testform

William Test

Step 1 - Legislation

Step 2 - Company Information

Step 3 - Ownership information

Shareholder Details Companies

Shareholder Details Individuals

Summary of Contributions

Calculation

NET EQUITY CALCULATION

INFORMATION FOR COMPLETION OF THE B-BBEE AFFIDAVIT

The information as stipulated below is required to complete the EME / QSE Affidavit as per the legislative requirements contained in the Amended Financial Sector Code Gazette no. 41287

COMPANY DETAILS

Registered Company Name

Trading Name

Type of Company

Company Registration Number

Company Tax Reference Number

VAT Number

Company Address

Name of Deponent

Identity Number of Deponent

Designation of Deponent

COMPANY FINANCIAL DETAILS

Total Revenue as per the Financial Statements

What is the Financial Year-end of the Company

What will be provided as proof of Revenue? (select one)

Qualification to be assessed on

IMPORTANT - The Company Infrmation provided above will be used to complete the affidavit, please ensure that all of the information provided is 100% correct and can be proven as per the evidence required.

INFORMATION FOR COMPLETION OF THE B-BBEE AFFIDAVIT

The information as stipulated below is required to complete the EME / QSE Affidavit as per the legislative requirements contained in the Amended Financial Sector Code Gazette no. 41287

EQUITY OWNERSHIP DETAILS

The detail as per the below must be accurate as the data will be used to populate the "calculator" that will provide a result to be read into the affidavit

What is the date of the first Equity Ownership Transaction or deal you are attesting to in the affidavit?

(if the date is pre the Gazette date the qualification for being Black Owned as defined will only be 50%)

According to Paragraph 4.3.2, Statement 000 of the Amended Financial Services Sector Code, and based on the information supplied above, the % to be obtained to qualify for a Level 2 B-BBEE Contributor would be?

B-BBEE Contributor

SHAREHOLDERS DETAILS

Total Number of Companies holding equity in the Measured Entity?

Total Number of Individuals holding equity in the Measured Entity?

Total Shares in issue of the Measured Entity?

Company 1

Company Name

Total Shares held by each company as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Company 2

Company Name

Total Shares held by each company as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Company 3

Company Name

Total Shares held by each company as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Company 4

Company Name

Total Shares held by each company as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Company 5

Company Name

Total Shares held by each company as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Company 6

Company Name

Total Shares held by each company as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Company 7

Company Name

% of Shares held

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Company 8

Company Name

Total Shares held by each company as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Company 9

Company Name

Total Shares held by each company as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Company 10

Company Name

Total Shares held by each company as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Individual 1

Individual Name

Total Shares held by each individual as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Individual 2

Individual Name

Total Shares held by each individual as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Individual 3

Individual Name

Total Shares held by each individual as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Individual 4

Individual Name

Total Shares held by each individual as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Individual 5

Individual Name

Total Shares held by each individual as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Individual 6

Individual Name

Total Shares held by each individual as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Individual 7

Individual Name

Total Shares held by each individual as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Individual 8

Individual Name

Total Shares held by each individual as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Individual 9

Individual Name

Total Shares held by each individual as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Individual 10

Individual Name

Total Shares held by each individual as indicated

% of Shares held:

% Voting Rights of Black People

% Voting Rights of Black Woman

% Economic Interest of Black People

% Economic Interest of Black Woman

% Black Designated Groups

% Black New Entrants

Summary of Company Shareholders Contributions

Summary of Individual Shareholders Contributions

EFFECTIVE BLACK SHAREHOLDING PRE ADJUSTMENT

(Effective Black shareholding prior to adjustment for Foreign Operations)

EFFECTIVE BLACK SHAREHOLDING OF AFTER ADJUSTMENT

1. SA Business

2. Mandated Investments

Was the Modified Flow-Through Principle Applied in obtaining any of the outcomes above?

No Yes

STEP 1 - CALCULATION OF THE DEEMED NET VALUE

A = (B - C) / D

STEP 2 - CALCULATION OF FORMULA A

A = B * (1 / ( C * 25%)) * 8

25% - Allocation % of the Debt to be settled as per Formula A

8 - Weighting Points to be allocated as per the Amended FSC Scorecard

IMPORTANT - DO NOT OVERRIDE THE CONTENT

Todays date

Years of transaction result

Single Line

Company 1

Company 2

Company 3

Company 4

Company 5

Company 6

Company 7

Company 8

Company 9

Company 10

Individual 1

Individual 2

Individual 3

Individual 4

Individual 5

Individual 6

Individual 7

Individual 8

Individual 9

Individual 10

EFFECTIVE BLACK SHAREHOLDING PRE ADJUSTMENT

EFFECTIVE BLACK SHAREHOLDING OF AFTER ADJUSTMENT

STEP 1 - CALCULATION OF THE DEEMED NET VALUE

STEP 2 - CALCULATION OF FORMULA A

***IMPORTANT - DO NOT OVERRIDE THE CONTENT***

IMPORTANT - DO NOT OVERRIDE THE CONTENT