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					                                         REPUBLIC OF SOUTH AFRICA                                                   CR1
                                          CO-OPERATIVES ACT, 2005                                                  R 215
         APPLICATION FOR REGISTRATION OF PRIMARY/SECONDARY/TERTIARY CO-OPERATIVE
                                         (Section 6)

Client Ref / Customer Code


                                       INSTRUCTIONS FOR COMPLETION OF FORM

 1 Write in block capital letters, typewrite or print in legible characters with deep permanent black ink and lodge one
   set of the documents to at the end of Part 1.
 2 An application, which does not comply with the requirements of the Act, these regulations or the notes of the form,
   may be rejected.
 3 If no identity document has been issued, a written statement to this effect must be attached to the application
   form and the date of birth must be entered where an identity number is required.
 4 Please note that the following documents are required from both Directors and Founder members:
   (a) Certified copy: RSA Identity document or Passport.
   (b) Certify copy of the birth certificate and Parental/Guardian consent.(Applicable to Minor)
   (c) Power of Attorney




                                                                PART 1

APPLICATION STATEMENT

We, as founder members, apply for the registration of the co-operative, particulars of which are set out below.
A meeting of interested persons was held and that the attached constitution was adopted for the co-operative and that the
persons whos names apper in Part 3 were elected as first directors of the co-operative.

We hereby confirm that a founders meeting was held on:



 1 Name of co-operative




 2 Shortened form of name

 3 Literal translation of name


 4 Type of co-operative


 5 Kind of Co-operative

 6 Date of end of financial year

 7 Province where co-operative registered office is located

 8 Main objective and description of business of co-operative
                                                                         PART 2
LIST OF FOUNDER MEMBERS OF


FULL FORENAMES, SURNAME AND IDENTITY NUMBER OF FOUNDER MEMBER (Primary Co-op) / FULL NAMES, SURNAME AND IDENTITY NUMBER OF REPRESENTATIVE OF FOUNDER
CO-OPERATIVE MEMBER - Name and Reg. No (Secondary/Tertiary Co-op)
HOME AND POSTAL ADDRESS OF FOUNDER MEMBER (Primary Co-op) PHYSICAL AND POSTAL ADDRESS OF FOUNDER CO-OPERATIVE MEMBER (Secondary/Tertiary Co-op)
Forenames
Surname
Idno.                                                                     Reg No.
Co-op Name


Home address


Postal address

Forenames
Surname
Idno.                                                                     Reg No.
Co-op Name


Home address


Postal address

Forenames
Surname
Idno.                                                                     Reg No.
Co-op Name


Home address


Postal address

                                                                      IMPORTANT NOTE
FORM OF CO-OPERATIVE                                                   MINIMUM NUMBER OF MEMBERS REQUIRED FOR FORMATION OF CO-OPERATIVE AND TYPE
Primary Co-operative                                                   5 Natural Persons (Juristic persons may be members but not founding members
Secondary Co-operative                                                 2 Primary Co-operatives (Jurisdic persons may be members but not founding members)
Tertiary Co-operative                                                  2 Secondary Co-operatives (Only Secondary Co-operatives may be members
FOUNDER MEMBERS CONTINUE

Forenames
Surname
Idno.                      Reg No.
Co-op Name


Home address


Postal address

Forenames
Surname
Idno.                      Reg No.
Co-op Name


Home address


Postal address

Forenames
Surname
Idno.                      Reg No.
Co-op Name


Home address


Postal address

Forenames
Surname
Idno.                      Reg No.
Co-op Name


Home address


Postal address
                                                                PART 3
FIRST DIRECTORS OF


                                                           Name of Co-operative


                                                       APPOINTED DIRECTORS

FULL FORNAMES, SURNAME, DATE OF APPOINTMENT OF DIRECTOR, IDENTITY NUMBER OF DIRECTORS, POSTAL ADDRESS AND HOME ADDRESS OF
DIRECTORS
Forenames
Surname
Idno.                                                            Date of appointment of Director
Position


Home address


Postal address

Forenames
Surname
Idno.                                                            Date of appointment of Director
Position


Home address


Postal address

Forenames
Surname
Idno.                                                            Date of appointment of Director
Position


Home address


Postal address
PAGE 2: APPOINTED DIRECTORS

Forenames
Surname
Idno.                         Date of appointment of Director
Position


Home address


Postal address

Forenames
Surname
Idno.                         Date of appointment of Director
Position


