Sworn Affidavit - B-Bbee Exempted Micro Enterprise Form printable pdf download

Sworn Affidavit - B-Bbee Exempted Micro Enterprise Form

SWORN AFFIDAVIT – B-BBEE EXEMPTED MICRO ENTERPRISE

I, the undersigned,

Full name & Surname

Identity number

Hereby declare under oath as follows:

1. The contents of this statement are to the best of my knowledge a true reflection of the facts.

I am a member / director / owner of the following enterprise and am duly authorised to act on

its behalf:

Enterprise Name

Trading Name

Registration Number

Enterprise Address

3. I hereby declare under oath that:



The enterprise is ______________% black owned;



The enterprise is ______________% black woman owned;



Based on the management accounts and other information available on the _______ financial

year, the income did not exceed R10,000,000.00 (ten million rands);



Please confirm on the table below the B-BBEE level contributor, by ticking the applicable

box.

100% black owned

Level One (135% B-BBEE procurement recognition)

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. The entity is an empowering supplier in terms of the dti Codes of Good Practice.

5. I know and understand the contents of this affidavit and I 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 matter.

6. The sworn affidavit will be valid for a period of 12 months from the date signed by

commissioner.

Deponent Signature:

Date:

Commissioner of Oaths

Signature & stamp

Sworn Affidavit - B-Bbee Exempted Micro Enterprise Form