NB: The form has to be completed in one seating. Make sure you have all the required documents

APPLICANT DETAILS

SUPPLIER DETAILS



Current black ownership: 0%


Current woman ownership: 0%


Current black management: 0%

TYPE OF FIRM(Please tick the relevant box or boxes)

PARTICIPATION CAPACITY (Please tick the relevant box or boxes)

SMALL, MEDIUM, MICRO ENTERPRISE (SMME) STATUS (Please tick the relevant box)

TOTAL NUMBER OF EMPLOYEES (Please tick the relevant box and state the number)


LIST ALL PARTNERS, PROPRIETORS & SHAREHOLDERS AS INDICATED BELLOW (COMPULSORY)

No Name and Surname Identity/Registration Number Citizenship Date of Ownership % of Ownership Specific Status if HDI, Women, Youth or Disabled % Voting (In Decision Making)
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8.

LIST AND IDENTIFY ANY OWNER OR MANAGEMENT OFFICE BEARER WHO HAS OWNERSHIP INTEREST IN ANOTHER FIRM

No Name and Surname Identity Number Citizenship Date of Ownership % of Ownership Specific Status if HDI, Women, Youth or Disabled % Voting (In Decision Making)
1.
2.
3.
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5.
6.
7.
8.

REFERENCES OF PREVIOUS CLIENTS

Client 1
Client 2
Client 3

GENERAL (Complete where applicable)

BUSINESS PROPOSAL

KEY CONSTRAINTS TO GROWTH (Choose a maximum of five constraints only)

UPLOAD SUPPORTING FILES