Netcare Group > Netcare Suppliers > Suppliers Application Form

This is an application for registration on the Netcare supplier database of products and services
ALL SUPPLIERS INFORMATION WILL BE TREATED AS STRICTLY CONFIDENTIAL
Please complete your company details below

Please attach an original cancelled cheque or an original bank verification letter.

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Please provide company name, contact person and telephone numbers of three suppliers and three customers that we can contact referrals.

Please click here for important conditions pertaining to documentation

Please note that you need to fax us certified copies of the following documents
1. Company registration documents
2. ID Documents in a case of a one-man concern or partners
3. Original cancelled Cheque or original letter from the Bank confirming your bank details
4. Broad Based Black Economic Empowerment Accreditation Certificate
5. Verification of Credit Worthiness
6. VAT Registration Certificate where Applicable
7. Tax Clearance Certificate
8. Any other registration certificate pertaining to your relevant industry
9. Membership certificate for all relevant trade association memberships
10. Proof of Workers' Compensation contribution
11. Signed copy of Netcare Supplier Code of Conduct
12. Price list of services and / or products
13. Brochures / catalogues / product list
14. Company profile and financial statements

The above information must be included in all submissions. Incomplete or incorrect submissions will not be considered. Please note that you are welcome to submit any other information over and above the required information, however submissions are restricted to 50 pages. Outdated information could lead to your company being disqualified or not receiving correct payment!

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

Street Address
Street Address 2
City	State / Province
Postal / ZipCode	Country

Street Address
Street Address 2
City	State / Province
Postal / ZipCode	Country

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Suppliers Application Form

SECTION A - Contact Details

Section B - Commercial Evaluation

Bank Information

Conditions

1st Partner's Details

2nd Partner's Details

Section C - Technical

Section D - Quality

Section E - Safety

Section F - References

Section G - Conditions of Purchase

Section H - Documentation Required

Section I - Signatories