ࡱ> DFE \pAnnie Ba==-[, 8X@"1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial1&Arial"R"\ #,##0;"R"\ \-#,##0!"R"\ #,##0;[Red]"R"\ \-#,##0""R"\ #,##0.00;"R"\ \-#,##0.00'""R"\ #,##0.00;[Red]"R"\ \-#,##0.00=*8_ "R"\ * #,##0_ ;_ "R"\ * \-#,##0_ ;_ "R"\ * "-"_ ;_ @_ .))_ * #,##0_ ;_ * \-#,##0_ ;_ * "-"_ ;_ @_ E,@_ "R"\ * #,##0.00_ ;_ "R"\ * \-#,##0.00_ ;_ "R"\ * "-"??_ ;_ @_ 6+1_ * #,##0.00_ ;_ * \-#,##0.00_ ;_ * "-"??_ ;_ @_                 + ) , *            @   @   (  @      @@   (@   (  "@@  " @  (     ("@ @     ("@     (" @   (@@  (@  (  @  (@@  (@  (  (   (@   (@  ( @  (  (""@ @   ( @  (  ("@@  ( " @   (@  (  (   (@  (  @   (  ("@ @  (  ("@  ("@  (   (  (  (  (  ("@  (  @@   @  `@  @ `Sheet1`Sheet2aSheet3"/#Statement of Assets and Liabilities LiabilitiesBalance sheet of:at:Note - Income and Expenditure to be detailed on back page.>Should space not be permit, please attach applicable schedules Previous YearBonds(And/or amounts owing under Deeds of Sale Current YearName of Farm or Plot NoName of Bondholder/Seller2Annual capital reductions Maturity DateBank OverdraftsSpecify briefly Security givenJOwing under Instalment sale transaction and Leasing Transaction agreementsMovable encuberedTo whomInstalments PayableAmount still owingBills Payable:Sundry Creditors:&Loans (Including Insurance Comapanies) Interest Rate When PayableAmountOther Liabilities (Specify)KNote: State if any of the above liabilities are covered by a Notarial BondLiability for Income Tax(Date to which Assesment paid) TOTAL LIABILITIES (Quantifiable)ESpecify here Contingent Liabilities as Guarantor, Surety or otherwisenI/We hereby declare that this is a full, true and correct Statement of all known liabilities at the above dateGDated at ________________________ on____________________________ 20 . Signature:Assets&Fixed Property (Registered in my name)nGive particulars of each Property seperately, starting whether Freehold, Leasehold, etc. and state if affected1by any Servitude, Usufruct or Fiduciary InterestsSizeDistrict(Date purchased/price paid MCV/DCVMachinery, Plant, etc.(Specify important items only)Vehicles, ImplementsFurniture & Fiitings InvestmentsLoans DLife Policies (Payable to the undersigned and not to any third party Date IssuedCompanyNumber Maturity DateSurrender Value less LoansShares Number Held Market ValueStock in trade Book DebtsCash!Bills Receivable (Not Discounted)Bank Balances (Specify) #Goodwill and other assets (Specify))Note: State if any assets are encumbered TOTAL ASSETSLESS LIABILITIES (Ref. Page 2) NET WORTH<my/our assets are not encumbered other than as stated above.sI/We hereby declare that this is a full, true and correct Statement of my/our positiion at the above date and that ]Dated at ______________________________________ on ___________________________________ 20 .[Signature: _______________________________________________________________________________Income and Expenditure Listing ofAtMonthly Income: Salary - SelfSalary - Spouse Commissions InvestmentOther TOTAL INCOMERMonthly ExpenditureTaxationPensionUIF Medical AidRent/Bond paymentsElectricity & Water Rates & TaxesHire Purchase InstalmLease AgreementsCredit Card AccountsInsurance PremiumsLife Assurance TransportLoan ReapymentsOther Expenses DonationsAlimony/MaintenanceChildren's Clothing/Edu Entertainment GroceriesClothing AccountsTelephone AccountsDocter/Chemist Maid/GardenerSecurity SystemTV rental/MNETTOTAL EXPENDITURESurplus Available=PLEASE GIVE A BRIEF MOTIVATION FOR THE FRANCHISE APPLICATION:VPLEASE WRITE A BRIEF PERSONAL PROFILE INDICATING MANAGEMENT PHILOSOPHIES, BUSINESS ANDPERSONAL GOALS:I understand that if this application for a Franchise is accepted, I will be required to sign a comprehensive Franchise Agreement ~I also hereby declare that the information given in this applications is correct and fully disclose my assets and liabililties'to the best of my knowledge and belief.wThe Applicant hereby consents and agrees that the Franchisor may perform a credit search on the Applicant's record withLa registered credit bureaux when assessing the Applicant's application form.Date: \PLEASE INCLUDE COPIES OF THE FOLLOWING DOCUMENTATION WHEN AREA IS CONFIRMED AND NEGOTIATIONS COMMENCED.A registered Copy of:CK1orCertificate of incorporationqCertified Copies of Identity documents of all the members, shareholders or partners concerned with the Franchise._Copies of Registration certificates and numbers of your Company with the following authorities:Regional Services CouncilReceiver of Revenue - VATReceiver of Revenue - PAYE!Receiver of Revenue - Company TaxDepartment of Manpower - UIFWConfirmation by all bankers (including bonds/loans) of bank balance/outstanding balanceCopies of property deedsXregulating all aspects of my franchise relationship with The Specialists Holdings SA cc.rIn addition, the Applicant hereby agrees to undergoing a Psychosymetric Test as part of the Application procedure.Workmen's Compensation bAg  7a  ` !K ={ccJ  DR$8,3^;CrGNdOTZ^D^L^t`  dMbP?_*+%&jZ?'jZ?(M&d2?)M&d2?MvEpson Stylus Photo 1270 ESC/P C odXXLetter0DINU"4d{ dOSPEAA" KXX `? `?U} } $&  h   ; , ;  ; , , , , , , , , ; , , , , , , ; , , , , , ; ; , , ; % & ' '  ( ) * ) & + ,,,,,, .  -(       ! 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