APPLICATION FOR EME EVALUATION
To be completed by representative of Measured Entity
This form should be completed in full and returned to Fax no. 086 500 8922 or email to [email protected].
Once ALL of the required documentation and Proof of Payment has been received, the Verification process takes
approximately 3 days to complete.
HOW DID YOU HEAR ABOUT SAB&T BEE SERVICES? (eg. Referral, DTI website, etc.)
SERVICES REQUIRED
Please indicate (X) your requirements where applicable
Initial EME BEE Verification (new applicant)
Annual EME BEE Verification (renewal)
Please complete ALL sections of the form in CLEAR PRINT
COMPANY NAME
TRADING NAME
CORE BUSINESS
INDUSTRY SECTOR
PHYSICAL ADDRESS
POSTAL
ADDRESS
COMPANY REGISTRATION NUMBER
VAT REGISTRATION NUMBER
COMPANY TYPE: CC, PTY, SOLE PROP, TRUST, PARTNERSHIP
CONTACT PERSON
POSITION
TEL:
FAX:
CELL:
EMAIL
Indicate whether you are in one of the following Sectors:
Construction
Contractors
Road
Freight
Construction
BEP
Clearing
Forwarding
15 Summit Drive, Sherwood, Durban, 4001
Tel: 0860 233 669 | Fax: 086 500 8922
REG Number: 2006/019048/07
Forestry
Bus
Coach
ISE1-EMEAPP
Document Control
Final Version 6
Chartered
Accountant
Aviation
01.04.13
TR
Tourism
Maritime
Please submit the following documentation:
LATEST STATUTORY DOCUMENTATION





Close Corporation
Company
Partnership
Trust
Sole Proprietor
- Original Certified CK1 or CK2 and original ID of all black members.
- Original Certified CM1, share certificates & original ID of all black Shareholders.
- Original Certified Partnership Agreement and original ID of Black Partners.
- Original Certified Trust Deed & original ID of black beneficiaries & Trustees.
- Original ID of owners.
PROOF OF TURNOVER
Please submit ONE of the following:
 Copies of your last 6 Vat 201 returns.
 Signed copy of the latest Annual Financial Statements for the last financial year.
 Auditor’s or Accounting Officer’s letter confirming revenue for the last financial period, (minimum criteria to be met
for validity) stated on the Auditor’s / Accounting Officer’s letterhead and states practice number.
 For Value Adding status; Proof of VAT registration, Annual financial statements and/or completed affidavit.
PRICE
1.
2.
3.
4.
Arrange EME verification, assess documents, processing application
Complete Verification Interview where necessary
Preparation of Verification Report
Issuing of Verification Certificate
R 990.00
(VAT Incl.)
□
SAB&T BEE SERVICES (PTY) LTD reserves the right to amend the price quoted based on verified information
related to the client’s turnover and staff numbers

Payment Terms: Payment is to be made BEFORE the application can be processed. Banking details:
ACCOUNT NAME:
BANK:
BRANCH CODE:
ACCOUNT NUMBER:
REFERENCE:
SAB&T BEE SERVICES (Pty) Ltd
ABSA BANK
632005
4073123918
YOUR COMPANY NAME
No payments in the form of cheques will be accepted. Should a cheque be deposited, there will be a 10-14 day waiting period before the
certificate will be issued. Proof of payment of deposit or EFT must accompany documentation.
TERMS AND CONDITIONS
I hereby confirm that I have read and accepted the Terms and Conditions related to Exempt Micro Enterprise
engagements as published on the SAB&T BEE Services website: http://www.sabtbee.co.za/emeterms.pdf.
DECLARATION: I hereby declare that the information provided herein is accurate and complete. The above business
entity is not operating as a procurement business with the purpose of utilising its EME status to procure work on behalf of
another business entity i.e. Fronting
SIGNATURE
CAPACITY
15 Summit Drive, Sherwood, Durban, 4001
Tel: 0860 233 669 | Fax: 086 500 8922
REG Number: 2006/019048/07
DATE
AFFIDAVIT
Confirming Financial Information & Ownership
Full Name (shareholder)
Identity Number
In my capacity as
Entity Name
Measurement/Financial Period
I hereby confirm that my annual Turnover for the financial period under review is below; (tick the appropriate box)
R 5 000 000
R 2 500 000
R 1 500 000
For Value Adding Status, please complete the below required information;
Net Profit
Before Tax
Turnover
Labour
Costs
Please note that the B-BBEE Codes have specific considerations based on gender and race. Please assist us by
indicating whether male or female and the race group in the space below
Shareholders Name
ID Number
Gender
Race
%
Shares
Value
I declare that no claims exist against the equity interest of *myself / participants of aforementioned entity in the above
Measured Entity in terms of the definition of ownership fulfillment and I therefore enjoy all voting rights and economic
interest associated with *my/our shareholding.
* delete that which is not applicable
SIGNED at __________________________ on the _________ day of __________________ 20___.
_____________________________
AUTHORISED SIGNATORY
____________________________________
NAME IN FULL
COMMISSIONER:
SIGNED and sworn before me at _______________ on the ______ day of ________________ 20___.
The deponent has acknowledged that *he/she knows and understands the contents and that is true and correct and binding on
*his /her conscience.
COMMISSIONER OF OATHS ________________________________________
15 Summit Drive, Sherwood, Durban, 4001
Tel: 0860 233 669 | Fax: 086 500 8922
REG Number: 2006/019048/07