Harmony VA1

VA1
HARMONY GOLD MINING COMPANY LIMITED

Randfontein 1760 Vendor Administration Department Tel: (011) 41140 30/31/34 Harmony Gold Mining Company Limited (Registration number 1950/038232/06)
VENDOR FORM
Applications for new Vendors require the completion of two forms, namely the VA1 Vendor Form to be completed by a Harmony representative that motivates the need for a new supplier and the VA2 Supplier Form to be completed by the supplier. The VA1 Vendor Form is also utilized to request the linking of an existing Vendor to a Harmony Business Unit, request the Activation of a Vendor previously de-activated or request a Vendor to be loaded for emergency usage.`
Type of Application:
New Application:
Motivation for a Sole Supplier After-Event Emergency New Vendor Vendor Vendor Maintenance: Activate a Vendor Link a Vendor to a (previously deBusiness Unit activated) Based on the type of application the following sections should be completed. Motivation for a New Section A, Section B, Section C Vendor Activate a Vendor Section A (Supplier Company Name and Motivation to activate a Vendor), Section B, (previously de-activated) Section C Link a Vendor to a Business Section A (up to Supplier Company Name) and Section D Unit Emergency Vendor Section A , Section B, Section E Sole Supplier Section A, Section B, Section C. The Supplier Information form (VA2) should be completed by the supplier and handed in with the Vendor Form (VA1). Proof of Sole Supplier status must be submitted along with the Vendor From. After the Event Vendor Section A, Section B, Section C. The Supplier Information form (VA2) should be completed by the supplier and handed in with the Vendor Form (VA1). Please ensure that the Motivation for loading an After the Event Vendor in Section A is completed.
Section A Motivation for a New Vendor (Only to be completed if the Motivation for new Vendor or Activate a Vendor were selected
at the top of the form.) This section captures the detail of the Harmony unit that requires the services of a new vendor.
Harmony Business Unit Harmony Representative Name Harmony Representative Position

Directors: PT Motsepe* (Chairman), GP Briggs (Chief Executive), HO Meyer (Financial Director), HE MAshego (Executive Director), F abbott*, JA Chissano*#, FFT de Buck*, Dr CM Diarra*##, KV Dicks*, Dr DS Lushaba*, CE Markus*, MJ Motloba*, CML Savage*, AJ Wilkens* *Non - Executive; #Mozambican, *##US/Mall Citizen Secretary: Registration Number: NY Maluleke 1950/038232/06
VA1
Contact Number Supplier Company Name Estimated Annual Spend with the supplier Motivation for New Vendor
(E.g. what product/service is required, why is it required, what value can they add, why can the product not be sourced from existing vendors?)
Motivation to Activate a Vendor (if applicable)
Motivation for loading an After the Event Vendor. (In the event that the services of a non-approved vendor was utilized, the requestor should complete this motivation)
Section B Product List Type A Products
(Select the products to be supplied by the proposed vendor)
Chemicals Conveyors and Accessories Crushers, breakers and grinders Drilling equipment Electric Motors Engineering services
Heating, ventilation and air circulation Hoisting and Scraping Equipment G.D.I instrumentation PPE and safety clothing Pumps and related equipment Railway and tramway machinery and related equipment
VA1
Explosives Fastener equipment Maintenance, Repair and Overhauling
Safety equipment Seismic monitoring equipment and services
Type B Products
Building and construction material Chains Cleaning material Consultancy services Contract labour Electrical Systems and Components Financial and Insurance Services Food and Beverage Products Hiring of Equipment Information Technology Mail and storage facilities Medical aid equipment Metal smelting, refining and forming equipment Mining and engineering services Oils, fuels and lubricants Organizations and Club services Pipes and Tubing supplies Processing of scrap products Sampling equipment Security equipment Stationery and office supplies Steel products Telecommunication equipment Tools Training and education services Transportation services Treatment of Woodchips Treatment of surface sources Travel, food and lodging services Underground support services Vehicles supply and/or maintenance Welding services
If none of the above, please describe product/service:
Section C Classification (The below chart will assist you in determining the Supplier Category)
Category 1 Supplier If product/service is only in the Type B Product List and no product in Type A Product List was selected and the Estimated Annual Spend with Harmony is less than R300 000. If product/service is only in the Type B Product List and no product in Type A Product List was selected and the Estimated Annual Spend with Harmony is greater than R300 000. If any product/service in Type A Product List was selected and the Estimated Annual Spend with Harmony is less than R300 000. If any product/service in Type A Product List was selected and the Estimated Annual Spend with Harmony is greater than R300 000.
Category 2 Supplier
Category 3 Supplier Category 4 Supplier
VA1
Based on the Category of supplier, the below documentation need to be submitted by the supplier to Harmony should the motivation be approved. Without the complete set of information the application will not be processed. Category 1 Supplier BEE certificate (if available) Category 2 Supplier BEE certificate (if available) Tax Clearance Certificate
Category 3 Supplier Category 4 Supplier
BEE certificate (if available) Risk Assessment BEE certificate (if available) Tax Clearance Certificate Risk Assessment
Section D Link a Vendor to a Business Unit

Vendor Number Business Unit ARM EOH KG AVG EVA REL CEN SERV FG SAMC ELK HGM RU
Section E Emergency Vendor Information

Banking Details Account Name Account Number Bank Bank Branch Code
VA1
Harmony Representative:
Signed at (Place) __________________________________ on (Date) ________________________ For (Harmony) ____________________________________________________________________ Initials and Surname: Position in Company: ______________________________________ ______________________________________
Signature: HOD:
_____________________________________ Initials and Surname: ______________________________________ ______________________________________
Date ________________________ Position in Company:
Signature:
_____________________________________

Harmony VA1

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VA1

HARMONY GOLD MINING COMPANY LIMITED

Harmony Business Unit Harmony Representative Name Harmony Representative Position

Motivation to Activate a Vendor (if applicable)

Section B Product List Type A Products

(Select the products to be supplied by the proposed vendor)

Explosives Fastener equipment Maintenance, Repair and Overhauling

Safety equipment Seismic monitoring equipment and services

If none of the above, please describe product/service:

Category 3 Supplier Category 4 Supplier

Category 3 Supplier Category 4 Supplier

Section D Link a Vendor to a Business Unit

Section E Emergency Vendor Information

_ Initials and Surname: ____

Date ________________________ Position in Company:

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