Enterprise Development Program

Entry Form

Name of business
Contact Person details:
First names
Surname
Telephone no.
Cellphone no.
Email address
Physical address
Province
Website address
FOR OFFICE USE
Date received
Received by
Industry
Please complete the entry form in full and send back
DETAILS OF THE BUSINESS
Registered name of the business
Registration number of the business
Trading name (trading as)
In which industry does your business fall?
1)Agribusiness / 5) Telecommunications
2)Clean and Renewable Energy / 6) Tourism
3)Infrastructure Development / 7) Waste Management
4)Manufacturing / 8) Other, please specify…
Names & Identity numbers of registered owner/s
Position/s in organisation
Where did you hear about this Enterprise Development Program?
Radio station, please name it
Newspaper, please name it
Magazine, please name it
Website, please name it
Other, please specify
Legal Status of the business:
Close Corporation(CC)
Company [(Pty) Ltd]
Partnership
Sole proprietor
Other(specify) e.g. Co-operative
When was the business established?
Description of business activities:75 max words
What’s compelling about your business offering: 75 words max
How does your business make money: 75 words max
What markets are serviced by your business and does your business have a captive market/s? How big is market/s your business is targeting? 75 words max
Turnover and net profit:
Annual turnover / Annual net profit
Year / Rand / Year / Rand
2014 / 2014
2013 / 2013
2012 / 2012
2011 / 2011

No of employees in the business:
List key employees, job titlesor their roles in the business
Employee name / Job title or role
Tell us about the management team: 100 words max
What skills / expertise does your team have to successfully run the business:
Perform abridged SWOT analysis for your business:
Strengths / Weaknesses
Opportunities / Threats
What does the business seek to achieve in the next three (3) years:
New products, services or markets:
Turnover growth %
Profitability growth %
Employment no.
Other:
What factors are holding you and your business back from achieving full potential? 75 words max
What assistance would your business require from the Program? 75 words max
Any other relevant information? 50 words max e.g. biggest success your business has achieved.
Has the business received any funding to date?
Is the business part of any other Program?
The business is not restricted from doing business with Government?
BEE Status
None / 26% and above / 51% and above / 100%
Undertaking
I hereby certify the correctness of data/information/figures/documents furnished herewith. I also undertake to give further particulars as required and to abide by the rules, regulations and instructions of the Enterprise Development Program as issued from time to time.
Name and Surname ______
Designation ______
Signature ______
Date ______