Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694265849571.pdf (Mauritius)
Ministry of Social Integration, Social Security and National Solidarity (Social Security and National Solidarity Division) SUPPLIER REGISTRATION FORM FOR ASSISTIVE DEVICES (WHEELCHAIRS, HEARING AIDS AND OPTICAL GLASSES) Instructions: This form must be submitted at the Registry of this Ministry on 12th Floor, Renganaden Seeneevassen Building, Port Louis Incomplete or incorrect submissions may not be retained for registration.

Section 1 – Corporate Information 1.


Name of Company / Business / Individuals ....................................................................................................................................... 2.

Registered Address: …………………..……………………………………………………………………………… 3.

Mailing Address ( if different from 2): …………………..…………………………………………………………………………….. 4.

Telephone (Head Office) : ………………………Mobile: ………………………………… 5.

Fax Number: ………………………………………………………………………………… 6.


Email Address: ……………………………………………………………………………… 7.

Contact Person/s Name and Title: ……………………………………………………………… 8.

Contact Person /s Tel / Mobile: ……………………………………………………………… 9.

Contact Person/s Email Address: ……………………………………………………………….

10.

Website if applicable: ………………………………………………………………………... 11.

Type of Business: □ Corporation □ Sole Proprietorship □ Limited Partnership □ Other (specify) 1 12.
Whether registered as a Medical Device Dealer / Retailer : ………………………… If Yes, copy of relevant license to be submitted.

13.

Assistive Device to be supplied: Wheelchair Hearing Aids Optical Glasses N.B: A company may qualify for Wheelchairs, Hearing Aids or Optical Items or for all Assistive Device.

14.

Has your company ever dealt with Ministry of Social Integration, Social Security and National Solidarity?
Yes No Sub Section 1 (i) Additional Requirement Suppliers are required to submit the following documents along with the Registration Form and comply with the criteria mentioned below for each assistive device: (i) For Suppliers of Optical Items a) Under THE OPTICIANS (REGISTRATION) ACT RL 4/117 of 24 April 1982, Section 5, no person, unless registered under this Act shall:  Practice sight-testing or dispensing either for or without reward  Carry on business as an optician  Take or use any name, title, addition or description implying that he/she is registered under this Act.
b) For Individual, suppliers must be registered under the Optician Registration Act either as an Ophthalmic Optician or a Dispensing Optician or as Opticien-lunetier as per Optician Registration Act, Section 6 (1) (a) and (b).

c) For Body Corporates one of the Director or an Employee is registered as an Ophthalmic or a dispensing Optician as per Optician Registration Act, Section 6 (1) (c).

Certificate of Registration must be made available for examination by the Ministry.
d) Companies shall hold spare parts up to three (3) years of operation.

(ii) For Suppliers of Wheelchairs a) Warranty shall be: One (1) year on the wheelchair and two (2) years on frame as from date of delivery.

2 b) After sales service for at least three (3) years is required for the supply of spare parts, like wheels, footrests, seat and back upholstery after warranty.
c) The supplier of wheelchair must have at least three (3) years of experience in the supply of a similar type of goods and should have the necessary knowhow in repairs of same.

d) Companies shall hold spare parts up to three (3) years of operation.

(iii) For Suppliers of Hearing Aids a) Period of time the Goods are expected to be functioning for the purpose of spare parts is three (3) years.

b) Warranty : One year on the Hearing Aids.


c) The supplier must have at least three (3) years of experience in the supply of a similar type of goods.

d) The Availability of spare parts and after sales service for the equipment up to three (3) years.

e) The suppliers shall furnish documentary evidence to demonstrate that they have the experience in handling tuning and repairs of similar type of goods.
(iv) Other Criteria (a) Manufacturer’s authorization or letter from local representative/reseller is a mandatory requirement.

(b) Suppliers must not be under a disqualification or debarment sanction.

(c) Suppliers must have a Business Registration Card/Certificate of Incorporation/Trade Licence.

(d) Average Annual Turnover of the company should be at least Rs 1 million.

Section 2 – Financial Information (to provide documents) Bank Name: …………………………………………………………………………………………….
Bank Account Number: ………………………………………………………………………………….

Business Registration Number: …………………………………………….…………………………… 3 V.A.T Number: ………………………………………………………………………………………….

T.A.N: …………………………………………………………………………………………………...

Section 3 – Nature of Business (a) Indicate company’s Nature of Business : ………………………………………………………………………………………………… (b) Is the company ISO Certified?
Yes No If Yes, to what levels: ..................................................................................................................... All information submitted on this form is true and can be ascertained.

I understand that any incorrect information given in this questionnaire may result in disqualification from Registration.
All information in this document will remain in strict confidence with the Ministry of Social Integration, Social Security and National Solidarity (Social Security and National Solidarity Division).

Name of Authorized Person : …………………………………………………………………….
Title :…………………………………………………………………………………………………… Signature ……………………………………………………………………………………………… Date : …………./…………/………… Seal of the Company: 10th Floor, Renganaden Seeneevassen Building, Cnr Jules Koenig & Maillard Streets, Port Louis Website: https://socialsecurity.govmu.org Email: fjhangeer@govmu.org Tel: 207-1438 Fax: 210-9664 4