PARTNERSHIP REQUEST FORM:

BUSINESS INFORMATION:

Entity Type*

Please select the entity type.

Registered Name*

Please enter the registered name of the business or entity.

Trading Name (if different)

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VAT Number

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Number of Employees*

Please add the number of people employed by the entity.

Scope of Business*

Please state what the business does.

Website Address

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Registration Number *

Invalid Input - please use format 2000/123456/07

Registration Date*

Please add the registration date.

Physical Address*

Please add the registered physical address of the entity.

Postal Address

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CONTACT DETAILS:

Contact People*

Primary

Accounts

Marketplace Admin

Information Officer

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First Name*

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Last Name*

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Primary Email Address*

Please complete the primary email address

Primary Contact Number*

Please enter as numbers only: 27821234567

Billing Contact Name*

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Billing Contact Last Name*

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Billing Email Address*

Please complete the primary email address

Billing Contact Number*

Please enter as numbers only: 27821234567

Marketplace Admin Name*

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Marketplace Admin Last Name*

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Marketplace Admin Email Address*

Please complete the primary email address

Marketplace Admin Contact Number*

Please enter as numbers only: 27821234567

Information Officer Name*

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Information Officer Last Name*

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Information Officer Email Address*

Please complete the primary email address

Information Officer Contact Number*

Please enter as numbers only: 27821234567

DIRECTOR DETAILS:

How many Directors are there?*

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To add 4 or more directors please click here to download the director spreadsheet template to upload. And only add the primary director below.

Please upload your Director spreadsheet*

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Director 1 Full Name*

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Director 1 ID/Passport Number*

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1 - Country of Citizenship*

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Director 1 Date of Birth*

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Director 1 Physical Address*

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Director 1 ID Copy*

Please attached a PDF copy of the Director's ID

Director 2 Full Name*

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Director 2 ID/Passport Number*

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2 - Country of Citizenship*

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Director 2 Date of Birth*

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Director 2 Physical Address*

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Director 2 ID Copy*

Please attached a PDF copy of the Director's ID

Director 3 Full Name*

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Director 3 ID/Passport Number*

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3 - Country of Citizenship*

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Director 3 Date of Birth*

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Director 3 Physical Address*

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Director 3 ID Copy*

Please attached a PDF copy of the Director's ID

BANKING INFORMATION:

Bank Name*

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Account Name*

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Account Number*

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Branch Code*

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Bank Country*

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Branch Name

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IBAN Number

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SWIFT Code

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Bank Telephone Number

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Bank Address

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FINANCIAL INTELLIGENCE CENTRE ACT (FICA):

Please expand on your sources of wealth and funding

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BENEFICIAL OWNERSHIP:

How many individuals directly own 5% or more of the shares or members interest or voting rights at a general meeting of the Client.*

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Full Name of Individual*

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Please upload your beneficial owner list

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Percentage of Shareholding*

Please select a number between 5 and 100

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How many individuals exercise effective CONTROL over the management of the Client*

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Full Name of Individual*

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Please upload an organogram

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Position*

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DETAILS OF ULTIMATE SHAREHOLDERS:

How many ULTIMATE shareholders are there? *

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Are there ULTIMATE shareholders not disclosed above?*

No

Yes

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Are any of the shareholders politically exposed?*

No

Yes

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For hidden ultimate or politically exposed shareholders, please include on your declaration for each of the applicable shareholders their full name, occupation, ID or passport number, source of wealth and source of funds. For complex structures, please provide a complete hierarchy of total influence and political exposure.

Please upload your PEP declaration

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When a business (an accountable institution) enters a relationship with another business, it must implement a risk-based approach to compliance, which includes a robust customer due diligence (CDD).

In terms of the Financial Intelligence Centre Act (FICA) and the Money Laundering and Terrorist Financing Control Regulations of FICA (the Regulations) (including subsequent amendments thereto), the relevant associates and subsidiaries of the Something Awesome group (which include @myfingertips®) are required to establish and verify particulars of their Clients and Natural Persons connected to the Client.