Home address


Postal address

Forenames
Surname
Idno.                         Date of appointment of Director
Position


Home address


Postal address

Forenames
Surname
Idno.                         Date of appointment of Director
Position


Home address


Postal address
                                   PART 4
            ADDRESSES AND CONTACT PARTICULARS OF CO-OPERATIVE
                             Section 20(3)
NAME OF CO-OPERATIVE




Completion of paragraphs (a) and (b) is compulsory


(a) Situation of Registered Office (Please provide street or other physical address)




(b) Postal Address




(c) Complete if available

      1 Co-operative Tel. No
      2 Co-operative Fax No

      3 Co-operative E-mail Address


      4 Website address




    Details where Registered/Rejection Application to be posted to:

      1 Person's Initials

      2 Person's Surname

      3 Postal Address
                                                            PART 5


                      STATISTICAL INFORMATION FOR PRIMARY CO-OPERATIVES
                     (Not compulsory but essential for planning and implementing support measures)


 NAME OF CO-OPERATIVE




Please complete the following information relating to the co-operative as accurately as possible:



 1 Number of female members



 2 Number of male members



 3 (a) Number of members younger than 35 years

   (b) Number of members 35 years and older



 4 Number of disable persons who are members



 5 (a) Number of black members

   (b) Number of members of other races



 6 Number of members who are not natural persons



 7 Size of the co-operative:

   (a) Total numbers of members as at foundation date

   (b) Total number of current members



 8 Number of persons employed by co-operative

   (members and non-members)
                                     APPLICATION STATEMENT CONTINUES
                                           DOCUMENTS ATTACHED

The following documents are attached to this application

 1 The proposed constitution of the co-operative duly signed by the minimum of founder members. (See important Note at the
     end of Part 2)

 2 A Power of attorney signed by the founder member in favour of the person signing the constitution of their behalf. (Only if
     the constitution is nog signed by the member personally)

 3 Form CR5 containing particulars of the name reserved for the co-operative. (Only if a name has been reserved for the co-
     operative to be formed)

 4 The persdrived fee or proof of payment thereof.
 5 Certified copies of identity documents.




SIGNATURES OF FOUNDER MEMBERS
(The persons who have signed the constitution as founder members must also sign this application)


                      FOUNDER MEMBER                                                  FOUNDER MEMBER
 1                                                                  2


 3                                                                  4


 5                                                                  6


 7                                                                  8


 9                                                                 10


11                                                                 12


13                                                                 14


15                                                                 16


17                                                                 18


19                                                                 20


21                                                                 22


23                                                                 24


25                                                                 26


27                                                                 28


29                                                                 30
FOUNDER MEMBERS CONTINUE
           FOUNDER MEMBER        FOUNDER MEMBER
31                          32


33                          34


35                          36


37                          38


39                          40


41                          42


43                          44


45                          46


47                          48


49                          50


51                          52


53                          54


55                          56


57                          58


59                          60


61                          62


63                          64


65                          66


67                          68


69                          70


71                          72


73                          74


75                          76


77                          78

79                          80
FOUNDER MEMBERS CONTINUE
           FOUNDER MEMBER   FOUNDER MEMBER
                           REPUBLIC OF SOUTH AFRICA                  CR1 COVER PAGE
                            CO-OPERATIVES ACT, 2005
        APPLICATION FOR REGISTRATION OF PRIMARY/SECONDARY/TERTIARY CO-OPERATIVE
                                        (Section 6)
Client Ref / Customer Code
Name of co-operative




                                               DETAILS OF REPRESENTATIVE
                                                             (If Applicable)
If this application is submitted by an Agent or a Government Body on behalf of the Co-operative, please give his or her
details:

 1 Name of the Agent or Person at the Government Body



 2 Surname of the Agent or Person at the Government Body



 3 Business Name or Government Body Name




 4 Contact details   (a) Landline Number
                     (b) Cellphone Number


                                                      DETAILS FOR DISPATCH
                 (If these details are not completed the documents will be posted to the postal address of the Co-operative)


   Mark the applicable box below and give details:

          Details of where the registered documents / Rejected application should be posted
          (a) Person's name

          (b) Person's Surname


          (c) Postal Address




          (d) Postal Code


OR


          Details of registered documents / Rejected application will be collected by
          (a) Person's Name



          (b) Person's Surname


          (c) Cellphone Number

				
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