Application Form BP FRANCHISE DEALERSHIP by mrs77385

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									Retail Franchisee/Dealer Selection Process
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                                            Application Form

                               BP FRANCHISE / DEALERSHIP
      (Please insert all the details required on the application form – incomplete/missing information would lead to
                                             immediate discarding of application)


PERSONAL DETAILS:

Applicant

Surname:



First Names:



Physical Address (Residential):




What is the proximity of your residential address to the Site that you are applying for:




Postal Address:




Code:


Contact Details

Telephone Number (Home):

Telephone Number (Work):

Cellular Number:

Fax Number:

E-mail Address:




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Retail Franchisee/Dealer Selection Process
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Identity Number (attach certified copy to application form):



Date of Birth:



Nationality:



Are you prepared to accept long and irregular working hours:




Do you have the support of your immediate family:




EDUCATION AND QUALIFICATIONS:

Secondary School
Name:




Date Attended:



University / College
Name:



Date Attended:



Course Name:



Degree Class:




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Retail Franchisee/Dealer Selection Process
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Other Academic Qualifications
Name of Institution:



Course Name:



Outcome (Pass/Fail):



Professional Qualification:



EMPLOYMENT / WORK HISTORY

Current Employer (if self employed, please describe in detail):
Name:



Address:




Position / Title:



Date Commenced:



Main Responsibilities:




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Retail Franchisee/Dealer Selection Process
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Current Salary (per annum):



Bonus:



Pension:


Annual days leave:



Other company benefits:




Previous Employment (Most recent first – cover only last 15 years)

Employer’s Name:




Address:




Position / Title:



Date Commenced:




Date Finished:




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Retail Franchisee/Dealer Selection Process
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Main Responsibilities:




Have you ever owned or worked in a business similar to the proposed franchises apart
from any information given above?
If yes, please give details. Detail any other relevant experience.




Have you ever had experience in the following areas? (Indicate your response by ticking
the correct box)
Handling Cash                                Yes                       No
Staff Management & Recruitment               Yes                       No
Analyzing Cash Flows                         Yes                       No
Stock Control                                Yes                       No
Retail / Selling to the public               Yes                       No
Working with Financial Statements            Yes                       No
Working weekends                             Yes                       No




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Retail Franchisee/Dealer Selection Process
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FINANCIAL INFORMATION
What are your prime business objectives for applying for this Business Opportunity




How much of your own capital do you intend to invest?




How much will be borrowed capital?




What annual income are you personally expecting to earn while you are receiving training?
(Please note that this question pertains to applicants for the Entrepreneur Programme
only)




How many hours per week are willing to spend at the service station?




Are you pursuing other business opportunities as well?


If so, in which industries?




If your application for the BP Franchise or Dealership is not successful, what are your
future plans?




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Retail Franchisee/Dealer Selection Process
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Have you, or your spouse, or any business entity in which you jointly or separately owned
interest, been involved in bankruptcy, insolvency proceedings or any compromise
offers with creditors?
If yes, give full details.




Have you or your spouse ever had a judgment in respect of a debt recorded against you?
If yes, please provide full details:




BANKING DETAILS:

Banking Details - Business
Name of Banking Institution:

Address:

Type of Account:

Branch Code:

Account Number:



Banking Details - Personal
Name of Banking Institution:

Address:

Type of Account:

Branch Code:

Account Number:




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Retail Franchisee/Dealer Selection Process
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If your present funds are less than required to purchase a service station, how do you
propose to finance the venture?




      Present Income (Annually)                       Present Expenditure (Annually)


Wage / Salary after                          Monthly Mortgage / Rent
tax:                     R                   repayments:                R




Bonus /                  R                   Monthly Loan Repayments:   R
Commission:


Dividends:               R                   Other (Details):           R




Property Income:         R



Other Income
(Details)                R




TOTAL:                   R                   TOTAL:                     R




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FINANCIAL INFORMATION (continue)

                 Assets
    (Cash in Banks / Building Society)                            Liabilities

Bank:
                         R                   Current Overdraft:          R

Branch:


Type Account:


Bank:
                         R                   Current Total               R
                                             Creditors:
Branch:


Type Account:



Bank
                         R                   Monthly Finance             R
                                             Repayments:
Branch:


Type Account:



Investments                                  Hire Purchase Repayment:    R
(Net realisable
value of shares,
bonds, unit trusts,
insurance)
List:




                                             Monthly Personal Loan       R
                                             Repayments:



                                             Other Loan Repayments:      R




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Retail Franchisee/Dealer Selection Process
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Other Assets                                 Other Liabilities

Monies due to you:       R                   Loan guaranteed for others   R
(Details)                                    (Details):




Property (Market         R                   Mortgage Payable:            R
Value):



Market Value of          R                   Any other debts              R
Business                                     (Details):
(If applicable):




