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Prospective Supplier - Details

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By completing this form I/we on behalf of the company I represent confirm that I have read and accept the terms and condition of the Supply Chain disclaimer in its entirety. Kindly complete the Prospective Supplier Details information provision pages. Access to all information submitted by yourself will be made available for editing via a secure login facility. If you disconnect before submitting the final detail page, not all the required details will be available to the Supply Chain functionality to make an informed decision. Exxaro reserves the right to remove incomplete registrations.
Company Information
Company Name:	*
Company Type:	Close Corporation Private Not Listed Private and Listed Sole Proprietorship Public Partnership Association Trust Section 21 Parastatal Medical Other *
Company Registration Number:	*
VAT Registered:	Yes No
Situated in: *	Eastern Cape Mpumalanga Western Cape Limpompo KwaZulu-Natal Northern Cape Gauteng North West Province Free State
Service Provision: *	Eastern Cape Mpumalanga Western Cape Limpompo KwaZulu-Natal Northern Cape Gauteng North West Province Free State
Contact Person Name:	*
Contact Person Surname:	*
Contact Number:	*
Email Address:	*
Website Address:
Postal Address:
City/Town:
Province/State:
Country:	Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, The Democratic Republic of The Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and The Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and The South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Postal Code:
Years of operation:	<1 01 02 03 >3 *
Turnover per annum:	<R1m R1m-R5m R5m-R35m R35m-R50m >R50m *
BBBEE Status:	Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 Level 7 Level 8 Non compliant No Status *
BEE Ownership (% Black ownership):	Not BBBEE Black Influenced (>5% and <25%) Black Empowered (>25% - <50%) 50%+1 or more Black Owned 30% or more Black Women Owned *
Rating agency:	SANAS Other N/A * Please specify:
BBBEE certificate validity:	Expiry Date:
ISO Certified:	9002 14001 18001
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