In the fields below, please provide the information required. We will contact you as soon as possible.

*	Organisation Name:
*	Trade Name:
*	Registration No:
*	VAT Registration No:
*	Organisation Type:	Single Business Organ of State Public entity Group structure Franchisor Franchisee Unincorporated joint venture Multinational Company Private Company PTY (Ltd)
*	Industry Type:	Agriculture Mining & Quarrying Manufacturing Electricity, Gas & Water Construction Retail Trade Motor Trade Repair Services Wholesale Trade Commercial Agents Catering, Accomm & Other Transport, Storage & Communications Finance & Business Services Community, Social Services
*	Annual Turnover:
*	No. Full-time Emp's:
*	No. of sites:
*	%Black Shareholding:
*	Phys. Address of H/O:
*	Head Office Province:	Western Cape Eastern Cape Northern Cape North-West Province Free State Kwazulu Natal Gauteng Mpumalanga Limpopo Vaal Triangle
*	Postal Code:
*	Contact Person:
*	Position:
*	Telephone:
*	Fax:
*	E-Mail:
*	Mobile:
	Last Verified Status:	No Previous Verification Level One Level Two Level Three Level Four Level Five Level Six Level Seven Level Eigth Non Compliant
* Denotes a required field

The measured enterprise agrees to comply with BEE Verification Agency CC requirements as per its Standard Terms and Conditions.
I understand the manner in which the verification system operates and functions. BEE Verification Agency does not accept any responsibility for the actions or the results of any actions of a measured enterprise.
I declare the information given in this application form is correct to the best of my knowledge and belief. I undertake to inform BEE Verification Agency immediately of any changes with respect to the application and accept full responsibility for any costs incurred as a result of any changes not reported to BEE Verification Agency timeously.

Top

---

Alternatively, you can contact us on:

National Headquarters
Tel: +2721-930-9215
Fax: +2721-930-9936
Mobile: +2782-800-8469