The Clients’ personal information and documents will be uploaded to our system for verification. To the fullest extent permissible in law, the Client hereby indemnifies and holds the Software Provider, its affiliates, public officers, directors, employees, consultants, agents, licensors and service providers, harmless against all loss, damages, claims, liability and costs, of whatsoever nature, howsoever and whensoever arising, as a result of and without limitation, from the use by us. In addition, the Client warrants that they will not seek recourse against the Software Provider on any basis in connection with any information given, or, in the Client’s view, not given.

ENTITY DOCUMENTS REQUIRED:

CIPC Certificate (reflecting directors)

Please attach your company registration document in pdf format up to 1MB (COR14.3 from CIPC for example)

Non-profit Certificate (reflecting members)

Please attach your NPO/PBO/NPC registration document in pdf format up to 1MB.

Trust Deed

Please attach your trust deed document in pdf format up to 1MB.

Partnership Agreement

Please attach your partnership agreement document in pdf format up to 1MB.

Bank Reference Letter

Please attach a bank account confirmation letter in pdf format up to 1MB.

Proof of VAT Registration (if applicable)

Please attach your VAT confirmation letter in pdf format up to 1MB.

Business Profile*

Please upload a company profile up to 2MB in pdf format.

ALL Shareholder ID copies*

Please upload a copy of each of the ultimate shareholders and directors listed above. PDF format, max 2MB each please.

ALL Shareholders Proof of Residence

Please upload a copy of each of the ultimate shareholders and directors listed above. PDF format, max 2MB each please.

Letter of Authority (showing address of the high court where the trust is registered)

Please upload a Letter of Authority showing address of the high court where the trust is registered. PDF only, up to 1MB.

HELP US DIRECT YOU TO THE RIGHT TEAM:

(Hold Ctrl while clicking to select multiple)

How did you hear about us?

Please assist us with this information.

Which of these most closely resembles your business?*

Please assist us with this information.

Who is your target market?*

Please select at least one option.

Estimated monthly trade with us?*

Please select at least one option.

ACCEPTANCE OF TERMS AND CONDITIONS & PERSONAL SURETY:

I accept the terms and conditions.

1. We warrant that the information set out in this Customer Registration Form and Personal Surety document is true and correct.
2. We hereby acknowledge that we have read and understood each and every term of the Terms and Conditions and accept the same as binding on the Customer.
3. We will promptly provide written notification of any changes in ownership or in the information provided.
4. We understand that personal information is held about us for the purpose of compliance with the Financial Intelligence Centre Act and Regulations of South Africa.
5. We consent to share our personal information voluntarily and understand that such consent may be withdrawn at any time. We have the right to see any information that myfingertips has about us, and to have our details updated or removed at any time.
6. We agree that personal information about us may be shared with the Something Awesome group its associated companies including myfingertips.
7. We warrant that consent from all natural and juristic people listed herein, has been provided to me in my capacity as authorised representative to receive, view, provide and validate all personal information herein and I hereby indemnify myfingertips and the Something Awesome group of companies against all losses, claims, damages, penalties and/or cost that may incur or suffer as a result of such receipt, viewing, provision and validation.

Please sign here*

Sign Above

Please sign to accept the agreement, terms and conditions. This is a legal contract.

Date*

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Signatory Full Name*

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Designation*

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Declare and accept:

The signatory hereto warrants that they have been duly authorised by the Customer to enter into this contract on its behalf and hereby binds himself/herself as surety and co-principal debtor in solidium with the Customer in favour of myfingertips for all obligations to the Something Awesome group and accepts the same as binding on him/her personally.

We take our partnerships seriously!

And we choose our partners carefully.

PARTNERSHIP REQUEST FORM:

BUSINESS INFORMATION:

CONTACT DETAILS:

DIRECTOR DETAILS:

To add 4 or more directors please click here to download the director spreadsheet template to upload. And only add the primary director below.

BANKING INFORMATION:

FINANCIAL INTELLIGENCE CENTRE ACT (FICA):

BENEFICIAL OWNERSHIP:

DETAILS OF ULTIMATE SHAREHOLDERS:

ENTITY DOCUMENTS REQUIRED:

HELP US DIRECT YOU TO THE RIGHT TEAM:

ACCEPTANCE OF TERMS AND CONDITIONS & PERSONAL SURETY: