HDC - Application Form

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PRIVATE & CONFIDENTIAL

APPLICATION FORM (please note that should there be more than (1) one member, partners or
shareholders, a separate application form must be completed by all parties)

DATE

NAME

SURNAME

INITIALS

GENDER

TITLE

NATIONALITY

IDENTITY NUMBER/PASSPORT NUMBER


DATE OF BIRTH

MARITAL STATUS  Married IN community ______


 Married OUT of community _______
 Single _______
 Divorced _______
 If Married IN Community of property,
(spouse must also complete an
application form)

NUMBER OF DEPENDANTS

POSTAL CODE

CONTACT NUMBERS HOME


OFFICE/WORK
CELL
FAX
EMAIL
ADDRESS PHYSICAL

POSTAL
HIGHEST SECONDARY EDUCATION

HIGHEST TERTIARY EDUCATION

COMPUTER LITERACY

CURRENT EMPLOYED

CURRENT OCCUPATION

BRIEF EMPLOYMENT HISTORY (STARTING 1. PERIOD


WITH CURRENT) 2. PERIOD
3. PERIOD
4. PERIOD
5. PERIOD

WHERE DID YOU HEAR ABOUT US

HAVE EVER EXPERIENCE SERVICE WITHIN


ANY OF OUR STORES
WHAT INTEREST YOU IN THE BUSINESS OR
THE REASON YOU APPLY

WHAT/WHERE IS YOUR SITE(S) OF 1.


INTEREST 2.
3.
4.
5.

ARE YOU PREVIOUSLY DISADVANTED Yes No


WOULD YOU QUALIFY FOR AN
EMPOWERMENT/PREVIOUSLY
DISADVANTAGE LOAN

HAVE YOU EVER BEEN DECLARED 1. INSOLVENT


YES / NO
2. SEQUESTRATED
YES / NO
3. UNDER DEBT REVIEW
YES / NO
4. CRIMINAL RECORD
YES / NO
5. BLACKLISTED
YES / NO
6. (IF YES TO ANY OF THE ABOVE,
GIVE SHORT EXPLANATION)
HOW ARE YOU PLANNING TO PAY FOR THE
BUSINESS

HOW MUCH OWNER CONTRIBUTION/OWN RAND VALUE


CASH CONTRIBUTION DO YOU HAVE
(LOAN FREE CASH)
PROOF REQUIRED
I WOULD LIKE TO GET REGULAR UPDATES YES NO
AND MARKETING MATERIAL – MARK
APPLICABLE OPTION

I THE UNDERSIGNED, HEREWITH GIVE MY


PERMISSION TO THE COMPANY TO DO A
CREDIT CHECK ON ME ________________________

I HEREWITH STATE AND CONFIRM THAT


ALL THE INFORMATION PROVIDED IN THIS
APPLICATION IS THRUTHFUL AND
CORRECT TO THE BEST OF MY
KNOWLEDGE
ANY ADDITIONAL INFORMATION THAT
MIGHT INFLUENCE YOUR APPLICATION

DOCUMENTS REQUIRED 1. CV
2. CK1 / CM29 / CK2 OR ANY COMPANY
DOCUMENTS (IF APPLICABLE)
3. FICA DOCUMENTATION (PROOF OF
ADDRESS)
4. COPY OF ID
5. 3 MONTHS BANK STATEMENTS
6. PROOF OF FUNDS AVAILABLE (IF NOT
REFLECTING ON BANK STATEMENT
MARRIAGE CERTIFICATE (IF APPLICABLE)

Please note that all information will be regarded as private and confidential

In the event where applicants are using external brokers/agents – associated costs & fees will be for the
applicant according to THEIR terms and conditions

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