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business registration warehouse ANNUAL RETURNS FOR CC / PTY

REGISTERED NAME OF CC/PTY SHORTENED NAME IF APPLICABLE REGISTRATION NUMBER OF THE CC SUPPLY THE MAIN BUSINESS OF THE CC FINANCIAL YEAR END ADDRESS OF REGISTERED OFFICE POSTAL ADDRESS OF CC/PTY DATE OF INCORPORATION LAST FINANCIAL TURNOVER

209 Van der Hoff Road Pretoria Gardens X 3 0082 PO Box 48444 Hercules 0030 Tel (012) 379 1804 Fax (012) 379 7961

CC / PTY INFORMATION
TELEPHONE NUMBER CELL NUMBER E-MAIL ADDRESS

ACCOUNTING OFFICER / AUDITOR INFORMATION

NAME OF ACCOUNTING OFFICER FIRM PROFESSION NUMBER POSTAL ADDRESS TELEPHONE NUMBER E-MAIL ADDRESS DATE OF APPOINTMENT

SUPPLY YOUR CONTACT DETAILS

YOUR NAME TELEPHONE NUMBER CELL NUMBER E-MAIL ADDRESS

DETAILS OF THE MEMBERS / DIRECOTRS OF THE CC / PTY

MEMBER 1 SURNAME FULL NAMES ID NUMBER POSTAL ADDRESS RESIDENTIAL ADDRESS TELEPHONE NUMBER CELL NUMBER E-MAIL ADDRESS MEMBER 2 SURNAME FULL NAMES ID NUMBER POSTAL ADDRESS RESIDENTIAL ADDRESS TELEPHONE NUMBER CELL NUMBER E-MAIL ADDRESS MEMBER 3 SURNAME FULL NAMES ID NUMBER POSTAL ADDRESS RESIDENTIAL ADDRESS TELEPHONE NUMBER CELL NUMBER E-MAIL ADDRESS MEMBER 4 SURNAME FULL NAMES ID NUMBER POSTAL ADDRESS RESIDENTIAL ADDRESS TELEPHONE NUMBER CELL NUMBER E-MAIL ADDRESS MEMBER 5 SURNAME FULL NAMES ID NUMBER POSTAL ADDRESS RESIDENTIAL ADDRESS TELEPHONE NUMBER CELL NUMBER E-MAIL ADDRESS

SPECIAL POWER OF ATTORNEY I / We the undersigned Full Forenames and Surnames of members Identity number. If not SA citizen, date of birth, attach copy of passport and residential/workers permit Signature of Member / director

1. ____________________________________

2. ___________________________________________

3. ____________________________________

4. ____________________________________

5. ____________________________________

6. ____________________________________

7. ____________________________________

8. ____________________________________

9. ____________________________________

10. ____________________________________

Being desirous of submitting the following annual returns: ____________________________________________________________________________ CC Do hereby nominate, constitute and appoint: Melissa Gerber 8409140018081 / Johannes Marthinus Oelofse 7802125003089 / Hendrik Petrus Oelofse 5606035006088 with full power of substitution, to be my lawful agent in my name. To deliver to CIPC any documents or form that might be required for the registration of the above mentioned CC / PTY and sign all the required documents and forms on my behalf. Signed at __________________ on ______ day of______________________________ 20 ____ Witness: ____________________ Witness: ____________________