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Document Sample
APPLICATION FORM
EXPORT MARKETING AND
INVESTMENT ASSISTANCE
Export Councils, Joint Action
Groups and Industry Associations
National Pavilions
Effective 1 April 2007
Warning:
Under no circumstances should any application form and/or the claim form be
altered. Amended application/claim forms will not be considered for evaluation.
Page 1 of 9
EXPORT MARKETING AND INVESTMENT ASSISTANCE
Important Notice to EMIA Customers
Customers please note that this application form goes hand-in-hand with the National Pavilion Guidelines booklet. The
conclusion of a successful application is only possible if it is done with cross-reference to the requirements as laid out in
the Guidelines booklet.
Applications for National and Mini National Pavilions should reach the dti no later than 6 months prior to the event
Please ensure that this application form is duly completed, signed and initialed on each page.
Customers please note that all correspondence to EMIA should be sent to one of the following addresses:
PHYSICAL POSTAL
ADDRESS ADDRESS (Registered
(Hand / Courier deliveries) Mail)
Mapungubwe - the dti Group House
EMIA Division Mapungubwe - the dti Group House
Building A: Ground Floor EMIA Division
77 Meintjies Street Building A: Ground Floor
Sunnyside Private Bag X84
Pretoria Pretoria
0002 0001
Correspondence that has not been properly addressed to the dti can be incorrectly forwarded to other
departments. This will result in delays in the processing of your application or claim. the dti does not accept
responsibility for mail that has not been properly addressed.
Cancellation of National Pavilions and Mini Pavilion participation.
IN THE CASE OF YOUR CANCELING YOUR PARTICIPATION, THE FOLLOWING CONDITIONS WILL APPLY:
1. For cancellation after the consolidation date for freighting of goods and delivery of your products for consolidation: R50
000 cancellation fee is applicable.
2. For cancellation after the issue of the air ticket to your firm by the official appointed travel agent (Preferred Service
Provider): Any cancellation fees are due directly to the travel agent.
3. Any cancellation fees that effect the block booking made by the officially appointed travel agent (Preferred Service
Provider) resulting in additional charges for the dti. These additional fees will be charged to your firm.
4. Cancellation before selection of approved exhibitors: No cancellation fee.
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EXPORT MARKETING AND INVESTMENT ASSISTANCE
Section A - Particulars of Applicant
Name of Councils, JAG or
Association
Trade Name
Other: Please specify
Entity type (Please Cross X
Section 21
Applicable)
Entity registration
number/ ID Number
Tax Reference Number
Postal Address
City
Province
Postal Code
Physical Address/es Head Office
Street Address
City
Province
Postal Code
Contact Details Code Number Code Number
Telephone
Facsimile
Cellular
Web site address
Email address
Contact person Title
Responsible person:
Title
(Man. Director / CEO)
Name of Proposed Traveller Designation
Proposed dates of visit FROM TO
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Section B - Type of Activity of Applicant
Turover last
Number of employees
financial year
Total assets (Excluding fixed Value of fixed
property) property
Membership at date of Application:
SMME's OTHER BEE WOMEN OWNED
Export Council NO
Indicate whether the Industry
NO
organisation is a: Association
Joint Action Group NO
Disclose information on related parties where the one party can exercise significant / insignificant / substantial /
insubstantial influence over party in making financial and operating decisions or can exercise control or joint control over
other party. Please refer to "Definitions & Terminology" on page 26 of 29 of the National Pavilions Guidelines, effective 1
April 2007.
Name of related party
Page 4 of 9
Section C - Previous Financial Assistance
In which foreign events have you participated during the last 3 years?
Pavilion/ Exhibition / Mission Country / City Date Did you receive assistance from EMIA (YES/NO)
Section D - Details of the event in which current participation is intended
Name of the Event
Location: Country & City
Dates of the Event
Name under which you will
participate:
Exhibition space required in the case of a National
Pavilion:
If the mission is of a
specialised nature, please
specify details
Confirm whether contact was made with the South
African Embassy in the country to be visited,
please specify a contact person
Promotional and or/display material
Description of Promotional Material Local Content
Page 5 of 9
Section E - Cost Estimate
Description of Expenditure Rand Value Office Use Only
Economy class airfare
Subsistence Allowance (Number of
days______ X R1 800)
TOTAL
Imporant Information
Travel Arrangements
the dti has appointed Preferred Service Providers, to the EMIA scheme, for the provision of travel services. These
services include the management of air travel for SMMEs and PDIs for the "National Pavilions and Mini National
Pavilions" component of the EMIA scheme. the dti / EMIA therefore makes the arrangements and bears the costs.
