Membership Application – Middelburg Chamber of Commerce and Industry

Affiliation Application + LPD

BUSINESS APPLICANT INFORMATION

Trading Name

Full registered name of business

Registration No

VAT No (please indicate if not applicable)

Business sector

Logo

Choose File

Area Serviced

COMPANY CONTACT INFORMATION

Tel No

Website

Physical address

City

Postal Code

Postal address

City

Postal Code

OWNER/DIRECTOR/MANAGER INFORMATION

Official position

First Name

Surname

Tel No

E-mail address

Cell No

SECRETARY INFORMATION

First Name

Surname

Tel No

Cell No

E-mail address

ACCOUNTS DEPARTMENT INFORMATION

Official position

First Name

Surname

Tel No

Cell No

E-mail address

MARKETING / COMMUNICATION DEPARTMENT INFORMATION

Official position

First Name

Surname

Tel No

Cell No

E-mail address

Professional Service Specialist Field

Certificate / Accreditation (SABS, SANS, ISO)

OTHER COMPANY INFORMATION

Would you like to receive email communication from the Chamber from time to time? *

Organisational Type

Scope of work (Products)

Nature of Business

Scope of work (Services)

List two of your core business activities

Other products & services

Main commodities or services provided (Please select a maximum of 7)

Number of employees

Ownership

Empowering Supplier

Designated Group

Do you buy local?

If not, what is your reason for not buying local?

BBBEE INFORMATION

BBBEE Level

Enterprise Size

Turnover per Annum

Is your company black owned? *

Is your company female owned? *

DOCUMENT UPLOADS

Company Profile *

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Company Registration Certificate

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NPO Certificate if company is a Non-Profit Organisation

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Tax Clearance

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Expiry Date

Owner ID Document (Preferable Certified Copy) *

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Proof of Certifications & Accreditations

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Health Certificate (Industry Dependent)

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Certificate of Acceptability of Food Premises

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Share Certificate (Optional)

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Shareholders Agreement (Optional)

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Proof of residence

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EEA1 Form (Optional)

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Disability Certificate (Optional)

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2025 MEMBERSHIP FEES (VAT INCLUDED)

Signed At

Date

Use your mouse to draw your signature here