P.O.

Box 13374
DAR ES SALAAM
CONTRACTORS REGISTRATION BOARD CRB-F2
Tel No. 2131169/2137962/3
E-mail: [email protected]
Web: www.crbtz..org

APPLICATION FORM FOR TEMPORARY REGISTRATION OF CONTRACTORS

(Foreign Category)

__________
By-law 4(1)
__________

For Official Use only

Application form received on: Application received by

Processing fee paid on: Receipt No.

Application fee paid on: Receipt No.

NOTES: 1. Should the space provided on the questionnaire prove insufficient, additional details may be provided on a
separate sheet of paper.
SECTION I: COMPANY PROFILE
1. Company’s Name in full..............................................................................................................................
2. Address of Head Office:..............................................................................................................................
...............................................................................................……………….......
Contact Details:
Telephone No. ........................................................ Fax No. ...............................………………..........
E-mail: ...................................................................... Website:.....................................................................
3. Name of Authorised Representative:1 …………………………………………............................
4. Banker’s Name(s) and Address(es): .........................................................................................................
.........................................................................................................................................................................
5 Contact Address in Tanzania
(House No./Plot No./Block No./Street and Village/Town/City, Postal Address)
..........................................................................................................................................................................
6.
Type of Contracting Business2....................................................................................................................
`
7 Class Applied for (in words) ……………………………………………………..............................
1
Attach power of Attorney
2
State whether Building, Civil, Mechanical, Electrical or Specialist. Specialist contractors should state clearly the
field of specialization e.g. Air-conditioning, Drilling, Glazing, etc.
1
8. No. of Certificate of Incorporation/Registration of Business Names:................................................
(Photocopy of Certificate required)
9. Country of Incorporation: ………………………………………………………..........................
10. Certificate of Compliance No.: …………………………………………………...........................
11. Names, qualifications/experience and nationality of shareholders or partners. Put asterism (*)
against the technically qualified shareholders/partners.

S/No. Name Qualification Nationality %Shares

1 .......... …………............................. ............................... ........................ .........
2 ........................................................... ............................... ......................... ..........
3 ........................................................... ................................ ......................... .........
4 ........... ............................................... ............................... ......................... …….
5 ........... ............................................... ............................... ......................... …….

SECTION II : PARTICULARS OF THE CONTRACTED PROJECT

12. (a) Name of Project : ………………………………………………………...…….................

(b) Scope of Works: …………………………………………………………….......................

13 Location of Project : ………………………………………………………….......………….

…………………………………………………………………….......

14. (a) Value of the Contract: …………………………………………………………..............

(b) Awarding Authority : …………………………………………………………...............

15. (a) Client : …………………………………………….…………………………..............

(b) Financier(s): …………………………………………………………………...............
(c) Consultants: …………………………………………………………………..............
………………………………………………………………….............
(d) Other Contractors on the Project: …………………………………………….............
........................…………………………………………………………………………
.......................................................................................................................................................

1. (a) Starting Date: ………………………………………………………………………..

(b) Expected Completion Date : ………………………………………………………..

2
 SECTION III: STAFF REQUIREMENTS
17. Particulars of Key Personnel (Including Directors/Partners, Technical and Administrative Staff)
Basic Terms Remarks(Give Number and
Academic Status and Working No of Years of Photostat Copy of Work
Name of Personnel Nationality Qualifications3 Position in the Experience with the Employment Permit, in case of foreign
Project (No. of years) Company (Permanent nationals)
or Contract)

......................................................... .....................................................
Signature and Official Stamp Date

3
Attach Certificates or Testimonials and CVs
3
 SECTION IV: PLANT EQUIPMENT OWNED/LEASED

18. Particulars of Plant to be Deployed in the Project

Name of Equipment Type/Make/ Date of Registration No/Serial No/ Owned/Leased Remarks

Model Manufacture Other Identification Mark

.............................................................................. ..............................
Signature and Official Stamp Date

4
20. I/We the undersigned hereby declare as follows:-

(i) My/our signing of this application form implies acceptance of responsibility for the veracity
and accuracy of all information submitted therein or therewith.

(ii) The information given will be used by the Contractors Registration Board for the purpose of
evaluating this application for registration. Such registration will be approved at the sole
discretion of the Board.

(iii) Any employer, consultant or banker, past or present, is hereby authorised and requested to
provide information on the competence and general reputation of this firm if so required by
the Board.

(iv) The Board is welcome to visit and physically inspect my/our establishment and works
(contracts) executed, when it deems fit to do so, in order to verify the authenticity of the
information given herein, or by our Referees, or obtained from any other source regarding our
firm.

(v) Failure to complete any part of this application form may result in not being registered.

(vi) My/our firm shall not be engaged in any acts of bribery or corrupt practices in whatever form.

Dated this ............................ day of .................................. 19.........................................

