a documented Emergency/Disaster/Business Recovery plan in place?
Yes
No
Does you company have a valid HACCP accreditation or a GMP in place?
Yes
No
Does your company maintain an Employment Equity Plan?
Yes
No
Have you submitted your Employment Equity Report to the Department of Labour?
Yes
No
Has your company experienced more than one illegal strike in the last year?
Yes
No
Is your company's annual staff turnover rate for the last year less than 5%.?
Yes
No
Does your Company comply with the minimum requirements of the Basic Conditions of Employment Act?
Yes
No
Is there a process to identify non-conforming product and prevent its unintended use or delivery?
Yes
No
Is there a Quality Policy reflecting the Quality Objectives and Management's commitment to Quality?
Yes
No
Does your company offer early settlement discount equal to or greater than 2.5% for less than 30 days payment from date of statement?
Yes
No
Has your company experienced more than one legal strike in the last year?
Yes
No
Does your company comply with all requirements of the workman's compensation insurance fund?
Yes
No
Are you prepared to deliver to neighboring states if required to do so?
Yes
No
Do you issue a delivery note or tax invoice with all goods delivered?
Yes
No
Does your company supply training material for the correct and safe use of your product?
Yes
No
Is your company ISO 14000 listed?
Yes
No
Has your company subscribed to the WEEE (Waste Electrical and Electronic Equipment) directive?
Yes
No
Is your company ISO 9001 listed?
Yes
No
Are the manufacturers that you purchase from ISO 9001 listed?
Yes
No
If you are an artwork supplier, do you only supply artwork that you have the rights to copy?
Yes
No
If you are a fabric supplier, does your company have a procedure/mechanism to inform customers of discontinued products at least 60 days prior to discontinuation?
Yes
No
Is your company prepared to provide a 5 year guarantee (from manufacturer) on your products?
Yes
No
Do you deem the person performing the service as being technically competent?
Yes
No
Does a documented measuring and monitoring system of the product provide assurance that specifications/standards are met?
Yes
No
Are the devises CE/TUV/FDA certified?
Yes
No
Are the devises registered with the DOH?
Yes
No
Does you company agree to contract with Netcare on the terms and conditions of Netcare's choice, whether standard industry, amended industry or Netcare specific?
Yes
No
Do you benchmark your prices, service and value added against the rest of the industry?
Yes
No
Does your company have a Health and Safety Policy?
Yes
No
Do you have a current CIDB Grading?
Yes
No
Do you accept Netcare's representative conduct policy?
Yes
No
Do you accept Netcare's NAPPI code policy?
Yes
No
Does your company inform customers of impending price changes at least 30 days prior to such change?
Yes
No
Is your company willing to enter into a memorandum of agreement with Netcare, which will include service levels required?
Yes
No
Do you deliver to major centres within RSA 24 hours?
Yes
No
Does manufacturer of the items you supply comply with a quality management system e.g. ISO 13485?
Yes
No
Do you have a minimum order rand value?
Yes
No
Do you break pack to enable purchase of single units?
Yes
No
Do you have certificates of quality management systems for all your products (e.g. CE mark)
Yes
No
Is your company registered with South African Health Products Regulatory Authority (SAHPRA)?
Yes
No
Section D - Signatories
I / We hereby certify that the above information is true and correct and properly documented. I / We grant permission that the above information may be audited by Netcare. I / We take note of the fact that if incorrect information is supplied, Netcare reserves the right to blacklist the company and/or cancel/terminate any orders awarded to the company
I Agree