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Bpesa.org.za

Business Process Services Incentive Programme THE BUSINESS PROCESS SERVICES (BPS) INCENTIVE
PROGRAMME
Please note the following before completing the form:
1. Please ensure that you have read this form fully and understood it.
2. Applications must be signed by the authorised representative of the company and dated before submitting.
3. Before submitting your application, please ensure that you have attached all required documentation.
4. Please read through the BPS Incentive Programme Guidelines before completing the application form.
How did you find out about the BPS Incentive Programme?
(Select the applicable block below and mark it with a "X".)
the dti
the dti Customer Contact Centre
□ Word of mouth □ Foreign Offices □ the dti Website
□ Private Sector Consultant □ Other - specify Please return completed forms by registered mail, courier or hand delivery to: The Enterprise Organisation the dti campus: 77 Meinjies Street
Department of Trade and Industry Pretoria 0002Republic of South Africa INITIAL OF CLERK .
*The BPS Incentive Programme (BPS) is the dti's incentive programme (scheme) aimed at attracting investment and creating employment in South Africa through
offshoring activities.
For the dti use only
Unique reference number : BPS_ApplicationForm_Version 1 /2011/01 Business Process Services Incentive Programme APPLICANT PROFILE
Section 1
APPLICANT CONTACT DETAILS
Application Receive Date 1. Name of Business (the registered name with Cipro):1a.Trading as Name:2. Business registration number: 3. Income Tax Number: 4. Financial Year End: 6. Physical Address for the serving of legal documents and other notices: Address line 1:Address line 2:Address line 3:Postal Code: 7. Postal address:Address line 1: Address line 2:Address line 3:Postal Code: 8. Contact Person: 10.Contact details: 11.Business Province: (Where an Agent acts on behalf of the Applicant)
1. Name of Business (the registered name with Cipro):2. Contact Person: 3. Registration number 5. Postal Address: Address line 1:Address line 2:Address line 3:Postal Code: 6. Contact details:Tel.No: OWNERSHIP STRUCTURE:(For the Private Companies / Public Enterprises)
Shareholder / Member / Owner(s) Country of Domicile CURRENT AND PREVIOUS GOVERNMENT SUPPORT UNDER THE FOLLOWING PROGRAMMES
Approved Entity Name
Approved Entity Number
Period of Benefit
Business Processing Outsourcing and Offshoring (BPO&O)Small and Meduim Enterprise Development (SMEDP)Monyetla Work Readiness ProgrammeTelecom Development Support BROAD BASED BLACK ECONOMIC EMPOWERMENT (
Provide details of BEE scoring in terms of the B-BBEE Code of Good Practice For statistical use only)
Level 6 contributor ( > / = 45 < 55) Level 5 contributor ( > / = 55 < 65) Non compliant contributor Level 8 contributor ( > / = 30 < 40) Level 4 contributor ( > / = 65 < 75) Level 7 contributor ( > / = 40 < 45) Above level 4 contributor ( >/= 75) BPS_ApplicationForm_Version 1 /2011/01 Business Process Services Incentive Programme Section 2
ENTITY TYPE
DETAILS OF APPLYING PROJECTS
Registered Project Name 1st Physical street address of the Project2nd Physical street address of the Project (if any)3rd Physical street address of the Project (if any) Commencement date of the Project (DD MM CCYY)Commencement date of the Training (DD MM CCYY) ENTITY TYPE
The applying projects is (Mark "X" where applicable)
A start-up of a new BPS operationAn expansion of an existing South African (SA) operationA new project in SA to expand an existing global operationOther, specify: THE APPLYING PROJECTS CAN BE DESCRIBED AS:
Provide a short narration, where necessary SELECT THE SERVICES/ACTIVITIES THAT WILL BE PROVIDED BY THE APPLYING PROJECTS BY MARKING "X" IN THE RELEVANT BLOCK.
IT and Technical Services Provide a short description of services/activities Contact Centre functionsFinance and Accounting servicesHuman Resource functionsData Entry, convertion & maintenanceInsurance industry functionsWebsite design and development PROVIDE DETAILS OF EXPECTED CONTRACTS WITH MAJOR CLIENTS:
Estamated Value of contract in Rands (enter only the value) Duration of service (contract in years) JOBS TO BE CREATED BY THE PROJECT
Number of new employment opportunities created (numbers are cummulative per year and excludes current employees) Jan 2011 - Mar 2011
Apr 2011 - Mar 2012 Apr 2012 - Mar 2013
Apr 2013 - Mar 2014
Permanent staff employment Temporary/casual staff employment / FTEs Total number of offshore jobs
Other staff (including support staff and managment) Total staff complement
PROVIDE PLANNED SALARY FIGURES
Jan 2011 - Mar 2011
Apr 2011 - Mar 2012 Apr 2012 - Mar 2013
Apr 2013 - Mar 2014
Salaries: New offshore jobs (enter values only)Other Salaries: Support staff and management) (enter values only) Total Salaries as per income statement
INDICATE HOW THE PROJECTS WILL BE FINANCED? STATE THE SOURCE AND AMOUNT:
Source (e.g internal resources, third party funding etc.) Amount (in Rands) Base year refers to the 12 month period preceeding the application submission date BPS_ApplicationForm_Version 1 /2011/01 Business Process Services Incentive Programme Section 3
DETAILS ABOUT COMPANY INTERNAL PROJECT EVALUATION
