Sworn Affidavit: B-BBEE Exempted Micro Enterprise (General)
I, the undersigned,
Full name and surname: [Your full name and surname]
Identity number: [Your identity number]
hereby declare under oath as follows:
- The contents of this statement are, to the best of my knowledge, a true reflection of the facts.
- I am a member, director or owner of the following enterprise and am duly authorised to act on its behalf. Enterprise name: [Enterprise name]. Trading name (if applicable): [Trading name (if different)]. Registration number: [Registration number (or ID number for a sole proprietor)]. Enterprise physical address: [Enterprise physical address]. Type of entity: (Pty) Ltd. Nature of business: [Nature of business].
- I declare under oath that the enterprise is [Black ownership (percentage)]% black owned, [Black woman ownership (percentage)]% black woman owned and [Black designated group ownership (percentage)]% owned by black designated groups, as measured under Code Series 100 of the Amended Codes of Good Practice issued under section 9(1) of the Broad-Based Black Economic Empowerment Act 53 of 2003 as amended. Based on the financial statements, management accounts and other information available for the latest financial year ended [Latest financial year-end], the annual total revenue was R10 000 000 (ten million rand) or less.
- The enterprise's B-BBEE level as an exempted micro enterprise is: [B-BBEE level contributor].
- "Black people" means Africans, Coloureds and Indians who are citizens of the Republic of South Africa by birth or descent, or who became citizens by naturalisation before 27 April 1994, or on or after 27 April 1994 and who would have been entitled to acquire citizenship by naturalisation before that date.
- I know and understand the contents of this affidavit. I have no objection to taking the prescribed oath and I consider the oath binding on my conscience and on the owners of the enterprise I represent.
- This sworn affidavit is valid for 12 months from the date it is signed by the Commissioner of Oaths.
Deponent: [Your full name and surname]
Signature: ____________________
Name: ____________________
Title: ____________________
Date: ____________________
Commissioner of Oaths: signature, full name, capacity, address and stamp, with the date
Signature: ____________________
Name: ____________________
Title: ____________________
Date: ____________________