Prevention of and Treatment for Substance Abuse Act, 2008 (Act No. 70 of 2008)RegulationsRegulations for Prevention of and Treatment for Substance Abuse, 2013AnnexuresAnnexure F : FormsForm 1 : Application to enter into contract |
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)
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Service provided
Registration number
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Date of establishment of service:
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Number of staff delivering service (Attach register of names)
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Number of beneficiaries (Attach register of names)
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Physical address
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Postal address
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Telephone No
Cell No.
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Fax |
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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.
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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 |