SMME APPLICATION FORM Gauteng Enterprise Propeller

Business Name
Contact Person Telephone No.

CHECKLIST

DATE RECEIVED

Registration Document
Original Tax Clearance Certificate
Certified Identification Document Copy
Financial Statements/ Declaration Letter/ Bank Statement/ Bank Letter (If applicable)
Company Profile (Optional)
Proof of address/ lease agreement (If applicable)

JOHANNESBURG OFFICE EKURHULENI OFFICE SEDIBENG OFFICE TSHWANE OFFICE WEST RAND OFFICE
7th Floor, Ground Floor  1st Floor, Block G, 23 Eloff Street 
124 Main Street 188 Victoria Street, GEP House  333 Grosvenor Street, Krugersdorp
Marshalltown, Germiston 22 Hertz Boulevard Hatfield Gardens, Tel: +27 11 950 9870
Johannesburg Tel: +27 11 821 2870 Vanderbijlpark Hatfield
Tel: +27 11 085 2002 Tel: +27 16 910 1200 Tel: 012 430 2359

HEAD OFFICE 6th Floor, 124 Main Street, Marshalltown, Johannesburg, Tel: +27 11 085 2001,
Website: www.gep.co.za

BDS FORM - REG 002 SMME/CO-OP APPLICATION FORM JUNE 2016 PAGE 1 of 2
SMME REGISTRATION FORM Gauteng Enterprise Propeller

SECTION A
PERSONAL INFORMATION

Title Surname
First Name Race classification
Date of Birth Citizenship ID Number
Residential Address
Postal Address
Telephone (Home) Fax
E-mail Cellphone

SECTION B
BUSINESS INFORMATION

Business name or proposed business name

Business trading name Region
Business Address Street Code
Township/Suburb City
Telephone Number Fax
Cell Business Email
Business Website

SECTION C
BUSINESS OWNERSHIP DETAILS
RACE GENDER DISABILITY
SURNAME & FIRST NAME ID NUMBER OWNERSHIP % (Black/Asian/ (Male/ DATE OF BIRTH
(Yes/No)
Coloured/ White) Female)

M F Y N

M F Y N
M F Y N

M F Y N

M F Y N

M F Y N
M F Y N

SECTION D
BUSINESS DESCRIPTION
Number of employees (excluding owners) Number of employees (including owners)
Type of business: Start-up Sole Proprietor Partnership Close Corporation Private Company
Company Trust Limited Co-operative Non-Profitable Organisation (NPO)
Annual Turnover (Rands) Registration Number
Vat Registration Number Tax Clearance Certificate
Commenced Trading Date Tax Clearance Certificate Expiry Date

PRODUCTS AND SERVICES

Detailed description of your product or service

BDS FORM - REG 002 SMME/CO-OP APPLICATION FORM JUNE 2016 PAGE 2 of 2