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Company Information

1. Registered Name of Company *

2. Registration Number *

3. Trading Name (if different from Registered Name)

4. Operating Address *

5. RSA Income Tax Number *

6. VAT Registration Number

7. Directors’ Details (Current)

Director 1 *

Full Names *

ID Number *

Nationality *

Residential Address *

Telephone Number *

Email Address *

Director 2

Full Names

ID Number

Nationality

Residential Address

Telephone Number

Email Address

Director 3

Full Names

ID Number

Nationality

Residential Address

Telephone Number

Email Address

Director 4

Full Names

ID Number

Nationality

Residential Address

Telephone Number

Email Address

8. Shareholders’ Details (Current)

Shareholder 1 *

Full Names *

ID Number *

Nationality *

Residential Address *

Telephone Number *

Email Address *

Shareholder 2

Full Names

ID Number

Nationality

Residential Address

Telephone Number

Email Address

Shareholder 3

Full Names

ID Number

Nationality

Residential Address

Telephone Number

Email Address

Shareholder 4

Full Names

ID Number

Nationality

Residential Address

Telephone Number

Email Address

Declaration

Date of Declaration *

I declare these particulars to be correct *