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Black Economic Empowerment Questionnaire

Black Economic Empowerment Questionnaire

Particulars of Applicant

Registered name of the Supplier

Trading name (if applicable)

VAT registration number

Income Tax reference number

PAYE reference number

Physical address

Postal address

E-mail address

Part A: General Information

1. The information provided in this questionnaire will be treated as confidential and will not be disclosed to any third party.

2. The information will be used only for the purpose of assessing your company in terms of our Black Economic Empowerment Policy.

3. ABC (Pty) Ltd reserves the right to request additional information or documents, or to perform audit procedures to substantiate or verify any of the answers provided in the question.

4. A copy of the completed questionnaire must be signed on behalf of your business by a duly authorised signatory.

5. Certified copies of requested documents are to be submitted as part of this information pack.

Particulars of contact person

Initials and Surname

Cellphone number

Business telephone number

E-mail address

ID or Company/Close

Corporation/Trust registered number

Part B: Direct Empowerment

1. Equity ownership

1.1. Ownership

a) What percentage equity is owned by blacks1

b) What percentage is owned by black women

c) What percentage equity is owned by people with disabilities2

1.2. Control

a) What % voting rights is controlled by blacks?

b) What % voting rights is controlled by black women?

c) What % economic interest3 is held by blacks?

d) What % economic interest is held by black women?

2. Management

2.1 What is the actual number of executive management positions in your company?

2.2 What percentage of your company’s executive management positions is occupied by black men?

2.3 What percentage of your company’s executive management positions is occupied by black women?

2.4 What percentage of your company’s executive management positions is occupied by people living with disabilities?

1.  Africans, Coloureds and Indians who are South African citizens.

2.  As described in the Employment Equity Act.

3. Economic interest means a member’s entitlement to receive any payment from an enterprise which arises by virtue of the member’s holding and equity.

Part C: Human Resource development and employment equity

1. Employment Equity (in terms of the Employment Equity Act)

1.1 What is the total number of people employed by your business?

1.2 Have you submitted your Employment Equity Plan to the Department of Labour?

Occupational Categories

Male

Female

TOTAL

African

Coloured

Indian

White

African

Coloured

Indian

White

Legislators, senior officials and managers

Professionals

Technicians and associate professionals

Clerks

Service and sales workers

Skilled agricultural and fishery workers

Craft and related trades workers

Plant and machine operators and assemblers

Elementary occupations

TOTAL PERMANENT

Non – permanent employees

TOTAL

Persons with disabilities

2. Skills Development (In terms of the National Skills Development Act)

2.1 What percentage of your payroll is contributed towards skills development?

2.2 How much has your company invested in skills development (in addition to the skills levy) as a proportion of payroll?

2.3 Is your business registered with your Sector Education and training Authority (SETA)?

2.4 How many learnership positions do you have? (As a percentage of total employees)

Part D: Indirect Empowerment

1. Preferential Procurement

1.1 Does your company have a preferential procurement policy?

yes

1.2 What was your total procurement spent in the past 12 months?

R

%

1.3 How much (both Rand and percentage) of this was spent with black owned enterprises?4

R

%

1.4 How much (both Rand and percentage) of this was spent with black woman owned enterprises?

R

%

1.5 How much (both Rand and percentage) of this was spent with black empowered enterprises5?

R

%

1.6 What percentage of the above procurement is on long term contracts (2 years and more)

%

2. Enterprise Development

2.1 Does your company have any strategic relationships/alliances with SMMEs that are black owned enterprises?

no

2.2 If “YES”, is the relationship/alliance permanent or only established to participate in specific tenders?

Please provide details of your alliances

Company name

Nature of relationship

Contact person and number

Part E: Residual

1. Corporate social responsibility

1.1 Does your company have a Corporate Social Responsibility Policy?

yes

1.2 If “YES”, what percentage of your pre-tax profits is contributed towards social responsibility?

1.3  Provide a list of 5 of your major contributions to social responsibility. (If the space provided is insufficient you can provide a separate attachment)

Project

Where located and purpose of the project

Rand value

Contact name and numbers



4 Defined in terms of the Government Strategy Document for Broad-Based Black Economic Empowerment as a company or economic entity that is 50,1% owned by black persons and where there is substantial management control by black people.

5 Defined according to the Government Strategy Document for Broad-Based Black Economic Empowerment as one that is at least 25.1% owned by blac persons and where there is substantial management control by black people.

Declaration

I ___________________________________________ hereby declare, in my capacity as _____________________________

and duly authorised thereto, that the information provided in the above questionnaire is to my knowledge factually correct.

Signed at ____________________this ____________________ day of ___________________

Signature _____________________________

 

Last modified onThursday, 04 August 2016 18:56
Gary Watkins

Gary Watkins

Managing Director

BA LLB

C: +27 82 416 7712

T: +27 12 669 3289

F: +27 86 689 7862

Website: www.workinfo.com
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