Any other assets         R
(Details):




MANAGEMENT STRUCTURE:
Would the business be managed as a closed corporation, private / public company,
partnership or by yourself as a sole proprietor? (Complete relevant section in detail)



Closed Corporation
Name and registration number of Closed Corporation:



Please list full names, surnames and identity numbers of all members:




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Retail Franchisee/Dealer Selection Process
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Please indicate each member’s share proportions:




Private / Public Company
Name and registration number of company:



Please list full names, surnames and identity numbers of all directors:




Please indicate the shareholding proportions:




Partnership
Name of Partnership:




Please list full names, surnames and identity numbers of all partners:




Please indicate each partner’s share proportions:




Sole Proprietor
Trading Name of Sole Proprietor:




Please provide details of a business / work reference
(If self employed –customer / client)
Name:


Job Title:




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Retail Franchisee/Dealer Selection Process
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Company Name:


Address:




Contact Numbers:



Please give the name of a financial referee

Name:


Address:




Contact Numbers:



GENERAL INFORMATION:
Health

Are there any health problems that may impact on your performance as a BP
Franchisee/Dealer:



If yes please mention the condition:




Drivers Licence:

Do you hold a valid South African drivers licence? (Yes / No)

Code of licence (attach certified copy to application form)?




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Retail Franchisee/Dealer Selection Process
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Criminal Record
Have you or your spouse ever been convicted of anything other than minor traffic
infringements (i.e. parking tickets or speeding offences)? If yes, please give full details.




Residence:

If you rent your property, please state details of the agent / landlord:

Name:


Address:




Contact Numbers:


I am applying for the following opportunity:

Existing service station:
Name:


New Service Station:
Name:


Pre-approved Applicant Pool:


BP Entrepreneur Program:




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Retail Franchisee/Dealer Selection Process
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Signature:

I understand that the purpose of this application is for information only. It is in no way
binding upon BP (the Franchisor), or me (potential Franchisee). I understand and grant
BP permission to contact my referees, previous employers and agencies to verify my
credit and criminal records. I certify that all the information given above is correct.

Full Names and Surname of Applicant:



Signature of Applicant:




Date:



If you are applying for an existing or new service station opportunity, your application form
must be accompanied by a comprehensive business plan for the opportunity you’re
applying.

The application form and business plan must be submitted to the relevant Territory Manager for
the opportunity.

If you are applying for the pre- approved Applicant Pool or the BP Retail Entrepreneur
Program, the application form must be submitted to:

                          The Dealer Relations Officer
                          Retail Department – BP Southern Africa (Pty) Ltd
                          Private Bag 87013
                          Houghton
                          2193




INDEMNITY BY APPLICANT

I, _____________________________________________________________ (Full name, surname)

ID no:
________________________________________________________________________________

Address__________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Has approached the following recruitment company ______________________________________

________________________________________________________________________________




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Retail Franchisee/Dealer Selection Process
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I hereby authorize the above recruitment agency / the recruitment agency’s duly authorized agent,
namely I-Digital, to make my name, surname and identity number and or fingerprints available to
the South African Police Services, and the following Tertiary Education Institutions.
Qualification                Institution             Year                     Student No




I furthermore authorize i-Digital to conduct all background checks including but not limited to credit
bureau searches, drivers licence, employment history, and any other relevant checks in the pre- or
post-employment vetting process and where necessary to request the South African Police Services,
Tertiary Education Institutions to furnish personal information regarding my criminal background,
criminal history, previous convictions and / or any other relevant information such as is usually
furnished by the Criminal Record Centre of the South African Police Service, and or Tertiary
Education Institutions in this regard, to the above agency / the recruitment agency’s duly authorised
agent.
I furthermore unconditionally indemnify the South African Police Service, Tertiary Education
Institutions and all its members, employees as well as the Government of the Republic of South
Africa against any liability which results or may result from furnishing information in this regard.
I understand that it is a condition of the South African Police Service and Tertiary Education
Institutions, that –
             a) the information is furnished solely for the purpose of my proposed employment
             b) any information furnished to the recruitment agency / the recruitment agency’s duly
                authorized agent, will be disclosed to me for comments before a decision is made on
                my employment /application; and
             c) the recruitment agency / the recruitment agency’s duly authorised agent is
                responsible for verifyingthe accuracy, in every respect, of the information furnished
                by the South Africa Police Service.

Signed at _________________________________________________________________(place)

this ______________________ day of __________________________(month) __________(year)

CONSULTANT: __________________________ I-DIGITAL USERNAME: ______________________


WITNESSES:
1. ____________________________________

2. ____________________________________


_____________________________
Signature of the applicant


_____________________________
Signature of parent or guardian (if the applicant is a minor)

PLEASE COMPLETE AND FAX TO LEXISNEXIS RISK MANAGEMENT +27(0) 866 888 711




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