The following particulars must be furnished. In the case of a joint venture, separate enterprise questionnaires in respect of each partner must be completed and submitted.

Section 1: Name of enterprise: ……………………………………………………………………………………………………

Section 2: VAT registration number, if any: …………………………………………………………………………………….

Section 3: CIDB registration number, if any: …………………………………………………………………………………...

Section 4: Particulars of sole proprietors and partners in partnerships

Name*

Identity number*

Personal Income tax number*

*Complete only if sole proprietor or partnership and attach separate page if more than 3 partners

Section 5: Particulars of companies and close corporations

Company registration number …………………………………………………………………………………………………

Close corporation number……………………………………………………………………………………………………

Tax reference number………………………………………………………………………………………..

Section 6: Record in the service of the state

Indicate by marking the relevant boxes with a cross, if any sole proprietor, partner in a partnership or director, manager, principal shareholder or stakeholder in a company or close corporation is currently or has been within the last 12 months in the service of any of the following:

a member of any municipal council

an employee of any provincial department, national or provincial public entity or constitutional institution within the meaning of the Public Finance Management Act, 1999 (Act 1 of 1999)

a member of any provincial legislature

a member of the National Assembly or the National Council of Province

a member of the board of directors of any municipal entry

a member of an accounting authority of any national or provincial public entity

an official of any municipality or municipal entity

an employee of Parliament or a provincial legislature

If any of the above boxes are marked, disclose the following:

Name of sole proprietor, partner, director, manager, principal shareholder or stakeholder

Name of institution, public office, board or organ of state and position held

Status of service (tick appropriate column)

Current

Within last 12 months

Insert separate page if necessary

Section 7: Record of spouses, children and parents in the service of the state

Indicate by marking the relevant boxes with a cross, if any spouse, child or parent of a sole proprietor, partner in a partnership or director, manager, principal shareholder or stakeholder in a company or close corporation is currently or has been within the last 12 months in the service of any of the following:

Name of spouse, child or parent

Name of institution, pubic office, board or organ of state and position held

State of service (tick appropriate column)

Current

Within last 12 months

*insert separate page if necessary

The undersigned, who warrants that he/she is duly authorized to do so on behalf of the enterprise:

Signed

……………………………………………

Date

………………………………….

Name

……………………………………………

Position

…………………………………..

Enterprise name

……………………………………………………………………………………..………