PREFERENCE POINTS CLAIM FORM IN TEMS OF THE PREFERENTIAL (MBD6.

1) PROCUREMENT REGULATIONS 2001

PURCHASES
This preference form must form part of all bids invited. It contains general information and serves as a claim form for Historically Disadvantaged Individuals (HDI) preference points as well as a summary for preference points claim ed for attachment for attainment of other specification goals________________________________________________________________________ NB: BEFORE COMPLETING THIS FORM, BIDDERS MUST STUDY THE GENERAL CONDITIONS, DEFINITIONS AND DIRECTIVEC APPLICABLE IN RESPECT OF EQUITY O NERSHIP BY HISTORICAL DISADVANTAGED INDIVIDUALS (HDI!"). AS PRESCRIBED IN THE PREFERENTIAL PROCUREMENT REGULATIONS, 2001. 1. 1.1 GENERAL CONDITIONS The following preference point systems are applicable to all bids 1.# 1.+ the !"#! system for re$uirements with a %and value of up to %&!! !!!' and the (!"1! system for re$uirements with a %and value above %&!! !!!.

The value of this bid is estimated to e)ceed"not e)ceed %&!! !!! and therefore the ******system shall be applicable. ,reference points for this bid shall be awarded for(a),rice' and (b).pecific contract participation goals/ as specified in the attached forms

1. +.1 1.#.1.1

The points for this bid are allocated as followsPOINTS PRICE ***.

1.#.1.2

SPECIFIC CONTRACT PARTICIPATION GOALS ($) H%"&'(%)$**+ D%"$,-$.&$/0, I.,%-%,1$*"0ho had no franchise in national elections before the 1( + and 1((+ 1onstitutions ..........

(i) (ii) (iii)

(I2) (2)

who is female who has a disability

who is young (youth) O&30( "40)%5%) /'$*" (/'$*" '5 &30 RDP6 4*1" *')$* 7$.15$)&1(0)

..........
.......... ***.

(i) (ii) (iii)

3ocally resident enterprise 4nterprise with its Head 5ffice within 4astern 1ape 3abour intensive

*** ***. ***.

100

T'&$* 4'%.&" 5'( P(%)0, HDI" $., '&30( RDP6 /'$*" 71"& .'& 08)00,

S04$($&0 P(050(0.)0 P'%.&" C*$%7 F'(7" 9%** 20 1"0, 5'( &30 4('7'&%'. '5 &30 "40)%5%) /'$*" 5'( 93%)3 4'%.&" 3$-0 200. $**')$&0, %. 4$($/($43 1.#.1.2 (2) $2'-0. 1.: 6ailure on the part of a bidder to fill in and "or to sign this form may be interpreted to mean that preference points are not claimed.

2H. COMPANY COMPOSITION

GENERAL 7ll information 71"& be filled in spaces provided. If additional space is re$uired/ additional sheets may be attached. The onus is on the bidder to fill in all the information. 6ailure to do so will result in points being lost under e$uity. The full company composition is re$uired including HDI and 8on9HDI status. The ownership must accumulate to 1!!:.
NO FRANCHISE IN ELECTION PRIOR 1<<: (Y=N) VOTING > > O NED

NAME

IDENTITY NUMBER

CITI;ENSHIP

DISABILITY

FEMAL E

DATE OF O NER SHIP