Application Form For 30 Days After Statement Account

Registered Name of Business:*

Trading Name (if any)

Previous Trading / Registered Name(s)

Form of Business (select) Form of Business (select)Public CompanyPrivate CompanyClosed CorporatePartnershipSole Proprietor

VAT Number

Date of Establishment of Business

Registered Name of Holding Companies

Registration Number

Name of Subsidiary

Registration Number

Activities

Registered Address

Postal Address

Delivery Address

First Contact Name

ID No

First Contact E-mail

First Contact Tel No

Second Contact Name

ID No

Second Contact E-mail

Second Contact Tel No

Landline No

FaxNo

Website

E-mail

Fullnames of Director(s) and Member(s)

% Shares of Director(s) and Member(s)

ID No of Director(s) and Member(s)

Passport No of Director(s) and Member(s)

Tel No (Res) of Director(s) and Member(s)

Cell No of Director(s) and Member(s)

Are you a South African Citizen? (Mark) Are you a South African Citizen? (Mark) Yes No

Country Name (If you are not a SA Citizen)

Residential Address

E-mail

Fullnames of membership, Partnership or shareholdings

ID No of membership, Partnership or shareholdings

% Shares of membership, Partnership or shareholdings

Passport No of membership, Partnership or shareholdings

Tel No (Res) of membership, Partnership or shareholdings

Cell No of membership, Partnership or shareholdings

Country Name (If you are not a SA Citizen)

Are you a South African Citizen? (Mark) Are you a South African Citizen? (Mark) Yes No

Residential Address

E-mail