Title: BEE Compliance Questionnaire for an Revision No: 06 Exempted Copy No: 01 Page: 1 of 6 Compiler: L Frank Date Compiled: 17 September2011 Approver: R Matthews Effective date: 17 September 2011 FOR THE ATTENTION OF: COMPLIANCE EVALUATION QUESTIONNAIRE FOR EXEMPTED MICRO ENTERPRISES IN TERMS OF THE BROAD-BASED BLACK ECONOMIC EMPOWERMENT ACT, ACT NO. 53 OF 2003 ( THE ACT ) As an Exempted Micro Enterprise you will achieve a B-BBEE Rating of 65 Points (if White Owned) and 75 Points (if > 50.1% Black Owned) With a 65 B-BBEE Rating your company will be rated as a Level Four Contributor to B-BBEE, with a B-BBEE Procurement Recognition Level of 100%, and With a 75 B-BBEE Rating your company will be rated as a Level Three Contributor to B-BBEE with a B-BBEE Procurement Recognition Level of 110% PLEASE SEE TABLE BELOW TO DETERMINE WHETHER OR NOT YOUR COMPANY QUALIFIES FOR AN EXEMPTED MICRO ENTERPRISE RATING AND THEN SIMPLY FOLLOW STEPS ONE TO FOUR HEREUNDER TO OBTAIN A EXEMPTED MICRO ENTERPRISE RATING FOR YOUR COMPANY STEP ONE Kindly indicate which Code is applicable to your company: Applicable Codes Annual Turnover Measured Entity Generic Codes of Good Practice R0 - R5 million Forest Sector Code R0 - R5 million Transport Sector Codes R0 - R5 million Tourism Sector Codes R0 - R2.5 million Construction Sector Codes: Contractor Construction Sector Codes: BEP (Built Environment Professional related enterprises which provide services related but not limited to consulting engineering, architecture and quantity surveying. R0 - R5 million R0 R1.5 million
Copy No: 01 Page: 2 of 6 STEP TWO Kindly complete Sections A and B hereunder: SECTION A: COMPANY INFORMATION COMPANY NAME TRADING NAME COMPANY REGISTRATION NUMBER VAT REGISTRATION NUMBER IF YOU DO NOT HAVE A VAT NUMBER, STATE NOT REGISTERED FOR VAT. IF SOLE PROPRIETOR, PROVIDE THE NAME OF THE SOLE PROPRIETOR CONTACT PERSON (NAME, SURNAME, DESIGNATION) NAME SURNAME DESIGNATION OFFICE NUMBER ( ) FACSIMILE NUMBER ( ) CELLULAR NUMBER E-MAIL ADDRESS DATE OF INCORPORATION ANNUAL TURNOVER SECTOR (CONSTRUCTION (STATE IF MEASURED ENTITY IS A CONTRACTOR OR BEP), FOREST OR TOURISM IF APPLICABLE) REGISTERED PHYSICAL ADDRESS POSTAL ADDRESS CODE CODE SECTION B: EQUITY OWNERSHIP (DIRECT EMPOWERMENT)
Copy No: 01 Page: 3 of 6 Details of Sole Proprietor / Shareholder(s) / Members / Partners Race Gender % shareholding / members interest Full Name(s) of Black Sole Proprietor / Shareholders / Members / Partners Race Gender SA Citizen by birth or who have obtained citizenship prior to 27 April 1994 (Yes / No) % shareholding / members interest Total STEP THREE Kindly furnish us with copies of the following supporting documentation IF THE MEASURED ENTITY IS A (PTY) LIMITED Memorandum (CM1) Articles of Association (CM2 and Table A (Public Co) or B (Private Co) of Schedule 1)
Copy No: 01 Page: 4 of 6 Certificate of Incorporation (CM1 / CM3) Certificate to Commence Business (CM46) Share Certificates Shareholders Agreement TAX Clearance Certificate (proof of VAT registration) (If applicable) Copies of ID documents of Black Shareholders Letter from accountant confirming that your company s turnover is less than R5 million. Note: If your company falls under the Tourism Sector Code, the letter must confirm that your company s turnover is less than R2.5 million per annum and if you are a BEP, the letter must confirm that your company s annual turnover is less than R1.5 million IF THE MEASURED ENTITY IS A CLOSE CORPORATION Founding Statement (CK1) Certificate of Amended Founding Statement (CK2) (If applicable) Copies of ID documents of Black Members TAXClearance Certificate (proof of VAT registration) (If