EE APPLICATION FORM

							                                           ANNEXURE A - APPLICATION: EQUITY EQUIVALENT EXEMPTION FROM SALE OF EQUITY

                                                                  A: BACKGROUND INFO
NAME OF APPLICANT
COMPANY
LOCAL REGISTRATION
                                                                           DATE OF EE APPLICATION
NUMBER
CONTACT PERSON AND
DETAILS
Designation:
Phone No:
Fax No:
Email Address:

LOCAL OFFICE DETAILS:
Physical Address:
Postal Address:
Phone No:
Fax No:

                                                            B: INFORMATION ON LOCAL COMPANY
LOCATION/s AND
DESCRIPTION OF
OPERATIONS


VALUE OF TURNOVER



VALUE OF EQUITY


VALUE OF TOTAL
OPERATIONS

TOTAL EMPLOYEES

REASONS FOR NOT SELLING
                        Specify legislation if applicable
EQUITY IN SA

Name of CEO/Managing
Director/Managing Member


CONTACT DETAILS FOR
CEO/MANAGING
DIRECTOR/MANAGING
MEMBER
Phone No:
Fax No:
Email Address:
                                                                  C: INFORMATION ON HOLDING COMPANY
HEAD OFFICE/HOLDING
COMPANY DETAILS &
CONTACT DETAILS
Location:
Physical Address:
Postal Address:
Phone No:
Fax No:           Website
Address:
VALUE OF TURNOVER         Split between local and foreign operations



VALUE OF EQUITY

VALUE OF TOTAL
OPERATIONS

TOTAL EMPLOYEES

                                             C1: FOREIGN COUNTRIES WHERE HOLDING COMPANY HAS SOLD SHARES

                              1                              2                      3                         4                    5
LIST OF COUNTRIES



MOTIVATION FOR                1                              2                      3                         4                    5
SELLING EQUITY IN
LISTED COUNTRY


                                         C2: INFORMATION ON EQUITY IN OTHER COUNTRIES BY THE HOLDING COMPANY
                                                                                                                  VALUE OF LOCAL       PERCENTAGE OF LOCAL
   NAME OF COUNTRY                VALUE OF TURNOVER               NO OF EMPLOYEES       VALUE OF OPERATIONS       SHAREHOLDING            SHAREHOLDING
                                                                                    E: DOCUMENT CHECKLIST
                                          DOCUMENT                                                         TICK                           COMMENTS


                                            PHASE I
7 x Letter from Holding Company confirming global practice on the selling of equity in global
7 x Annual Financial Statements for past 3 years for South African Subsidiary, including the last
financial year
7 x Annual Financial Statements for past 3 years for Holding Company, including the last
financial year

7 x A Copy of the Group Structure( must include a layout of all the subsidiaries)
7 x Independent audit verifying global practice and list of countries where equity has been sold,
inlcuding SA if applicable

                                            PHASE II

7 x Detailed Valuation Report (refer to Guidelines)

7 x Detailed Business Proposal of EE Programme (refer to Guidelines)

                                                                                        F: the dti ADMIN
                                                                                                                  EE Contribution Value
DATE SUBMITTED:
                                                                                                                  Approved
BRIEF DESCRIPTION OF
PROPOSAL/S
RECOMMENDATION BY the
dti:
EEF1-03