Any extra costs incurred, over and above those benefits as approved by the dti / EMIA, will be for the applicant's
account.
Preferred Service Supplies: DISCLAIMER
Whilst every effort has been made to ensure that the Preferred Service Providers on the National Pavilion
Guidelines and application forms are competent and efficient, the dti is discharged and exempted from all liability
which might arise from all acts pertaining to the transport of samples and air travel arrangements.
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Section F - Declaration (To be completed by all applicants)
AUTHORISED OFFICIAL OF THE ENTITY
I,
In my capacity as
of
am aware of the fact that the information which I have submitted will have a material bearing on the adjudication of the
application and if it, therefore, subsequently transpires that any information in the application and addenda was incorrect, or
that certain information was omitted, the Department of Trade and Industry shall be entitled to withdraw or amend its
approval and without prejudice to its rights, recover any amounts already paid or to withhold further payments due.
I further undertake to: 1)
Furnish details of trade leads obtained during the event/mission to EMIA within 20 (twenty) days of my return
(Details should include: Name of Company, Contact Details and Business Interests); and
2) Furnish follow-up reports on the
successes achieved by the visit no later than six months after my return. (Failure to submit either of the above will
result in you/your organisation being barred from further assistance under the EMIA scheme.)
This application (with any addenda), if successful, will form part of your contract with The Department of Trade and Industry.
Please Note: Cessions of the incentives granted are not allowed unless consented to in writing by the dti . Any cessions of
these EMIA incentives or part thereof invalidate the contract from the date such cession is effected. The dti reserves the
right to cede or transfer its rights to any other Government Agency.
Signed (Authorised
Designation
Official of Entity)
Name in Print
Date
Appointment
TO ACT AS A CONSULTANT
The Board of Directors of
declare that
Physical address
Postal address
Telephone Facsimile
E-Mail address
was appointed as a consultant to act on our behalf with regard to issues pertaining our participation in the EMIA Scheme of
the Department of Trade and Industry. This appointment will remain in force until written notification of change by the entity.
NB. This appointment does not authorise the consultant to sign any EMIA documents on behalf of the applicant. All
documents submitted to EMIA must be signed by the applicant.
Signed (Authorised
Designation
Official of Entity)
Name in Print
Date
Page 7 of 9
Section G - Document Checklist for National Pavilions
Kindly ensure that all the required documentation is attached to the
application in the following order. Please tick the documentation
submitted in the last column. Refer to NP Guidelines
(a) A copy of an exporter's registration certificate from Customs & Excise (if
registered).
(Note: Not applicable to domestic pavilions held in South Africa.)
(b) Details and brochures of at least five South African businesses and
letters of permission to represent these businesses at this event. (Note:
Not applicable when separate stand space is not required by the
entity and space will be shared with the dti reception area.)
(c) Electronic industry product photos/Images in high definition.
(This is in additon to the product brochure. The cost of preparing these
images is for the industry's account).
(d) An original valid Tax Clearance Certificate, which must be obtained
from SARS.
(e) Certified copy of the certificate of Incorporation and certified copies of
all name changes effected.
(f) A certified copy of a valid passport of the proposed traveller.
(Note: Not applicable to domestic pavilions
held in South Africa).
(g) Promotional or marketing plan or strategy for the event
(h) Business Plan
(Note: Not applicable to domestic pavilions held in South
Africa).
(i) Latest audited financial statements.
(j) Company profile according to the attached template.
COMPANY PROFILE
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The dti requires the following information for the publication of the National Pavilion Brochure.
COMPANY PROFILE
The dti requires the following information for the publication of the National Pavilion Brochure.
Please use font: Arial 11. Title case
Name of company as on
the stand:
At show:
Contact persons at the
show and in SA:
In SA:
At show:
Designations:
In SA:
Postal address and
code: South Africa
Telephone: +27 ( )
Fax: +27 ( )
E-mail:
Website: www.
Main products which
you
manufacture/exhibit:
Quality systems: (i.e.
ISO)
Desired co-operation:
What are you doing at
this show? Are you
looking for wholesalers,
agents manufacturers,
importers, distributors,
joint ventures?
Brief history of
company
(max 80 words)
Cover: date established,
years in business, new
products, new
technology, production
capacity, quality
standards?
What makes you firm
better than your
competitors? Why
should someone do
business with your
firm?
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