Ubuhlanti Ethnoveterinary Medicine Cluster EoI questionnaire

Registered legal name *

Trading name, if different

Entity country of registration *

CIPC Registration Number

South African operating address

Street Address *

Apartment, suite, etc

City *

ZIP / Postal code *

Country *

Website

Prefix

First Name *

Last Name *

Contact Email Address *

Mobile Number *

Authorised representative *

Ownership and beneficial ownership summary *

Core business activities *

Proposed role in the Cluster or project *

Names of proposed subcontractors or affiliates *

Legal standing

1.1 *Is the applicant a duly registered legal entity in South Africa? If foreign-registered, describe the formal South African operating arrangement.

Explanation:

1.2 *Is the applicant in good standing with all applicable company or entity registration authorities?

Explanation:

1.3 *Is the applicant tax-compliant in South Africa and, where applicable, in its home jurisdiction?

Explanation:

1.4 *Does the applicant hold all registrations, licences or approvals presently required for its operations?

Explanation:

1.5 *Have any registrations, licences or approvals been suspended, withdrawn or made subject to material conditions during the past five years? If yes, provide details and remedial action.

Explanation:

Upload files *Registration certificate; founding documents; proof of South African operating arrangement, where applicable; valid tax-compliance evidence; relevant licences or registrations; certificates of good standing.

Strategic Fit

2.1 *In which relevant areas does the applicant have demonstrated expertise or a credible interest: ethnoveterinary medicines, animal health, indigenous medicinal plant products, veterinary services, agro-processing, biomanufacturing, distribution, or another enabling value-chain capability?

Explanation:

2.2 *Describe the applicant’s relevant products, services, facilities, technologies, market channels or programmes.

Explanation:

2.3 *Provide up to three relevant projects, contracts, partnerships or investments completed or underway during the past five years.

Explanation:

2.4 *Explain how the applicant’s capabilities and proposed contribution advance the Cluster’s objectives and complement other value-chain partners.

Explanation:

Upload files *Company profile; project sheets; client or partner references; product portfolio; facility information; market or distribution evidence; relevant permits, certifications or quality credentials.

Commitment to community partnership

3.1 *Does the applicant accept indigenous knowledge holders and communities as substantive partners in project design, governance, benefit-sharing and, where appropriate, enterprise opportunities?

Explanation:

3.2 *Describe how communities and knowledge holders will participate in decision-making from project inception through implementation and review.

Explanation:

3.3 *Describe the applicant’s proposed approach to prior informed consent, mutually agreed terms, fair attribution and equitable benefit-sharing.

Explanation:

3.4 *Identify potential community enterprise, employment, supplier-development, capacity-building or ownership opportunities.

Explanation:

3.5 *Provide examples of previous community partnerships and lessons learned, if any.

Explanation:

Upload files *Signed statement of commitment; community-engagement policy or framework; previous agreements or case studies, where available; proposed participation and benefit-sharing approach.

Ethical and legal compliance

4.1 *Does the applicant commit to identifying and obtaining all applicable approvals, permits, consents and agreements before regulated activities begin?

Explanation:

4.2 *Describe the systems used to ensure compliance relating to indigenous knowledge, access and benefit-sharing, biodiversity, animal health, veterinary products, research ethics, environmental management, data protection and intellectual property.

Explanation:

4.3 *Identify the approvals and agreements likely to be required for the proposed role and indicate their current status.

Explanation:

4.4 *Has the applicant had any material compliance breach, sanction or unresolved corrective action during the past five years? If yes, disclose details.

Explanation:

4.5 *Who will be accountable for legal, regulatory and ethical compliance?

Explanation:

Upload files *Signed compliance undertaking; compliance register or plan; relevant permits, approvals and policies; ethics or regulatory history; details of the responsible officer.

Operational capacity

5.1 *Identify the key personnel proposed for the project and summarise their qualifications, experience and responsibilities.

Explanation:

5.2 *Describe the applicant’s governance, project-management, financial-control, quality-management, risk-management and reporting systems.

Explanation:

5.3 *Identify the facilities, equipment, technologies, certifications and supply-chain resources available to perform the proposed role.

Explanation:

5.4 *Provide an indicative implementation plan, including key activities, milestones, dependencies and resourcing.

Explanation:

5.5 *Identify material capacity gaps and explain how they will be addressed.

Explanation:

Upload files *Organogram; curricula vitae of key personnel; management-system summaries; certifications; facility or equipment list; implementation plan; recent audited or independently reviewed financial statements, where applicable.

Co-investment readiness

6.1 *Is the applicant willing and able to provide an agreed cash and/or in-kind contribution, subject to the approved project plan and funding agreement?

Cash amount:

In-kind value:

6.2 *State the indicative cash contribution, its source and the expected timing of availability.

Cash amount:

In-kind value:

6.3 *Describe each proposed in-kind contribution, its basis of valuation, availability and relevance to the project.

Cash amount:

In-kind value:

6.4 *Identify any internal approvals, conditions or dependencies that could delay or prevent the contribution.

Cash amount:

In-kind value:

6.5 *Does the applicant agree that all contributions will be documented, verifiable and auditable?

Cash amount:

In-kind value:

Upload files *Board or authorised commitment letter; proof of funds or budget allocation, where appropriate; schedule and valuation of in-kind contributions; internal approval timeline.

Transparency

7.1 *Disclose the applicant’s direct and indirect ownership, controlling interests and ultimate beneficial owners.

Explanation:

7.2 *Disclose any actual, potential or perceived conflict of interest involving the Cluster, participating communities, public officials, evaluators, funders or project partners.

Explanation:

7.3 *Disclose material pending or concluded litigation, insolvency proceedings, regulatory investigations, findings, sanctions or debarments during the past five years.

Explanation:

7.4 *List all subcontractors, affiliates or related parties proposed for the project, their roles and the basis for their selection.

Explanation:

7.5 *Confirm that the applicant will promptly disclose any material change to this information.

Explanation:

Upload files *Ownership structure; beneficial-ownership declaration; conflict-of-interest declaration; litigation and regulatory disclosure; subcontractor or affiliate schedule.

Transparency

8.1 *Does the applicant agree to comply with the Cluster’s governance arrangements and authorised decisions?

Reservations:

8.2 *Does the applicant agree to applicable confidentiality, information-security and data-management provisions?

Reservations:

8.3 *Does the applicant accept the required technical, financial, impact and compliance reporting obligations?

Reservations:

8.4 *Does the applicant accept the dispute-resolution mechanisms and monitoring framework?

Reservations:

8.5 *Identify any requested qualification, reservation or condition. If none, state “None”.

Reservations:

Upload files *Signed governance acceptance; confidentiality undertaking or non-disclosure agreement; authorised resolution or delegation confirming acceptance.

Applicant Declaration and Authorisation *I certify that I am duly authorised to submit this questionnaire on behalf of the applicant. I declare that the information and supporting documents provided are true, complete and accurate to the best of my knowledge. I understand that any material misstatement, omission or failure to disclose relevant information may lead to disqualification, termination of participation, recovery of funds or other appropriate action. I authorise the Cluster and its designated representatives to verify the information submitted, subject to applicable law and confidentiality requirements.

Authorised signatory name *

Position *

Date *

Place *

Office Address

Phone Number

Email Address

TIA006/2026 – LEASING OFFICE IN DURBAN FOR THE TECHNOLOGY INNOVATION AGENCY (TIA)

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