WHAT INTERNAL PROJECT EVALUATION BENCHMARKS WERE USED TO ASSESS THE FINANCIAL VIABILITY OF THIS PROJECT? PLEASE PROVIDE DETAILS ON THE OUTCOMES OF THAT EVALUATION. {E.G. PROJECT INTERNAL RATE OF RETURN, BREAK-EVEN ANALYSIS, FINANCIAL RATIOS, COST-BENEFIT ANALYSIS, COST STRUCTURE ANALYSIS, ETC.) IS THE COMPANY CONSIDERING OTHER PROJECTS? IF YES, HOW DO THESE PROJECTS COMPARE TO ALTERNATIVE PROJECT(S) THAT ARE BEING CONSIDERED? IS THE COMPANY CONSIDERING OTHER LOCATIONS FOR THESE PROJECTS? IF YES, HOW DOES LOCATING THE PROJECTS IN SA COMPARE WITH LOCATING ELSEWHERE? PROJECT SIGNIFICANCE: WHAT IS THIS PROJECT'S POTENTIAL % CONTRIBUTION TO OVERALL ANNUAL COMPANY REVENUE? Section 4
FINANCIAL PLANNING FOR THE PROJECT
PROJECTED INVESTMENT AND OPERATIONAL EXPENDITURE (R'000)
Base Year (1)
1. Expected Investment
Investment in land and building
Total Expected Investment
2. Operational expenditure
Total Operational Expenditure
Section 5
FINANCIAL PLANNING FOR THE LEGAL ENTITY
PROJECTED BALANCE SHEET (R'000)
BASE YEAR
TOTAL EQUITY/MEMBERS INTEREST
Share Capital / Members InterestShare PremiumShareholders LoansReserves : DistributableReserves : Non-DistributableAccumilated Profit / (Loss) Deferred Taxation:Long Term LoansCurrent Liabilities TOTAL CAPITAL EMPLOYED
FIXED ASSETS
Land (at Cost)Buildings (at Cost + Additions)Capitalised Equipment Hardware CostsCapitalised Software CostsTelecoms Installation CostsOther Less: Accumilated Depreciation Deferred TaxCurrent Assets TOTAL ASSETS
BPS_ApplicationForm_Version 1 /2011/01 Business Process Services Incentive Programme PROJECTED INCOME STATEMENT (R'000)
Base Year (1)
Plus: OtherPlus: Other IncomeLess: Cost of Sales Gross Profit / (Loss)
Less: Expenses - Rental of Premises - Training Expenditure - Other expences Less: Interest Paid Profit / (Loss) after Interest before Tax
Less: SA Normal Tax Profit / (Loss) after Tax before Extraordinary items
Plus: Extraordinary itemsLess: Extraordinary itemsLess: DividentsPlus: Retained Profit at the beginning of the year Less: Retained (Loss)at the beginning of the year Retained Profit / (Loss) at the end of the year
Section 6
DOCUMENTS TO BE ATTACHED TO THIS FORM
Business Plan (which includes details on the internal evaluation of the project) Tax Clearance Certificate Valid Incorporation Certificate Latest Annual Financial Statements (Latest Audited Annual Financial Statement Copies of Contracts for Off-shore services or Letters of intent or Board Reselution Monthly Financial Projections for 36 month period BPS_ApplicationForm_Version 1 /2011/01 Business Process Services Incentive Programme Section 7
DECLARATION BY THE APPLICANT
NOTE: The information contained in this application form will be used as the basis of approval or declining the application, monitoring the impact of the envisaged investment project. It will be
integral to the contract between the dti and the applicant. If, upon review, the facts differ significatly from the information provided in this appliation form, to the extent that mandatory
requirement or criteria are no longer met, the funding approved with respect to the application shall be withdrawn, and in addition to the funds already disbursed at the time of such
withdrawal. Consequently it is in the interest o f the applicatnt to provide full and acurate information in this application form.
I hereby declare that the information in this application is a fair and true reflection of the intended project and that all relevant information has been disclosed. I am aware of the fact that the information which I have submitted above will have a material bearing on the adjudication of the application and if it subsquently transpires that any information in the application and addenda is not correct, or that certain information was omitted, the Adjudication Committee shall render the application invalid and be entitled to withdraw or amend its approval, without prejudice to its rights.
This application (with any addenda), if successful, will form part of your contract with the Department of Trade and Industry.
NOTE: If an independent consultant completes the application form, the applicant must ensure that the information provided is correct before signing the application. If at a
later stage it transpires that any information is not correct, the applicant will be held solely responsile for misrepresentation and the Department of Trade and Industry reserves

(Signature of Chief Executive Officer / Managing Director / General Manager of the entity in terms of the attached resolution of the Board members) NAME IN PRINT
Section 8
RESOLUTION OF THE BOARD OF DIRECTORS/MEMBERS/OWNER (S)
The Board of Directors/ owner(s) of (name of the business) hereby authorises (name of the entity/project) in his/her capacity as to sign all documents pertaining to this application or any documentation pertaining thereto.
SIGNATURE OF DIRECTORS/ OWNER(S): Section 9
AUTHORISATION OF AGENT ACTING ON BEHALF OF APPLICANT:
The Board of Directors/ owner(s) of (name of the business) hereby declaire that (name of the agent) in his/her capacity as (position and name of agent business) was appointed as consultant for the purposes of preparing and lodging an application for funding under the BPS Incentive Programme.
SIGNATURE OF DIRECTORS/ OWNER(S): BPS_ApplicationForm_Version 1 /2011/01

Source: http://www.bpesa.org.za/wp-content/uploads/2011/07/BPS-Application-Form1.pdf

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