Broad-Based Black Economic Empowerment Act, 2003 (Act No. 53 of 2003)

Regulations

Purchase

BROAD-1 BASED BLACK ECONOMIC EMPOWERMENT COMMISSION

FORM: B-BBEE 16

SUBMISSION OF DEVIATION OR EXEMPTION REPORT

(in terms of Regulation 20(10)(a))

SECTION A: BASIC DETAILS ABOUT THE ENTITY

1.	Name of entity:

2.	Registration number:

3.	The twelve month period this report covers:

4.	Contact person:

•	Contact person designation:

•	Telephone number:

•	Fax number:

•	Email address:

5.	Physical Address of Entity:

6.	INDICATE PROGRAMMES AIMED AT ACCELERATING TRANSFORMATION:

7.	GIVE DETAILS ON THE LEVEL OF DIVERSITY OF THE ENTITY:

8. B-BBEE rating:

SECTION B: THE IMPACT OF EXEMPTION OR DEVIATION

9. GIVE ACCURATE INFORMATION ON THE FOLLOWING:

State the conditions in the Certificate of Approval	Indicate measures taken by entity to meet conditions/comply with the Codes of Good Practice	Indicate impact of the Exemption/Deviation