Full registered name of organization (“Applicant”)

Trading name of Applicant (If applicable)

Registration number

Holding company (If applicable)

VAT Registration number

Date organization was established

Type of entity
Private CompanyClose CorporationPartnershipTrustSole ProprietorOther (specify)

Type of entity (If other was selected advise)

Street address

Town

Area code

Postal Address

Postal code

Telephone number

Fax number

Email address

APPLICANT’S BANK ACCOUNT DETAILS

Account name

Bank

Account number

Branch code

OWNERS/PARTNERS/DIRECTORS/MEMBERS

Full name

Identity number

Add Another Person
YesNo

ATTACH SUPPORTING DOCUMENTS

CIPC registration documents

Copy of VAT certificate

Bank confirmation letter

Copy of Identity of all owners/partners/directors/members

Photos of previous installations

SIGNATURE (Please use your mouse to sign your signature)

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