APPLICATION FOR FIDELITY FUND CERTIFICATE by HC120914222348

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									                                          AGRICULTURAL PRODUCE AGENTS COUNCIL
                                          Benvista Office Park No 5, Edgar Road, Jansen Park, Boksburg
                                          Suite No 69, Private Bag X9, East Rand, 1462
                                          Tel: (011) 894-3680 Fax: (011) 894-3761
                                          Website: www.apacweb.org.za
                                          Email – jeandre.holmes@apacouncil.co.za




             APPLICATION FORM – REGISTRATION OF SALES PERSONNEL
                         (SECTION 16 OF ACT 12 OF 1992)

                                   Part I: PARTICULARS OF APPLICANT


Full Names

Surname

Identity Number


Clear copy of ID attached
                                             Yes                            No


Name of agency

Physical address where business will be
carried on

Postal Address


Telephone Number (B)

Mobile Number

Fax Number


E-mail address


Web-site address (if applicable)


Did the sales personnel previously worked
at another agency?                           Yes                            No

If yes, please provide the name of the
agency and period of employment together
with approval letter to transfer the
registration

KINDLY ATTACH A CONFIRMATION LETTER FROM MARKET MANAGEMENT, CONFIRMING
THAT THEY HAVE NO OBJECTION AGAINST THE REGISTRATION.



Application Form: Sales Personnel                                                                        Page 1
                            PART II: DECLARATION OF CONFLICT OF INTEREST

DECLARATION – COMPLIANCE TOWARDS ACT 12 OF 1992 AND THE RULES
Rule 2.2: A fresh produce agent shall maintain an impartial approach in practicing his occupation, and for this
purpose be free of any influence or relationship that, either directly or indirectly, could impair his judgment or
independence.
Rule 2.3: A fresh produce agent shall maintain such integrity and objectivity in the practicing of his occupation as
is necessary to enable him to apply unbiased judgment and objective consideration in forming an opinion or
arriving at decisions.
Rule 4: A fresh produce agent shall not hold decision making positions, controlling interests or offices of whatever
nature, or engage in any venture, business or occupation, which results or could result in a conflict of interest or an
impairment of his independent judgment in the practicing of his occupation.
You are hereby requested to complete the following, confirming your adherence to Rule 2.2, 2.3 and 4:


  Please indicate if you, your wife or relatives has      Yes                             No
 any interest in other business which buys or sells
                    fresh produce



  If indicated yes, please complete all details, for
 example Names and Surname of family member,
 Name of Company and type of conflict (e.g. Buys
       at Agency for Wholesaler business, etc)




                                        PART III: CREDIT INFORMATION




Has a civil judgement ever been passed against
you? Provide details thereof (If applicable)




Have you been rehabilitated?
Provide details hereof




Application Form: Sales Personnel                                                                              Page 2
Have you ever been convicted of an offence in
terms of the National Credit Act, 2005 Act 34 of
2005 or any other credit legislation? Provide
details thereof (if applicable)




                                     PART VI: INCOME TAX DETAILS


Employee Tax Number




Have you ever been convicted of an Income Tax
related offence? Provide details thereof (If
applicable)




                                      PART VII: CRIMINAL RECORD

 Have you ever been convicted of an offence in the
      Republic of South Africa or elsewhere?
  Provide details thereof and of any sentence that
            was imposed (if applicable)


 Have you ever at any time by reason of improper
 conduct been dismissed from a position of trust?
             Provide details thereof



  Have you ever at any time been convicted of an
   offence involving an element of dishonesty?
              Provide details thereof



  Have you ever after an investigation in terms of
    section 24, been found guilty of improper
        conduct? Provide details thereof




Application Form: Sales Personnel                                  Page 3
                                    PART VIII: PREVIOUS EXPERIENCE




 Particulars of previous employment during last 5
 years.




 Have you studied the Act and the Rules?                       Yes                          No


                         PART IX: REQUEST FOR INFORMATION BY APPLICANT

 Indicate by marking the appropriate box with an X, which of the following information you require.

 Agricultural Produce Agents Act, 1992 Act No 12 1992

 The Agricultural Produce Agents Council Rules in Respect Of Fresh Produce Agents



                             PART XI: SUPPLEMENTARY DOCUMNETATION

The applicant must attach the following documentation to this application

    1. Copies of the ID documents of this application
    2. Confirmation letter from Market Management, confirming that they have no objection against the
       registration.
    3. If the sales person previously worked at another agency, a reference letter must be included in the
       application.
    4. Applicant must provide a comprehensive memorandum in terms of his/her understanding of the
       Agricultural Produce Agents Act, the Rules (Government Gazette Nr. 27892) and market regulations
       that must be complied with at ALL TIMES. This memorandum must be signed by the applicant as well
       as the owner of the Agency.

                             PART XII: ACKNOWLEDGEMENT BY APPLICANT


I the undersigned                                                being the applicant hereby declare as
follows;

    a)   I will comply to Act 12 of 1992 and the Rules;
    b)   I have carefully read the application form and am fully aware of the contents thereof ;
    c)   The information contained in this application form is both true and correct in every aspect ;
    d)   I hereby consent to APAC conducting a credit search or to take any other reasonable measures in
         order to verify that the information contained in this application form is both true and correct ;




Application Form: Sales Personnel                                                                     Page 4
   Signed at                        on this         day of            2012




   _________________________________          ___________________________
   APPLICANTS SIGNATURE:                      NAME IN PRINT




   _________________________________          ___________________________
   SIGNATURE OF OWNER / DIRECTOR /            NAME IN PRINT
   SHAREHOLDER OF AGENCY




Application Form: Sales Personnel                                            Page 5

								
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