‘SWORN AFFIDAVIT ~ B-BBEE EXEMPTED MICRO ENTERPRISE | the undersigned, Full name & Surname ‘entity number “ici SSR OSE Hereby declare under oath a follows: 1 2 ‘The contents of this statement are tothe best of my knowledge a true reflection ofthe facts. |1am a member J director / owner ofthe following enterprise and am duly authorised to act on its behalf, Enterprise Name LEWOGO “eRoSe cnrecrate PTYLID | Trading Name Le TECH Registration Number 20 / 658367 Jot Enterprise Address Nlo. S33, DANE Zeno, CNE FEIMi5 Steam SUEN Pastin 1685 eee | hereby declare under oath that: The enterprise is 12D % black owned; ‘The enterprise is | .% black woman owned; Based on the management accounts and other information available on thes 2014. financial year, the income dd nt exceed R10, 000,000.00 (ten milion rand); Please confirm on the table below the B-BBEE level contributor, by ticking the applicable box. 700% Black owned evel One (135% B-BBEE procurement recognition) a ‘More than 51% black | Level Two (125% B-BBEE procurement recognition) ‘owned Less than 51% black | Level Four (100% B-BBEE procurement recognition) ‘owned 4, 5 Cee, on ‘Commissioner of Oaths ‘Signature & stamp ‘The entity is an empowering supplier in terms ofthe dti Codes of Good Practice. | know and understand the contents of ths affidavit and | have no objection to take the prescribed oath and consider the oath binding on my conscience and on the owners of the enterprise which I represent in this mater ‘The sworn afdait willbe valid for a period of 12 months rom the dai signed by commissioner. Deponent Signature: