Jalusi ESD - Application

Personal & Contact Details

Full name

South African ID number

Email address

Phone number

Race

Gender

Physical Address

Province

I am a South African citizen

Disability / Special Needs

Business Details

Registered Company Name

Registration Number

Industry Sector

Applicant Type

I am the Owner/Funder

Are you employed while running the business?

Company is Trading

Trading Duration

Business Description

Financial Information

Active Business Bank Account

Record Keeping System

Records Up to Date

Have Bookkeeper

Have Accountant

Management Accounts

Tax Up to Date

CIPC Up to Date

Accounting System Used

Annual Turnover (R)

Number of Employees

Business Status & Turnover History

Trading before COVID-19?

Current Month Turnover (R)

Last 3 Months Combined (R)

Last 12 Months Combined (R)

Previous Financial Year (R)

Business Lined Up (Contracts/Pipeline)

Critical Needs

Justification & ROI

Additional Information

How did you hear about the programme?

What is your understanding of this programme?

Why are you applying?

What do you want to achieve?

Access to Laptop/PC

Reliable Internet Access

Supporting Documents

Upload required documents (PDF, JPG, PNG). Max 5MB each.

Certified ID Copy *

CIPC Registration Document *

B-BBEE Affidavit / Certificate *

Tax Clearance Certificate *

Company Profile

Declaration

E-Signature (Type Full Name) *

Date *

I certify that the information provided is true and correct to the best of my knowledge. I understand that any false information may lead to disqualification.