EME APPLICATION FORM CERTIFICATE NUMBER: The purpose of this document is to obtain relevant information and documents to rate the Measured Entity as an Exempted MicroEnterprise (EME) according to the Codes of Good Practice Broad-Based Black Economic Empowerment Act, 2003. Please complete this form and attach all the required documents and fax back to 086 585 3885 or email to [email protected] COMPANY INFORMATION Company Name Trading Name Company Registration Number VAT Registration Number Type of Entity (PTY, CC, Sole Proprietor, Trust, Partnership) COMPANY STATUS Sector/Industry/Core Business Please Tick Construction Tourism Information and Communication Technology (ICT) Transportation Financial services Property Other (specify) Forestry Construction -Built Environment Profession (BEP) % Black Ownership % Black Female Ownership CONTACT DETAILS Contact Person Designation Telephone Number Fax Number Mobile Number E–mail Address Physical address of Head Office Province Postal Code I, ____________________________________________________, hereby acknowledge that the above information provided by myself is true and correct and I accept the terms and conditions. Signed at __________________________ on this ______ day of ______________ _____________________________ Signature 20______ Accompaning Documents to attach: Please only collect the relevant documentation stated below as per your company status. Documents required for a CC Check list Entity Registration Documents- CK1 & CK2 documents Certified ID copy(ies) for natural person 12 months Bank Statements Letter from an accountant confirming turnover Audited Financial Statements for the last financial period VAT returns for last 12 months Documents required for a PTY (LTD) CM Documentation or CIPC Documentation Share certificates Certified ID copy(ies) of black shareholders Shareholders Agreement VAT returns for last 12 months Documents required for a Trust Entity Registration Documents Letter of authority from the Master of the High Court and Trust deed List of all beneficiaries and Certified ID copy(ies) VAT returns for last 12 months Documents required for a Start-up Business CM Documentation or CIPC Documentation Share certificates Certified ID copy(ies) of black shareholders Shareholders Agreement N.B. Should the client not provide the neccessary documentation provided above, we can ask for additional information/documentation. Our Banking details: Payment of R450.00 into our bank account: Account holder: Fimcorp Consulting (Pty) Ltd Account number: 371 783 658 Bank: Standard bank Branch: Castle Walk Branch code: 014645 Please quote your Trade Name as a reference, and send us proof of payment once this is done. Should a cheque be received as payment, Fimcorp will wait the full clearance period before the final EME certificate is dispatched to the client. To avoid this delay, please make payment via an EFT transaction or cash deposit. A tax invoice will be provided on payment. Should your business have any complex shareholding eg. Organizational shareholders, we reserve the right to charge additional fees for this assessment.