MEMBERSHIP APPLICATION FORM

COMPANY DETAILSReg Name of CompTrade Name of CompCompany Reg NoVAT Reg NoCompany Type Head Office Branch Franchise

Structured as(select one)

Public Private Partnership (PTY) LTD CC Sec 21

Trust Sole Owner Government Depart NGO Unknown

Size Large Medium Small Very Small Micro Unknown

Sector Agriculture Architecture Arts & Crafts Automotive Building & Construction Chemicals Clothing

Communication Education Electronics Engineering Entertainment Financial Services Forestry

Government & Municipal HR Services Labour Brokers Legal Services Manufacturing Marine &

Coastal Metals

Mining & Quarrying Paper Pharmaceutical Financial

ServicesCatering &

Accommodation

Plastics Printing & Stationary

Property Recycling Retails Security Textiles Tourism Transportation

Shipping Rubber Products Advertising Wholesale Energy & Fuel Water

No of StaffPostal Address Physical

AddressCity SuburbPostal Code CityTel 1 ProvinceTel 2 FaxWebsiteContact Ability If you wish to be contacted for the items below, please supply relevant details for individuals

By SMS (Cell number) By E-MailGeneral infoEventsTender Info

CONTACT PERSONS / KEY STAFFMain Contact Name Designation

(eg. Manager, Sales, HR, PRO, Ops, Accounts)Tel / Cell Number

1.2.3.4.5.

MISSION & VISION STATEMENT

Mission

Vision

PRODUCTS & SERVICES

IntroductionNarrativeDescription of Business

Keywords (add keywords for website search engine)

1. 6. 11.2. 7. 12.3. 8. 13.4. 9. 14.5 10.

CERTIFICATE OF CORRECTNESSI, the undersigned, hereby certify that all information provided is true and correct and that I am duly authorised to sign the document.

Signed at _________________________________________ on ___________________________________ (date)

Signature _________________________________________ Name _________________________________________

Capacity __________________________________________

Company Stamp ____________________________________

Membership fees can be paid into the following bank account:

Acc Holder : Zululand Chamber of Commerce & industryBank : First National bankAcc No : 52166068076Branch Code : 220830Type : ChequeRef : Company Name / Membership Number

Email: pr@zcci.co.za.