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    Application Form Cis

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    emlelosa
    This document appears to be an application form for the Co-operative Incentive Scheme (CIS) in South Africa. The form requests information about a cooperative's details, members, activities being applied for, and other sources of support received. Supporting documentation is required, including proof of registration, a business plan, tax documents, the cooperative's constitution, quotes for activities, and identity documents of directors. Completed applications must be submitted by registered mail or in person to the listed addresses.

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    Download as PDF, TXT or read online from Scribd

    Application Form Cis

    Uploaded by

    emlelosa
    1K views3 pages
    This document appears to be an application form for the Co-operative Incentive Scheme (CIS) in South Africa. The form requests information about a cooperative's details, members, activities being applied for, and other sources of support received. Supporting documentation is required, including proof of registration, a business plan, tax documents, the cooperative's constitution, quotes for activities, and identity documents of directors. Completed applications must be submitted by registered mail or in person to the listed addresses.

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    This document appears to be an application form for the Co-operative Incentive Scheme (CIS) in South Africa. The form requests information about a cooperative's details, members, activities being applied for, and other sources of support received. Supporting documentation is required, including proof of registration, a business plan, tax documents, the cooperative's constitution, quotes for activities, and identity documents of directors. Completed applications must be submitted by registered mail or in person to the listed addresses.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views3 pages

    Application Form Cis

    Uploaded by

    emlelosa
    This document appears to be an application form for the Co-operative Incentive Scheme (CIS) in South Africa. The form requests information about a cooperative's details, members, activities being applied for, and other sources of support received. Supporting documentation is required, including proof of registration, a business plan, tax documents, the cooperative's constitution, quotes for activities, and identity documents of directors. Completed applications must be submitted by registered mail or in person to the listed addresses.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    `

    THE CO-OPERATIVE INCENTIVE SCHEME (CIS)


    APPLICATION FORM

    o All questions must be answered.


    o This Scheme is for Primary Co-operatives only.
    o Your Co-operative must not be receiving financial assistance from a government or semi government
    source for the activity for which you are applying for assistance.

    SUPPORTING DOCUMENTATION REQUIRED


    (Refer to Guidelines for description of documentation)

    The following documentation must be attached to this application form.

    o Proof of registration of the co-operative


    o Cooperative’s Business Plan
    o Original valid tax clearance certificate
    o Copy of Constitution
    o Three comparable quotations per activity applied for
    o Certified copies of directors’ IDs
    o Copy of minute’s resolutions to apply for CIS
    o Copy of the latest Bank Statement

    Please return completed forms by registered mail or by courier/hand deliver to:


    Registered Mail Courier Hand Delivery

    The Enterprise Organisation the dti Campus the dti Campus


    Private Bag X86 Building A, Ground Floor Building A, Ground Floor
    Pretoria 0001 12 Esselen Street 77 Meintjies Street
    Sunnyside, Pretoria 0002 Sunnyside, Pretoria 0002

     Website: www.thedti.gov.za Call Centre: 0861 843 384

    DATE STAMP
    OF RECEIPT

    The Co-operative Incentive Scheme (CIS) Page 1 of 3


    SECTION A: CO-OPERATIVE DETAILS

    Name of the co-operative:

    Assistance applied for, please tick: New (Start Up) Expansion

    Registration no. Income Tax No.

    Details of the contact person:

    Name and designation: Cell Phone:

    Telephone: Fax (if any):

    E-mail (if any):


    Physical Address of co-operative (Location of operation/ Place Postal Address of co-operative
    from which the cooperative conducts business)

    Province: Province:
    Code: Code:
    Financial year end:
    Bank Balance of the Co-operative
    (attach the latest statement)
    Current Turnover (Sales) (if
    operating)
    Projected Turnover (Sales) (for the
    next 12 months)
    List all the Raw Materials and sources

    Transport of Raw Materials

    How do you transport your products?

    Name the main products and/or services provided by your co-operative?


    Description of Products or Service(s) Main Customers

    Main Competitors

    Name Product

    The Co-operative Incentive Scheme (CIS) Page 2 of 3


    SECTION B: LIST OF MEMBERS/EMPLOYEES
    Name and Surname Member / Gender Race Youth Disabled
    Employee M/F Less than Yes/No
    35
    Yes/No

    SECTION C: ACTIVITIES APPLIED FOR: What assistance does the cooperative apply for?

    Activities (List of Preferred Cost of activity (As Applicant’s contribution


    machinery/equipment) Supplier * per quote) (10%)

    *[If the cheapest quotation is not accepted, attached a motivation letter why you prefer to use a more expensive
    quotation]

    SECTION D: OTHER SOURCES OF SUPPORT RECEIVED

    Organization Type of Support (if monetary state When received


    amount in Rand value)

    SECTION E: DECLARATION
    I hereby declare that the information in this application is a fair and true reflection of our intended project. I am aware of
    the fact that the information which we have submitted above will have a material bearing on the adjudication of the
    application and if it therefore subsequently appears that any information in the application with addendum was not
    correct, or that certain information was omitted, the Adjudication Board shall be entitled to withdraw or amend its
    approval and without prejudice to its rights, to recover any amounts already paid or to withhold further payments due.

    I/We have declared that I/we are authorised to make this application and I/we have read and accept the terms and
    conditions listed in the guidelines.

    I/we authorise you to make any enquiries in accordance with your procedures in connection with this application.
    Name of Authorised official

    Designation (Job title/role)

    Signature

    Date

    The Co-operative Incentive Scheme (CIS) Page 3 of 3

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