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Part 1
Part 2
Part 3
Part 4
Part 5
PART 1: APPLICANT INFORMATION
First Name
Last Name
South African ID number
Gender
Date of birth
Mobile phone number
Email address
Physical home address
Province
District municipality
Local municipality
Village/ Community
Industry (if applicable)
Race
Please Select
African
Coloured
Indian
White
PART 2: MOTIVATION AND INTEREST TO JOIN THE
ENTERPRISE AND SUPPLIER DEVELOPMENT PROGRAMME
How did you hear about the program?
Please Select
Word of mouth
Media
Social Media
Other
Key areas where you feel your business needs support.
Choose 5 options
Coach and Mentoring
Compliance
Financial Management
Technical Skills
Business Strategy
Operations Management
Human Resource Management
Personal Development
Funding
Branding and marketing management
Business processes
Other Needs
Comments (Please provide clear explanation of your business need)
Why are you interested in this programme? What do you hope to gain from this programme? What do you expect to achieve at the end of the program? (max. 400 words)
The program requires a time commitment of at least 2 to 12 hours per month, over the next 9 to 12 months. Do you have the time to commit to the program and regularly attend?
Please Select
Yes
Sometimes
No
The program does not offer transport. Do you have time and transportation to attend training and advisory sessions?
Please Select
I can travel up to 15 kilometers to attend training
I can travel up to 10 kilometers to attend training
I can travel up to 5 kilometers to attend training
I can travel up to 2 kilometers to attend training
I cannot travel
PART 3: BUSINESS INFORMATION
Name of business/trading name
Company registration number
SARS tax registration numbers (if applicable)
Business phone number
Business email address
Business website
Physical business address
Your title or role in business
What does your company do (goods and/or services)?
Primary (Maximum of two (2) choices allowed)
Secondary (Maximum of three (3) choices allowed)
Sector of your business
Please Select
Manufacturing
Wholesale
Construction
Retail
Financial services
Transport
Mining
Agriculture
Tourism
Fashion & beauty
information technology & communication
Type of business entity
Please Select
Sole Proprietorship
Close corporation
Private Company(Pty) Ltd
Personal liability company (Inc.)
Public Company(Ltd)
None
How involved are you in this business
Please Select
Full time
Part time
Other
How long has your venture been in operation?
Please Select
Less than 3 months
Between 3 months and 3 years
More than 3 years
Describe your business. What do you sell? Who are your customers? (Maximum 400 characters)
Number of active client contracts
Please Select
I have no contract
1 to 5 Contracts
6 to 10 Contracts
Indicate the number of people working in your business (consider people who work part time or full time who should receive payment even if they do not receive it now).
Full time employees
Part time employees
Names of owners os shareholders
Delete
Name & Surname
ID Number
Age
Race
Ownership
Disability
Gender
Add Owner
Indicate the annual turnover. This could include formal and informal sales, and should be supported by annual financial statement.
Please Select
I have no sales yet
Less than R1 000 000 per annum
Between R1 000 000 and R10 000 000 per annum
Between R10 000 000 and R50 000 000 per annum
More than R50 000 000 per annum
Which of the following best describe the exclusivity of your business to your customers:
Please Select
We sell goods/services that our customers can get from many other suppliers
We sell goods/services that our customers can get from few other suppliers
We sell ninche goods/services that are unique in the marketplace so our customers would have to work hard to find another supplier of what we sell
We have a monopoly on the goods/services we sell
Not sure
Trade References
Delete
Project Name
Client Names
Client Location
Industry of Client
Contract Value
Contact Person
Contact Numbers
Add Reference
PART 4: DECLARATION
I understand and agree that a
representative will contact the references(s) identified above for feedback about the good/services provided.
I will abide by
's discretion to process my personal information as per the Protection of Personal Information Act No of 2013(POPIA) read together with Section 18 of the POPI Act.
I agree that
conduct a credit review of myself or my business, if required.
These consent and declaration statements are all completely true and correct, and I will notify
immediately in writting of any change of details pertaining to this application.
First & last name
ID Number
Place
Clear Signature
Your signature
I accept that my signature may be used on other documentation as needed
.
Delete
Delete
PART 5: REQUIRED DOCUMENTS – ATTACHMENTS CHECKLIST
Please attach the following required documents and tick for attached/provided:
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