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1. SPECIFICATION REF N0…………….. - Department of Education

1. SPECIFICATION REF N0…………….. - Department of Education

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4.7. List full details <strong>of</strong> directors/trustees/members/ shareholders<br />

Full Name Identity Number Personal Tax<br />

reference number<br />

State<br />

Persal Number<br />

employee<br />

I certify that the information furnished in Paragraph 4 above is correct and I accept that the<br />

state may reject the bid or act against me in terms <strong>of</strong> Paragraph 23 <strong>of</strong> the General Conditions<br />

<strong>of</strong> Contract should this declaration prove to be false.<br />

5. DETAILS OF THE COMPANY<br />

Registration CK No. ___________________________<br />

Company Name: _____________________________<br />

Compilers Name: _____________________________<br />

Signature<br />

: _____________________________<br />

Date<br />

: ____________________________

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