Registration Form

AMS VENDOR FORM

Section A: VENDOR INFORMATION

Supplier Trading Name

Specify Product or Service Type

Company Registration Number
(if applicable)

Vat Registration Number
(if applicable)

Tax Clearance Number
(if applicable)

Accountable Manager:

Accounts Contact Person:

First Name & Surname

Phone No

Physical Address

Postal Address

Section B: PROVIDE SUPPORTING DOCUMENTS

Please indicate that you have provided the following supported (if applicable)

1. valid B-BBEE Certificate or Sworn Affidavit

2. valid Bank confirmation letter (confirming bank details)

3. valid Tax Clearance Certificate

Section C: VERIFICATION

I hereby verify that the contents of this document are valid at the date of signature, and I have attached all relevant copies of supporting documentation.
By signing this form, I consent to the company information to be processed by the AMS, consent is effective immediately and will remain effective until such consent is withdrawn.

Name:

Signature:

Designation:

Date: