CLAIM FORM
EXPORT MARKETING AND
INVESTMENT ASSISTANCE
EMIA Claim Form
Individual Exhibitions and In-Store Promotions
Primary Market and Foreign Direct Investment Research
Individual Inward Missions
Effective 01 August 2010
Warning:
Under no circumstances should any application form and/or the claim form be altered. Amended
application/claim forms will not be considered for evaluation.
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EXPORT MARKETING AND INVESTMENT ASSISTANCE
Claim Form
Important Notice to EMIA Customers
Customers please note that this claim form goes hand in hand with the guidelines booklet. The conclusion of
a successful claim is only possible if it is done with cross-reference to the requirements as laid out in the
guidelines booklet.
Late claims will be rejected without exception.
The following forms of payment will not be considered for reimbursement:
1. Cash Payments
4. Offset Payments
2. Book Entries
5. Travellers Cheques
3. Credit Notes
This claim form need to be submitted within three months (or earlier) from the date of event. Late claims
will not be considered for payment.
All correspondence to EMIA should be sent to one of the following addresses
PHYSICAL
ADDRESS
(Hand / Courier deliveries)
POSTAL
ADDRESS
(Registered Mail)
The dti
Mapungubwe-the dti Group House
Utangamiri : Ground Floor
77 Meintjies Street
Sunnyside
Pretoria
0002
The dti
EMIA- TEO
Private Bag X86
Pretoria
0001
Correspondence that has not been properly addressed to the dti can be incorrectly forwarded to other departments. This
will result in delays in the processing of your application or claim.The dti does not accept responsibility for mail that has
not been properly addressed.
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Section A - Claim Calculation Sheet
Company legal name
(As on the company Tax
Clearance certificate)
Name of event
Dates of event
Event/Claim Type
From:
Individual Exhibition
To:
Individual Missions
PMR
FDI
In-Store Promotions
All claims are to be entered as per the request on the application form and the subsequent approval from the dti.
An expense that was not approved will not be considered for reimbursement
Exchange Rate used
Amount Claimed
Amount Approved
Office Use Only
Amount Claimed
Amount Approved
Office Use Only
Return Air Ticket
Subsistence Allowance as per the approval letter
S U B - T O T A L [A]
Foreign Currency
Transport cost of samples
Rental of stand / Registration Fees
Listing in official exhibition
directory
Construction, erection and
painting of shell (excluding
interior decorating)
Telephone installation, rental
and internet connection
Furniture and equipment
rental
Electrical installation and
consumption
Cleaning and security fees
Interpreting fees
Design and printing of
marketing materials(IE)
Design of videos & CD (PMR)
Registration of products in an
export market (Patents Only)
S U B - T O T A L [B]
T O T A L C L A I M [A + B]
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Section B - Declaration (To be completed by all claimants)
AUTHORISED OFFICIAL OF THE ENTITY
I,
In my capacity as
of
hereby certify that the information submitted in the claim as well as the report back questionnaire is a true and correct
statement of my participation and actual expenses incurred by me/my company/organisation at the mentioned event. I
have not received any payments in this connection from any other source. I also undertake to submit a follow-up report
on the export successes achieved as a result of participation in the event, within six months of the event. I understand
that failure to submit the follow-up report could result in me/my company/ organisation being barred from further
assistance from the EMIA scheme.
I am aware that information which I have supplied will have a fundamental bearing on the adjudication of the claim and if
it, therefore, subsequently transpires that any information as per this claim is incorrect, or that certain information was
omitted, the Department of Trade and Industry (the dti) shall, without prejudice to any other of it’s rights, be entitled to
claim back any amounts already paid with interest as prescribed by the Public Finance Management Act or to withhold the
payment of any amounts due to the entity for which this claim has been submitted.
Signed (Authorised
Official of Entity)
Designation
Name in Print
Date
Appointment
TO ACT AS A CONSULTANT
The Board of Directors of
declare that
Physical address
Postal address
Telephone
Facsimile
E-Mail address
was appointed as a consultant to act on our behalf with regard to issues pertaining our participation in the EMIA Scheme
of the Department of Trade and Industry. This appointment will remain in force until written notification of change by the
entity.
NB. This appointment does not authorise the consultant to sign any EMIA documents on behalf of the applicant. All
documents submitted to EMIA must be signed by the applicant/claimant.
Signed (Authorised
Official of Entity)
Designation
Name in Print
Date
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Section C - Claim Checklist
Kindly ensure that all the required documentation is attached to the signed claim form in
the following order. Only invoices and proofs of payment made in the name of the
approved company will be considered for reimbursement.
Refer to the General
EMIA Guidelines
A copy of the letter of approval for the relevant trip.
All Schemes
Original or certified copies of Invoices. Invoices without Vat registration, company registration,
telephone numbers and addresses will not be considered for the claim as they cannot be
authenticated.
All schemes
Original or certified copies of Proof of payment for all the relevant costs incurred during the
trip. The only acceptable means of payment are by bank statement, cheque or credit card. These
proof of payments must be in the name of the approved entity. Bank statements printed from
the internet will not be accepted as proof of payment.
All Schemes
Original or certified copies of the air ticket receipt accompanied by an invoice or faxed copies
of the e-ticket receipts or e-mailed e-ticket receipts from the travel or issuing agent
specifying the routes, dates, name, time, agent, the value and proof of payment.
All Schemes
Certified copy of passport clearly showing: Personal Particulars (Not Visa) & SA Passport control
departure & re-entry date stamps. If scanned, boarding passes must be submitted.
All Schemes except
Inward Missions
Inward Missions only: A certified copy of the invitees passport clearly showing: Personal
Particulars and South African Entry Stamp
An original current valid Tax clearance certificate. Please note that the Tax clearance must
still be valid at the date of payment of the claim, it is therefore advisable to be at least valid
for a two month period from the submission date of this claim.
Attending Conference:Copies of the conference proceedings / programs, papers, and plenary
notes
Inward Missions
All Schemes
PMR Only
A fully completed credit order instruction form with a bank stamp. (Attached)
All Schemes
A copy of a cancelled cheque or in the case of a savings account, a bank statement on the
bank's letterhead.
All Schemes
Please ensure that the company's details on all the following documents are the same: Customs
& Excise registration/ Tax clearance certificate/ Credit Order instruction and cancelled cheque.
All Schemes
Copies of the waybill or bill of lading, SAD500 or SARS Export Release Notification if SAD500 not
stamped by Customs
Exhibitions Only
Section D - Individual Exhibition Participation Report Back
Section E - Market Research Report
Individual Exhibitions
PMR Only
Section F - Foreign Direct Investment Report
FDI Only
Section G - Individual Inward Mission Report
Individual Missions
Only
Section H - A work itinerary
PMR/FDI & Inward
Missions
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Section D - Report-Back Questionnaire (Complete only for participation in Individual Exhibitions)
INDIVIDUAL EXHIBITION PARTICIPATION
CONFIDENTIAL "REPORT-BACK" QUESTIONNAIRE
Name of participating firm
Represented by
Postal Address
Code
Telephone
Fax
E-MAIL
Exhibition Name
Venue
Period
Frequency
Size of Stand
HS Codes & Products Displayed
How did you dispose of the
display material?
Did you occupy a stand under
your firm's own name?
YES
NO
If NO please provide full details
What percentage of the stand was occupied
by your firm?
%
Comments: Suitability of this Exhibition
Excellent
Good
Fair
Poor
Type of Exhibition
Type of Visitors
Gathering of Marketing
Information
Please list market acess and
logistical issues
Establishing Business
Contacts
Comments: Your Experiences at this Exhibition
Excellent
Good
Services rendered by Freight
Forwarding Service Provider
Was this Exhibition suitable
to promote your product?
