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

Business sector

Logo

Choose File

Area Serviced

COMPANY CONTACT INFORMATION

Tel No

Fax No

Website

Physical address

City

Postal Code

Postal address

City

Postal Code

OWNER/DIRECTOR/MANAGER INFORMATION

Official position

First Name

Surname

Tel No

Fax No

E-mail address

Cell No

SECRETARY INFORMATION

First Name

Surname

Tel No

Fax No

E-mail address

Cell No

ACCOUNTS DEPARTMENT INFORMATION

Official position

First Name

Surname

Tel No

Fax No

E-mail address

Cell No

MARKETING / COMMUNICATION DEPARTMENT INFORMATION

Official position

First Name

Surname

Tel No

Fax No

E-mail address

Cell No

PROFESSIONAL SERVICE

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

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

BBBEE Expiry Date

Enterprise Size

Turnover per Annum

Is your company black owned? *

Is your company female owned? *

DOCUMENT UPLOADS

Company Profile *

Choose File

BBBEE Document

Choose File

Expiry Date

Company Registration Certificate

Choose File

NPO Certificate if company is a Non-Profit Organisation

Choose File

Tax Clearance

Choose File

Expiry Date

Owner ID Document (Preferable Certified Copy) *

Choose File

Proof of Certifications & Accreditations

Choose File

Health Certificate

Choose File

Certificate of Acceptability of Food Premises

Choose File

Share Certificate

Choose File

Shareholders Agreement

Choose File

Proof of residence

Choose File

EEA1 Form

Choose File

Disability Certificate

Choose File

2024 MEMBERSHIP FEES (VAT INCLUDED)

I, the undersigned, undertake to abide by the Constitution of the Middelburg Chamber of Commerce & Industry (MCCI) and to
pay my subscriptions annually in advance.

This membership is automatically renewed in October every year, and valid for the next financial year unless cancelled by myself in writing, providing all outstanding fees are paid in full.

MCCI’s financial year is 1 January to 31 December.

Terms & Conditions:

The MCCI membership only becomes active on payment of the Membership fee. A business will only qualify for the benefits and discounts when the membership fee is paid in full. If after 30 days of the application the payment is not received, your application will be archived, and after 90 days you would have to reapply for membership again.

Signed At

Date

Use your mouse to draw your signature here