Complete and forward to:

Transcription

1 14/10/2012 PULP Pulp franchise application form Complete and forward to: Francois Hamman 14/10/2012 Application process Instructions Pulp 1. Take your time in completing this application form. 2. Read each question carefully. 3. Print clearly. 4. If you have any questions, or need assistance in completing This application, please contact: Francois hamman on Page 1

2 5. Your completed application form, a copy of your identity document As well as any additional information you think we should have, must be placed in a sealed envelope, and dropped off at our offices, during Office hours, Pulp Kitchen, Willow Bridge Shop 76 Carl Cronje drive Tygervalley Pulp 2

3 Pulp Kitchen franchise application Form Please print or type PERSONAL INFORMATION ID Number : Surname: First name: Residential address : Postal Address : Postal code : Telephone numbers (B) (C) (H) Others: Date of birth: Marital status : married spouse single divorced Highest level of education : Current employer : Years of employment: Employer address: Telephone: Pulp 3

4 Position held Responsibilities: If Self-employed, please tell us the type of business you operate: General business information 1. Are you prepared to devote your total working day to the business? Yes No: 2. How do you intend to finance your total investment? 3. Do you have a preference regarding the location of the business? 4. If yes, where? 1 st choice 2 nd choice 5. Where do you bank? Branch : 6. Name of branch manager: 7. Have you ever owned, or managed you own business before? Yes No If yes: what kind of business was it? How long did you own the business? 8. Why are you interested in our franchise opportunity? Pulp 4

5 Franchise application process 9. Business references (those people that you do business with, such as supervisors if you hold employment or suppliers if you own or use to own your own business) name : Relationship : Telephone number: Address: Name: Relationship: Telephone number: Address: Name : Relationship: Telephone number: Address: Personal statement of assets and liabilities 1. Assets (fixed property) Physical address (erf description) Property type Registered owner Purchase date Purchase price Market 2. Investments (market ) Share /unit description Quantity Price per share/unit Market 3. Private companies, cc or trusts Entity name Type i.e share/ loan % interest Asset Pulp 5

6 accounts 4. Assurance policies (surrender ) Name of assurance company Policy no type Life Surrender 5. Moveable assets (insurance ) a. Motor verchile model Year cost market b. Household contents Asset 6. Bank accounts Institution branch Type of acc Acc number Current Total assets R: 1. Fixed property Current liabilities physical address (erf description) Property type Registered owner Purchase date Purchase price Market Pulp 6

7 2. Installment sales/ lease institution Type of asset Monthly repayment Expiry date Current 3. Loans (amounts owing) institution Type of facility amount Secured by Current 4. Bank accounts (overdraft/ credit cards, ect) institution Type of acc Acc number limit 5. Other liabilities (SPECIFY) Institution branch Type of acc Acc number Current R: Total liabilities R: Nett assets/(nett liabilities) Pulp 7

8 Monthly income & expenditure statement Income Gross basic salary: Bonus (detail): Investment/ others (specify): Total income: Less deduction (pension fund, tax etc) Spouses gross salary Less deductions Nett salary Total income R Expenditure Fixed property bond payments/rental _ Rates & taxes Water & electricity Maintenance (house, garden etc._ Vehicles installment/ lease _ Petrol & maintenance _ Insurance household, car _ Assurance life, R.A s, etc. _ Other installments Installment credit Loans/ overdraft interest Capital Housekeeping groceries Pulp 8

9 Clothing Domestic wages Education Entertainment Other (phone, provisional taxes, ect.) TOTAL Expenditure SURPLUS INCOME/ (DEFICIT) I hereby declare that all the above information is true and correct to the best of my knowledge and that I will make all the required financial information available on request. I also understand that submission of this application does not mean automatic acceptance. I herby authorize Pulp Kitchen Franchise to make enquiries about my credit worthiness to any credit bureau, character and ability to pay, and to contact anyone, whether or not listed on the original application, in order to obtain personal and finical information about me. I release all such person from any liability or damages that may incurred as a result of such inquiry or of the furnishing of such information. Applicants Signature date Pulp 9