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PROCEDURE MANUAL Doc Ref No: BEE/CP/13/A17Title: BEE Compliance Questionnaire for an Exempted Micro Enterprise Verification
Revision No: 07
Copy No: 01 Page: 1 of 7 Compiler: L Frank Date Compiled: 13 September 2012Approver: R Ackerdien Effective date: 17 September2012
FOR THE ATTENTION OF:
COMPLIANCE EVALUATION QUESTIONNAIRE FOR EXEMPTED MICRO ENTERPRISES IN TERMS OF THE BROAD-BASED BLACK ECONOMIC
EMPOWERMENT ACT, ACT NO. 53 OF 2003 (“THE ACT”) As an Exempted Micro Enterprise you will achieve a B-BBEE Rating of 65 Points (if White Owned) and
75 Points (if > 50.1% Black Owned)
With a 65 B-BBEE Rating your company will be rated as a Level Four Contributor to B-BBEE, with a B-BBEE Procurement Recognition Level of 100%, and
With a 75 B-BBEE Rating your company will be rated as a Level Three Contributor to B-BBEE with a B-BBEE Procurement Recognition Level of 110%
________________________________________________________________________________________
AFFIDAVIT
UNDERTAKING BY THE REPRESENTATIVE OF THE COMPANY:
I, the undersigned ____________________________
1. I am an adult male/female. By submitting this form, the signatories acknowledge that he/she has the required authority to do so.
2. I authorize BEE Empowered and Labour Consultancy CC, to commence the EME Verification process.3. I hereby declare that the information furnished herein, is true and correct.
I, hereby certify that the representative has acknowledged that he/she knows and understands the contents of this affidavit
_________________________COMMISSIONER OF OATHS
Place of signing: ________________________________
Capacity of commissioner: ________________________
Date: _________________________________________
PLEASE SEE TABLE BELOW TO DETERMINE WHETHER OR NOT YOUR COMPANY QUALIFIES FOR AN EXEMPTED MICRO ENTERPRISE RATING AND THEN SIMPLY FOLLOW STEPS ONE TO
PROCEDURE MANUAL Doc Ref No: BEE/CP/13/A17Title: BEE Compliance Questionnaire for an Exempted Micro Enterprise Verification
Revision No: 07
Copy No: 01 Page: 2 of 7Compiler: L Frank Date Compiled: 13 September 2012Approver: R Ackerdien Effective date: 17 September 2012
FOUR HEREUNDER TO OBTAIN A EXEMPTED MICRO ENTERPRISE RATING FOR YOUR COMPANY
STEP ONE
Kindly indicate which Code is applicable to your company:
Applicable Codes Annual Turnover Measured EntityGeneric Codes of Good Practice R0 - R5 million
Forest Sector Code R0 - R5 million Transport Sector Codes R0 - R5 millionTourism Sector Codes R0 - R2.5 million
Construction Sector Codes: Contractor
R0 - R5 million
Construction Sector Codes: BEP (Built Environment Professional
related enterprises which provide services related but not limited to
consulting engineering, architecture and quantity surveying.
R0 – R1.5 million
Property Sector Code: Service Based
R0 – R5 million
Property Sector Code: Estate Agents R0 – R2.5 millionProperty Sector Code: Asset Based R0 – R30 millionInformation and Communication
Technology Sector CodeR0 – R5 million
Chartered Accountancy Profession R0 – R5 million
STEP TWO
Kindly complete Sections A and B hereunder:
PROCEDURE MANUAL Doc Ref No: BEE/CP/13/A17Title: BEE Compliance Questionnaire for an Exempted Micro Enterprise Verification
Revision No: 07
Copy No: 01 Page: 3 of 7Compiler: L Frank Date Compiled: 13 September 2012Approver: R Ackerdien Effective date: 17 September 2012
SECTION A: COMPANY INFORMATIONCOMPANY NAMETRADING NAME COMPANY REGISTRATION NUMBERPROOF OF VAT REGISTRATION (WHERE APPLICABLE) IF YOU DO NOT HAVE A VAT NUMBER, STATE “NOT REGISTERED FOR VAT”.IF SOLE PROPRIETOR, PROVIDE THE NAME OF THE SOLE PROPRIETORNAME OF REPRESENTATIVE OF THE MEASURED ENTITY (NAME, SURNAME, DESIGNATION)
NAME SURNAME DESIGNATION
OFFICE NUMBER ( )FACSIMILE NUMBER ( )CELLULAR NUMBERE-MAIL ADDRESSDATE OF INCORPORATIONANNUAL TURNOVERAPPLICABLE SECTOR CODEREGISTERED PHYSICAL ADDRESS
CODEPOSTAL ADDRESS
CODE
ONLY COMPLETE THIS SECTION IF THERE IS ANY BLACK OWNERSHIP IN THE BUSINESS (REMEMBER “BLACK” INCLUDES AFRICAN, INDIAN, COLOURED AND CHINESE)
SECTION B: EQUITY OWNERSHIP (DIRECT EMPOWERMENT)
DECLARATION OF BLACK OWNERSHIP
PROCEDURE MANUAL Doc Ref No: BEE/CP/13/A17Title: BEE Compliance Questionnaire for an Exempted Micro Enterprise Verification
Revision No: 07
Copy No: 01 Page: 4 of 7Compiler: L Frank Date Compiled: 13 September 2012Approver: R Ackerdien Effective date: 17 September 2012
I, the undersigned, hereby declare that the percentage black ownership in our business is as reflected below:
1. % Shareholding by Black People in the Business
%
2. % Shareholding by Black Women in the Business
%
Has all debt, if any, associated with the purchase of the above
Black Shareholding been repaid?
