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Sworn Affidavit Form

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SWORN AFFIDAVIT

FOR PURPOSES OF B-BBEE COMPLIANCE OF A BLACK OWNED QUALIFYING SMALL ENTERPRISE (QSE)

This template is provided freely by the B1SA Opportunities Network ( )

Note that this is a fillable PDF document i.e. you can type directly in the form fields provided before printing and signing.

COMPANY DETAILS

Company Registered Name

iThemba: Training and Development

Company Trade Name

iThemba: Training and Development

Company Address

1212 Ruimsig Crescent, Woodhill 0076

Registration Number

VAT Number

1989/026291/23

4640110450

Close Corporation

Company Type

Company

Sole Trader

Partnership

Non Profit Organisation

Trust

TO BE COMPLETED BY THE DEPONENT

I (full name)

Sarah F.P. Swanepoel

RSA ID / Passport Number

5212130080084

Residing Address

1212 Ruimsig Crescent, Woodhill 0076

Tel (w)

(012) 998-0809

(h)

(012) 998-0809

(cell)

(082) 345-9062

I hereby declare under oath that:

I am a member / director / owner of the above-mentioned entity and am duly authorised to act on its behalf.

The annual turnover of the above-mentioned entity was greater than R10,000,000 (Ten Million Rand) and less than or equal to R50,000,000

(Fifty Million Rand) in terms of the most recent audited financial statements or factual finding from an independent review, qualifying the entity as a

Qualifying Small Enterprise (QSE).

I also confirm that the company has a Black (as defined per the B-BBEE Codes of Good Practice) shareholding as follows:

Total Black Shareholding

Total Black Female Shareholding

25.00

I am familiar with, and understand the contents of this declaration. I have no objection to taking the prescribed oath. I consider the prescribed oath as

binding to my conscience and on the owner/s of the above mentioned enterprise I represent.

Pretoria

12-Apr-2017

Place

Date (dd/mm/yyyy)

Signed

TO BE COMPLETED BY THE COMMISSIONER OF OATHS

I certify that the DEPONENT has acknowledged that he/she knows and understands the contents of this affidavit, that he/she does not have any

objection to taking the oath, and that he/she considers it to be binding on his/her conscience, and which was sworn to and signed before me.

on this the (dd/mm/yyyy)

12-Apr-2017

Pretoria