Prevention of and Treatment for Substance Abuse Act, 2008 (Act No. 70 of 2008)

Regulations

Regulations for Prevention of and Treatment for Substance Abuse, 2013

Annexures

Annexure F : Forms

Form 1 : Application to enter into contract

Purchase

FORM 1

APPLICATION TO ENTER INTO CONTRACT

(Regulation 3(2))

I, __________________________________________________________________________(full names and surname) on behalf of ..............................................................................(organisation's name and NOP number), here by apply to enter into a contract referred to in section 7(1)(c) of the Act. I provide the following services to (number) _____________________________________ persons (see attached list) at (physical address)

______________________________________________________________________________________

Service provided Registration number
Date of establishment of service:
Number of staff delivering service (Attach register of names)
Number of beneficiaries (Attach register of names)
Physical address
Postal address
Telephone No e-mail Cell No.		Fax

I declare that the above information is true and correct. I understand that any misrepresentation or omission of pertinent information may be considered as sufficient grounds for rejecting the application.

__________________________ _____________________________

__________________________

Signature of applicant

Place _________________________________ Date ______________

Documents to be attached to the form

•	Business plan of organization and a list of services rendered by organization

•	Names and certified copies of ID of members of the organization

•	Constitution of the organization

•	NPO registration certificate, if registered as an NPO

•	Any other registration certificates or documents that can support the application

•	Names and contact details of Auditors

•	Provide reference and contact details of persons/organizations supporting the application

•	Disclose all sources of funding/income