Tick applicable box
YES NO
Are you entitled to receive dividends in the company?
Tick applicable box
YES NO
Do you have voting rights in the company
Tick applicable box
YES NO
PROCEDURE MANUAL Doc Ref No: BEE/CP/13/A17Title: BEE Compliance Questionnaire for an Exempted Micro Enterprise Verification
Revision No: 07
Copy No: 01 Page: 5 of 7Compiler: L Frank Date Compiled: 13 September 2012Approver: R Ackerdien Effective date: 17 September 2012
STEP THREE
Kindly furnish us with copies of the following supporting documentation
IF THE MEASURED ENTITY IS A (PTY) LIMITED Memorandum (CM1)Articles of Association (CM2 and Table A (Public Co) or B (Private Co) of Schedule 1)
Certificate of Incorporation (CM1 / CM3)Certificate to Commence Business (CM46)Share Certificates – ONLY for companies that have any % Black OwnershipTAX Clearance Certificate or similar proof of VAT registration. (If applicable)Certified copies of ID documents of the shareholders of the Company Diagram setting out ownership of the Measured EntityWhere the business is more than 50% black owned, signed affidavit confirming that there are no third party rights attached to the black shareholders’ shares.Signed certificate by the business’ Auditor or Accounting Officer confirming Annual Turnover is less than R5 million. Note: If your company falls under the Tourism Sector Code or if you are an Estate Agent, the letter must confirm that your company’s turnover is less than R2.5 million per annum, if you are a BEP, the letter must confirm that your company’s annual turnover is less than R1.5 million
IF THE MEASURED ENTITY IS A CLOSE CORPORATIONFounding Statement (CK1)Certificate of Amended Founding Statement (CK2) (If applicable)Certified copies of ID documents of Black MembersTAX Clearance Certificate or similar proof of VAT registration. (If applicable)Letter from accountant confirming that your company’s turnover is less than R5 million. Note: If your company falls under the Tourism Sector Code or if you are an Estate Agent, the letter must confirm that your company’s annual turnover is less than R2.5 million per annum and if your company is a BEP, the letter must confirm that your company’s annual turnover is less than R1.5 million
IF THE MEASURED ENTITY IS TRUSTCopy of the Trust DeedProof of Registration of TrustCopies of ID documents of Black BeneficiariesTAX Clearance Certificate or similar proof of VAT registration. (If applicable)Letter from accountant confirming that the trust’s turnover is less than R5 million. Note: If the trust falls under the Tourism Sector Code or if you are an Estate Agent, the letter must confirm that the trust’s annual turnover is less than R2.5 million per annum and if the trust is a BEP, the letter must confirm that the trust’s annual turnover is less than R1.5 million
IF THE MEASURED ENTITY IS A SOLE PROPRIETORCopy of ID document of sole proprietor
PROCEDURE MANUAL Doc Ref No: BEE/CP/13/A17Title: BEE Compliance Questionnaire for an Exempted Micro Enterprise Verification
Revision No: 07
Copy No: 01 Page: 6 of 7Compiler: L Frank Date Compiled: 13 September 2012Approver: R Ackerdien Effective date: 17 September 2012
TAX Clearance Certificate or similarproof of VAT registration. (If applicable)Letter from accountant confirming that the trust’s turnover is less than R5 million. Note: If the trust falls under the Tourism Sector Code or if you are an Estate Agent, the letter must confirm that the trust’s annual turnover is less than R2.5 million per annum and if the trust is a BEP, the letter must confirm that the trust’s annual turnover is less than R1.5 million
IF THE MEASURED ENTITY IS A START-UP ENTERPRISE (* a Start-up Enterprise must be measured as an EME for the first year following their formation or incorporation. This provision applies regardless of the expected total revenue of the start-up enterprise)Independent confirmation of status (CK documents, Certificate of Incorporation, etc)Certified copies of ID documents of Black MembersLast twelve months’ bank statements of the business (only where the certificate from the auditor or accounting officer or the financial statements of the business is not available or if you are a sole proprietor).of bank statements from date of incorporation to date of application for an Exempted Micro Enterprise Rating.Affidavit confirming that the business is a start-up company with no trading history and that it is not merely a continuation of a pre-existing business (Only applicable for businesses that have a trading history of less than 12 months)
PROCEDURE MANUAL Doc Ref No: BEE/CP/13/A17Title: BEE Compliance Questionnaire for an Exempted Micro Enterprise Verification
Revision No: 07
Copy No: 01 Page: 7 of 7Compiler: L Frank Date Compiled: 13 September 2012Approver: R Ackerdien Effective date: 17 September 2012
STEP FOURKindly deposit the verification fee in the amount of R1 083.00 (VAT inclusive) directly into our bank account and fax/email us proof of payment, together with your company details.
Our bank details are as follows:
BEE Empowered & Labour Consultancy CCFirst National Bank, Account no. 62091730400, Branch Code: 201109
PLEASE USE YOUR COMPANY NAME AS THE REFERENCE WHEN MAKING A DEPOSIT
Upon receipt of proof of payment, we will email, post or fax or deliver to you your BEECompliance Questionnaire for you to complete
Once you have completed your BEE Compliance Questionnaire, you must deliver same to ouroffices together with the supporting documentation. We shall process and verify the information
received from you
On finalisation of your assessment, you will be issued with a BEE EMPOWERED B-BBEEVERIFICATION CERTIFICATE. This will be emailed or posted to you and a copy thereof would be made
available on our website: www.bempowered.net
BEE EMPOWERED CONTACT DETAILST: 021 – 511 0802 - F: 021 – 511 0210 – E: info@bempowered.net
Block 1, Unit A21, Northgate Island, Paarden Eiland, 7405
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