SWORN AFFIDAVIT - B-BBEE EXEMPTED MICRO ENTERPRISE - GENERAL

I, the undersigned,

Full name & Surname

Identity number

Hereby declare under oath as follows:

  • 1. The contents of this statement are to the best of my knowledge a true reflection of the facts.

  • 2. I am a Member / Director / Owner (Select one) of the following enterprise and am duly authorised to act on its behalf:

Enterprise Name:

Trading Name (If Applicable):

Registration Number:

Vat Number (If applicable)

Enterprise Physical Address:

Type of Entity (CC, (Pty) Ltd, Sole Prop etc.):

Nature of Business:

Definition of "Black People"

As per the Broad-Based Black Economic Empowerment Act 53 of 2003 as Amended by Act No 46 of 2013 "Black People" is a generic term which means Africans, Coloureds and Indians -

  • (a) who are citizens of the Republic of South Africa by birth or descent; or

  • (b) who became citizens of the Republic of South Africa by naturalisation-

    • i. before 27 April 1994; or

    • ii. on or after 27 April 1994 and who would have been entitled to acquire citizenship by naturalization prior to that date;"

Definition of "Black Designated Groups"

"Black Designated Groups means:

  • (a) unemployed black people not attending and not required by law to attend an educational institution and not awaiting admission to an educational institution;

  • (b) Black people who are youth as defined in the National Youth Commission Act of 1996;

  • (c) Black people who are persons with disabilities as defined in the Code of Good Practice on employment of people with disabilities issued under the Employment Equity Act;

  • (d) Black people living in rural and under developed areas;

  • (e) Black military veterans who qualifies to be called a military veteran in terms of the Military Veterans Act 18 of 2011;"

3.

I hereby declare under Oath that:

  • The Enterprise is ______________% Black Owned using the flow-through principle as per Amended Code Series 100 of the Amended Codes of Good Practice issued under section 9 (1) of B-BBEE Act No 53 of 2003 as Amended by Act No 46 of 2013,

  • The Enterprise is ______________% Black Female Owned as per Amended Code Series 100 of the Amended Codes of Good Practice issued under section 9 (1) of B-BBEE Act No 53 of 2003 as Amended by Act No 46 of 2013,

  • The Enterprise is ______________% Black Designated Group Owned as per Amended Code Series 100 of the Amended Codes of Good Practice issued under section 9 (1) of B-BBEE Act No 53 of 2003 as Amended by Act No 46 of 2013,

  • Black Designated Group Owned % Breakdown as per the definition stated above:

    • Black Youth % = ______________%

    • Black Disabled % =______________%

    • Black Unemployed % =______________%

    • Black People living in Rural areas % = ______________%

    • Black Military Veterans % =______________%

  • Based on the Audited Financial Statements/Financial Statements and other information available on the latest financial year-end of _____________ (DD/MM/YYYY), the annual Total Revenue was R10,000,000.00 (Ten Million Rands) or less

  • Please Confirm on the below table the B-BBEE Level Contributor, by ticking the applicable box.

    100% Black Owned

    Level One (135% B-BBEE procurement recognition level)

    At least 51% Black Owned

    Level Two (125% B-BBEE procurement recognition level)

    Less than 51% Black Owned

    Level Four (100% B-BBEE procurement recognition level)

  • 4. I know and understand the contents of this affidavit and I have no objection to take the prescribed oath and consider the oath binding on my conscience and on the Owners of the Enterprise which I represent in this matter.

  • 5. The sworn affidavit will be valid for a period of 12 months from the date signed by commissioner.

29 March 2023

Deponent Signature:

Cape Town

Commissioner of Oaths Signature & stamp Date:

Date :

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Randgold and Exploration Company Limited published this content on 29 March 2023 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 30 March 2023 14:33:02 UTC.