RFP Declaration of interest Form - Cycling South Africa

DECLARATION OF INTEREST : RFP CYCLING IT AND DIGITAL PLATFORMS

In order to give effect to you / your company’s interest to make proposal to as service provider to manage and / or partner with Cycling SA to manage its IT and digital platforms, please complete and submit the following questionnaire where after further information shall be shared:

1. Company Name:(Required)

2. Registration number of company, enterprise, close corporation, partnership agreement or trust:(Required)

3. Tax Reference Number:(Required)

4. Vat Registration Number:(Required)

5. Full name of company representative(Required)

6. Identity Number(Required)

7. Position occupied in the Company(Required)

Director, trustee, shareholder, member

8. The names of all directors / trustees / shareholders / members, their individual identity numbers, tax reference numbers and, if applicable, employee numbers must be indicated in the paragraph below.(Required)

"Shareholder means” – a person who owns shares in the company and is actively involved in the management of the enterprise or business and exercises control over the enterprise.

9. Are you or any person connected the proposal you will be submitting, related to any Executive Board member or staff member of Cycling SA(Required)

If your answer is ‘yes’ to the above question, furnish the following particulars:

9a. Name of person / director / trustee / shareholder / member:

Name

Last name

Position

9b. Name of Cycling SA Staff Member to which the person is connected.

Name

Last name

Position

9c. Any other significant particulars.

Name

Last name

Position

10. Did you or your spouse, or any of the company’s directors/ trustees/shareholders / members or their spouses conduct business with Cycling SA in the previous twelve months?(Required)

11. Do you, or any person connected with this RFP have any relationship (family, friend, other) with a person employed by Cycling SA and who may be involved with the evaluation and or adjudication of this bid?(Required)

12. Are you, or any person connected with the bidder, aware of any relationship (family, friend, other) between any other bidder and any person employed by Cycling SA who may be involved with the evaluation and or adjudication of this bid?(Required)

13. If your answer is ‘yes to any or all questions, 10 - 12, please furnish particulars.

First Name

Surname

Identity Number

Please provide Full name and Identity Number of persons.

14. Do you or any of the directors /trustees /shareholders/members of the company have any interest in any other related companies whether or not they are bidding for this contract?(Required)

15. If your answer is yes to question 14, please furnish details of directors /trustees /members /shareholders:

First Name

Surname

Identity Number

Please provide Full name and Identity Number of persons.

Name(Required)

First Last

Date(Required)

Email(Required)

DECLARATION OF INTEREST : RFP CYCLING IT AND DIGITAL PLATFORMS

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