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LOGIS Supplier Registration Form SUPPLIER DETAILS CREDIT ORDER INSTRUCTION COMPANY S FULL TRADING NAME please print clearly Year Number Type ENTERPRISE REGISTRATION NUMBER Please attach a copy of the Registration Certificate If Sole Proprietor VAT NUMBER BUSINESS ADDRESS Line 1 1. I/We will not hold the Eastern Cape Provincial Administration liable for any payment not made into my/our bank account if the bank account details are incorrect or were not supplied to the Department within a reasonable time prior to the expected date of payment subject to appropriate contracting or order procedures being followed. 5. The information provided for this registration as it applies to the supply of all goods and services and the related payment will be subject to the General Conditions of Contract or as otherwise agreed with the relevant department. Line 2 City Telephone no and area code Fax no and area code Initials and Surname Name of Bank Name of Branch Branch Code Postal Code PAYMENT ADDRESS Date E-mail Address POSTAL ADDRESS Authorised Signature DETAILS OF MY/OUR BANK ACCOUNT Account Name Account If Cheque Account attach a blank cancelled cheque Please complete this form and forward only original documents to Post to SCMO Logis Registrations Provincial Planning and Treasury Private Bag X0029 Bhisho CESD Account Type By Hand Shop 5 Tyamzashe Building Phalo Avenue 1 Cheque Acc 2 Savings Acc FOR INTERNAL USE ONLY 3 Transmission Acc Bond Acc Not in use 6 Sub-scription Acc FOR COMPLETION BY BANK OFFICIAL LOGIK Request Number Bank account details are hereby certified as being correct Name BANK STAMP WITH DATE Filing Number Signature. I/We hereby request and authorise you to pay any amounts which accrue to me/us to the credit of my/our account with the mentioned bank. 2. I/We understand that the credit transfer hereby authorised will be processed by Electronic Fund Transfer EFT and I/We also understand that no additional advice of payment will be provided other than the details of each payment as provided by my/our bank. 3. This authority may be cancelled by me/us by giving thirty day s notice by pre-paid/registered post or by hand delivered instruction* 4. I/We will not hold the Eastern Cape Provincial Administration liable for any payment not made into my/our bank account if the bank account details are incorrect or were not supplied to the Department within a reasonable time prior to the expected date of payment subject to appropriate contracting or order procedures being followed* 5. The information provided for this registration as it applies to the supply of all goods and services and the related payment will be subject to the General Conditions of Contract or as otherwise agreed with the relevant department. Line 2 City Telephone no and area code Fax no and area code Initials and Surname Name of Bank Name of Branch Branch Code Postal Code PAYMENT ADDRESS Date E-mail Address POSTAL ADDRESS Authorised Signature DETAILS OF MY/OUR BANK ACCOUNT Account Name Account If Cheque Account attach a blank cancelled cheque Please complete this form and forward only original documents to Post to SCMO Logis Registrations Provincial Planning and Treasury Private Bag X0029 Bhisho CESD Account Type By Hand Shop 5 Tyamzashe Building Phalo Avenue 1 Cheque Acc 2 Savings Acc FOR INTERNAL USE ONLY 3 Transmission Acc Bond Acc Not in use 6 Sub-scription Acc FOR COMPLETION BY BANK OFFICIAL LOGIK Request Number Bank account details are hereby certified as being correct Name BANK STAMP WITH DATE Filing Number Signature. .

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