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Fair
Poor
Will you consider an
alternate exhibition?
Names of Trade Representatives from the Local Embassy or Consulate
who visited the firm's stand
Comments: Benefits of Participation
Country/Region
Number
Country Region
Number
Geographic analysis of
enquiries received:
In Host Country
In Other Countries
Names of
agents/representatives
appointed:
Other distribution channels
of interest
Number of confirmed orders
received(please specify whether orders
were receive from existing or new
contacts
Value
New Technology required/ Agreement
signed/ Joint Venture Agreement?
Please specify whether assistance is
required in terms of a Patent registration
General comments
Page 7 of 11
Section E - Report-Back Questionnaire (Complete only for PMR)
PRIMARY MARKET RESEARCH REPORT
CONFIDENTIAL REPORT
Primary Market Research Report
A market research report must be compiled detailing, at least, the information indicated below:
1) Outline the objectives, scope and method used during the research.
2) Name the countries in which the research was conducted.
3) Name and describe the products for which the research was undertaken.
4) Describe the product's market in SA and the envisaged foreign market.
5) Indicate the applicable trade restrictions such as import licensing requirements, quotas, foreign
product registration, etc, for the product in the specific market.
6) Provide import statistics (if available) concerning the product or similar/substitute products. (How
much product is available for export?)
7) Names of competitors and their related market share.
8) Domestic production and sales statistics for the product or similar/substitute products.
9) Briefly describe any special marketing requirements of the product in the foreign market, such as
after-sales service, local warehousing, technical back-up, etc.
10) Provide a price analysis of the product, i.e., give an indication of the price of your product
depending on the particular delivery term: FOB,CIF and possible retail prices in the foreign market.
11) Indicate the customs duties and other taxes payable upon importation and marketing of the
product in the specific country, eg. GST, VAT
12) Indicate the prices of competing or substitute products.
13) How are products of this nature advertised in the country.
14) Indicate domestic consumer preferences as it affects the marketing possibilities of the product.
15) Comment on product acceptability in the foreign market, eg. Design, quality, packaging and price.
16) Indicate the most frequent comments/remarks of persons contacted concerning the marketability
of the product.
17) Comment on the most appropriate channels of distribution. Eg. Who, where, how, logistics.
18) Given the findings of your research, please comment on the export potential and marketability of
the products concerned.
19) Provide the names and addresses of potential purchasers, importers, agents, and/or distributors
who showed interest in the product.
20) Indicate expected export sales as a result of the visit, i.e. during the next 18 Months in Rands.
Page 8 of 11
Section F - Report-Back Questionnaire (Complete only for FDI)
FOREIGN DIRECT INVESTMENT RESEARCH
CONFIDENTIAL REPORT
Foreign Direct Investment Research Report
A market research report must be compiled detailing, at least, the information indicated below:
1) Outline the objectives, scope and method used during the research.
2) Name the countries in which the research was conducted.
3) Name and describe the products for which the research was undertaken.
4) Provide full particulars of the investment research and state findings.
5) Indicate the firm or industry's potential to attract investment and what was achieved during negotiations.
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Section G - Mission Reports (Complete for all Individual Mission Claims)
INDIVIDUAL INWARD MISSION
CONFIDENTIAL REPORT
Inward Missions
A report on the mission which must include the following information:
Value of ExportOrders/Investments generated during mission
Specify value of expected Orders/ Investments generated as a result of mission
Major problems experienced in South Africa should be specified
An indication should be provided of South Africa's suitability as a future supplier
Specify the names of companies to be interacted with in future to secure export/investments contracts
What is your overall impression of the visit?
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Section H
WORK ITINERARY
Complete for all PMR,FDI & Mission Claims
Name & Physical Address Contact Person &
Position in
of Company
Date Company
Visited
Telephone
Number
Please copy should you require additional space
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Facsimile Number