(i) Signed by....................................................................…………………………. (Name in Block letters)

in the capacity of ...........................................................………………………. (status in Firm)

..........................................................
Signature

(ii) Signed by....................................................................... (Name in Block letters)

in the capacity of ..............................................................(Status in Firm)

..........................................................
Signature

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 SECTION VI

LIST OF ATTACHMENTS TO BE SUBMITTED4

AT 1 — Company Memorandum & Articles of

Association from country of origin (with official / transaction) English
AT 2 — Certificate of Compliance
AT 3 — CV’s of Shareholders /Partners.
AT 4 — CV’s of Key Personnel
AT 5 — Supporting letters from Client
AT 6 — Affidavit
AT 7 — Duly Signed Anti-Bribery Pledge
AT 8 — Letter of Acceptance (Intent) from Client

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 CRB-F10
CONTRACTORS REGISTRATION BOARD

THE CONTRACTORS REGISTRATION ACT, 1997

AFFIDAVIT
________
Made under bylaw 4(2)(h)
_______

I__________________________________ an adult Christian/Muslim/Hindu/Pagan of P.O Box

___________________________
For the purpose of carrying out a specific contract in Tanzania.

DO HEREBY solemnly take oath/affirm and state as follows:

That I __________________________________ am the ______________________________ of applicant
Company M/S _________________________________________________________________________
with Certificate of Compliance No. ____________________ that the company has contracted works with a
specific project at ________________________________ for a period of
____________________________ months/years.

That the duration of the project is __________________________ months/years commencing from

______________ and that once the contracted works are completed we the applicant company shall wind up
business and not engage in any other business beside the above mentioned project.
On behalf of the applicant I declare that the facts deposed to hereinabove are true to the best of my
knowledge.
________________________________
__
DEPONENT
Sworn/Affirmed at __________________________ by the said _________________________ who is the
_________________________________________ of M/S __________________________________
this _____________________________ day of __________________________ 20…….

BEFORE ME: ________________________________________

SIGNATURE: ________________________________________
POSTAL ADDRESS: __________________________________
QUALIFICATIONS: __________________________________

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 P.O. Box 13374
DAR ES SALAAM
Tel No. 2131169/2137962-3
CONTRACTORS REGISTRATION 2132508/2132510
FAX NO. 2137964
BOARD E-mail: [email protected]

CURRICULUM VITAE FOR SHAREHOLDERS OR PARTNERS OF CONSTRUCTION FIRM – Bylaws 3(2)

(Each Shareholder/Partner of the Company should fill this Form)

PART A: PERSONAL BIODATA:

1. Names: Surname: ……………………………………..

First: ………………………………………….
Middle: ……………………………………….

2. Date of Birth: Year: ………………...………………………..

Month: …………….………………………….
Date :: ………………………………………...
Place of Birth: …...…………………………...

3. Nationality: ………………………………………………..

Passport No. ………………………………….

Date of Issue: …………………………………

4. Residential Address: Street: …………………………………………….

Town/City: ………………………………………..
Country: ………………………………………….

5. Postal Address: P.O. Box ………………………………………….

Tel No. ……………………………………………
Town/City: ………………………………………..
Country: …………………………………………..

6. Non-Citizen Passport No.: ……………………………………..

Date of Issue: ……………………………………..
Resident Permit No.1 …………………………….

7. (a) Number of Shares Held2 ……………………………………………………

(b) Percentage of Shares Held …………………………………………………….

1
Attach copies of residence permit
2
Attach copies of Share Certificates

8
PART B: FORMAL TRAINING

S/N Date Schools/College/University Certificate/Award3

From To

PART C: WORKING EXPERIENCE

Date Employer/Organization Position Duties and Actual Assignments

Executed4
From To

PART D: DECLARATION

I declare that the information given above is correct.

Signed: ……………………………………… Date: ………………………………..

3
Attach copies of certificates awarded
4
Technical Director to submit a detailed CV.

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 CONTRACTORS REGISTRATION BOARD
ANTI BRIBERY PLEDGE – Bylaws 3(1) (c) (vii)

(To be signed by all applicants for First Registration or Upgrading)

M/S……………………………………………………… ……...........(name of applicant)

Recognises, that corruption has a devastating impact on the social and economic development of any
country. We share in the growing global consensus that action is needed to strengthen transparency
and accountability, particularly in international development, trade and investment.

M/S ……………………………………………therefore pledged to support the effect of the

Government of the United Republic of Tanzania and to participate, along with the Contractors
Registration Board and other members of the business community and financing institutions, in
forming a coalition against corruption.

M/S………………………………………………Welcomes the action taken by the Government to

strengthen transparency and accountability. In this context we will:-

(a) not offer or give any bribes or any other form of inducement to any public official in
connection with a pending bid.

(b) not permit anyone (whether our employee or an independent commission agent) to do so on
our behalf.

(c) make full disclosure in our bids of the beneficiaries of payments relating to the bids to any
person other that employees but including bonus payment which may made to employee.

(d) formally undertake to issue instructions to all our employees and agents or other
representatives in Tanzania directing them all times to comply with the laws of Tanzania and
in the particular not to offer or to pay bribes or other form of inducement to officials, whether
directly indirectly.

……………………………………………….. ………….………
(to be signed by Chief Executive Officer of the firm) Date

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