applicable) Letter from accountant confirming that your company s turnover is less than R5 million. Note: If your company falls under the Tourism Sector Code, the letter must confirm that your company s annual turnover is less than R2.5 million per annum and if your company is a BEP, the letter must confirm that your company s annual turnover is less than R1.5 million IF THE MEASURED ENTITY IS TRUST Copy of the Trust Deed Proof of Registration of Trust Copies of ID documents of Black Beneficiaries TAXClearance Certificate (proof of VAT registration) (If applicable) Letter from accountant confirming that the trust s turnover is less than R5 million. Note: If the trust falls under the Tourism Sector Code, the letter must confirm that the trust s annual turnover is less than R2.5 million per annum and if the trust is a BEP, the letter must confirm that the trust s annual turnover is less than R1.5 million IF THE MEASURED ENTITY IS A SOLE PROPRIETOR Copy of ID document of sole proprietor TAXClearance Certificate (proof of VAT registration) (If applicable) Letter from accountant confirming that the trust s turnover is less than R5 million. Note: If the trust falls under the Tourism Sector Code, the letter must confirm that the trust s annual turnover is less than R2.5 million per annum and if the trust is a BEP, the letter must confirm that the trust s annual turnover is less than R1.5 million
Copy No: 01 Page: 5 of 6 IF THE MEASURED ENTITY IS A START-UP ENTERPRISE (* a Start-up Enterprise must be measured as an EME for the first year following their formation or incorporation. This provision applies regardless of the expected total revenue of the start-up enterprise) Independent confirmation of status (CK documents, Certificate of Incorporation, etc) Copies of ID documents of Black Members In the absence of the letter from accountant referred to hereunder, copies of bank statements from date of incorporation to date of application for an Exempted Micro Enterprise Rating. Letter from accountant confirming that your company s turnover is less than R5 million. Note: If your company falls under the Tourism Sector Code, the letter must confirm that your company s annual turnover is less than R2.5 million per annum and if your company is a BEP, the letter must confirm that your company s annual turnover is less than R1.5 million NOTE: IF YOU DO NOT HAVE AN ACCOUNTANT, WE WILL ACCEPT THE MOST RECENT TWELVE (12) MONTHS BANK STATEMENTS & AN AFFIDAVIT SIGNED BEFORE A COMMISSIONER OF OATHS CONFIRMING YOUR ANNUAL TURNOVER. STEP FOUR Kindly deposit the verification fee in the amount of R1 083.00 (VAT inclusive) directly into our bank account and fax/ email us proof of payment, together with your company details. Our bank details are as follows: BEE Empowered & Labour Consultancy CC First National Bank, Account no. 62091730400, Branch Code: 201109 PLEASE USE YOUR COMPANY NAME AS THE REFERENCE WHEN MAKING A DEPOSIT Upon receipt of proof of payment, we will email, post or fax or deliver to you your BEE Compliance Questionnaire for you to complete Once you have completed your BEE Compliance Questionnaire, you must deliver same to our offices together with the supporting documentation. We shall process and verify the information received from you On finalisation of your assessment, you will be issued with a BEE EMPOWERED B-BBEE VERIFICATION CERTIFICATE. This will be emailed or posted to you and a copy thereof would be made available on our website: www.bempowered.net
Copy No: 01 Page: 6 of 6 BEE EMPOWERED CONTACT DETAILS T: 021 511 0802 - F: 021 511 0210 E: info@bempowered.net Block 1, Unit A21, Northgate Island, Paarden Eiland, 7405