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NEW Services Application Form 1 April 2011 Final

NEW Services Application Form 1 April 2011 Final

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Published by: Durban Chamber of Commerce and Industry on Oct 29, 2012
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E
XPORT MARKETING ANDINVESTMENT ASSISTANCEGROUP OUTWARD INVESTMENT& OUTWARD SELLING TRADEMISSIONSAPPLICATION FORM FORQUALIFYING SERVICES ENTITIES
 All correspondence to EMIA should be sent to one of the followingaddresses:
Effective 1 April 2011
Warning:Under no circumstances should any application form and/or the claim form bealtered. Amended application/claim forms will not be considered for evaluation.Correspondence that has not been properly addressed to
the dti
can beincorrectly forwarded to other departments.
the dti
does not accept responsibility for mail that has not been properlyaddressed
POSTAL ADDRESS(Registered Mail)
 
EMIA: DivisionBuilding A: Ground FloorPrivate Bag X84Pretoria0001
 
PHYSICAL ADDRESS(Hand/Courier Deliveries)EMIA: DivisionBuilding A: Ground Floor77 Meintjies StreetSunnyside Pretoria
 
0002
Page 1 of 6
 
General(Pty) LtdCloseCorp.Sole Prop.PartnershipLimitedDivisionExportsDesignation
Day: ……/Month: …..……./20….TO Day: ……/Month: …..……./20….
Physical Address 
Street AddressStreet AddressWeb site addressIndicate the nature of the missionCityEntity type (Please Cross X Applicable)Cellular Proposed dates &country of visit:
GROUP OUTWARD MISSIONS:APPLICATION FORM FOR QUALIFYING SERVICES ENTITIES
Important Notice to EMIA Customers
This application form needs to be submitted by the mission Organiser and each of the proposed participants at least
two months(or earlier)
before the departure date of the mission. Late applications will not be considered.Please ensure that this application form is duly signed and initialled on each page.
To be completed by Mission Organiser only
Telephone numberFacsimile NumbeName of organisationCountry/ies to be visitedProvincePostal CodeProposed dates of visit :
Day: ……..…./Month: …..……./20….… TO Day: ………./Month: …..……./20….…
CityCityIf the mission is of a specialised nature, please specify details
Section A - Particulars of Mission Participants
Entity Name
Physical Address Factory Address 
Postal CodeE-mail addressMission LeadePostal CodeCellularAlternative NumbersSpecialisedTelephone numberFacsimileOther: Please specifyProvinceProvinceEmail addressWeb site addressTitleName and SurnameContact PersonName and SurnameCEO/MD/OwnerTitleName and SurnameProposed Traveller Purpose of participation (For ITI's only)Investments
Page 2 of 6
 
YESNOYESNOYESNOYESNOYESNO%%%%DescriptionLocal Content %Event / Mission
White Woman Owned EntityDisabled Enity
Name of related party
Emerging Exporter
Type of entity
Please refer to the latest Group MissionGuidelines as well as Section G of thisform for the relevant criteriaSection B- Type of Activity of Applicant
Number of EmployeesTurnover last financial yeaShort description of the relationshipDisclose information on related parties where the one party can exercise significant / insignificant / substantial / insubstantial influence over another party inmaking financial and operating decisions or can exercise control or joint control over the other party. Please refer to the EMIA guidelines, effective 1 April 2011.
Built Environment ProfessionsPlease indicate the percentage (%) of ownership in your entityBlack Owned EntityBlack Woman Owned EntityTourism
Please list any local or international industry accreditation acquired (pertaining to this application)Total assets (Excluding fixed property)Value of fixed property
Business Process Outsourcing
Indicate nature of business:
ICT (Software development)Other (please specify)Section C - Service Capacity
Give a brief description of the nature of your business, as well as information on services exported over the last two years.EMIA OfferingPlease list the number and value of major local/international projects undertaken over the last two years.Rand ValueCountry
Section D - Previous Financial AssistancePlease indicate financial assistance received under any of the EMIA offerings during the last 3 years? (This includes both the Individual and Groupofferings.)
VenueDatesDescription
Page 3 of 6

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