EIP Application form for Enterprise Investment Programme

4:-INCORPORATION NOINCORPORATION DATE5:-TRADING NAME6:-POSTAL ADDRESSPostal code7:-CONTACT PERSONTitle Mr Mrs Ms Dr Prof Sir8:-CONTACT NUMBERS (with area codes)EMAILFAX e.g. +27(0)12 394 1234MOBILE e.g. +27(0)83 394 1234WORK e.g. +27(0)12 394 1234WEBSITE9:-NAME OF CONSULTANT COMPANYNAME OF CONTACT PERSONEMAILFAX e.g. +27(0)12 394 1234MOBILE e.g. +27(0)83 394 1234WORK e.g. +27(0)12 394 123410:-FINANCIAL YEAR-END11:-ASSISTANCE ENJOYED UNDER THE FOLLOWING PROGRAMMESPROGRAMMEAPPROVED ENTITY NAMESmall medium enterprise development(SMEDP)Production asset allowance(PAA)Regional industrial development(RIDP/SRIDP)Strategic investment project(SIP)Small medium manufacturingdevelopment(SMMDP)Tax holiday(TH)OTHERe.g. FebruaryAPPROVEDENTITY NUMBERPERIOD OF BENEFIT12:-TAX OFFICEVAT NUMBER TAX NUMBERTAX CLEARANCE CERTIFICATE NUMBER13:-LITIGATIONProvide details of ongoing litigation14:-BROAD BASED BEEProvide details of BEE scoring in terms of the Broad-Based Black Economic Empowerment Code of GoodPractiseLevel 6 contributor (>/=45 < 55) Level 5 contributor (>/=55 < 65) Non compliant contributorLevel 8 contributor (>/=30 < 40) Level 4 contributor (>/=65 < 75)Level 7 contributor (>/=40 < 45) Above level 4 contributor (>/=75)TSP_ApplicationForm_Version 2 / 2008/11/12 Applicant’s signature___________________________________________