Expression of Interest (EOI)

First Name *

Last Name *

Gender *

Male

Female

Racial Group *

African

Indian

Asian

Coloured

White

Are you a South African citizen? *

Yes

No

ID Number *

Phone Number

Cell Number *

Email Address *

Confirm Email *

Province *

Gauteng	Northern Cape	North West Province
Western Cape	KwaZulu-Natal	Mpumalanga
Eastern Cape	Limpopo	Free State

Area / Town *

Please indicate which Raizcorp office you are closest to *

Company Name *

Is this your only business? *

Yes

No

What is the nature of your business? *

Average monthly turnover for the last 6 months *

R20 000 - R60 000

R60 000 - R100 000

R100 000 - R500 000

More than R500 000

Less than R20 000

Years in Business *

Less than 1 year

1 to 3 years

3 to 5 years

More than 5 years

*

I understand that this information will be verified and companies that do not pass this verification will not be eligible to reapply to join any Raizcorp programme for 12 months after submission.

Please add me to the Raizcorp mailing list *

Yes

No

Staff

Do you have other staff (other than yourself)? *

Yes

No

How may permanent staff?

How may temporary staff?

How may contract staff?

Partners / Shareholders

Do you have partners? *

Yes

No

Partner shareholding 🛈

	Name	Shareholding	Contact Number
Partner One	Name	Shareholding	Contact Number
Partner Two	Name	Shareholding	Contact Number
Partner Three	Name	Shareholding	Contact Number
Partner Four	Name	Shareholding	Contact Number

Raizcorp Questions

In what way do you believe a development programme could assist your business? *

What has been the biggest obstacle to getting your business to where you would have ideally wanted it by now? *

Do you think you are an entrepreneur? *

Yes

No

If yes, please elaborate

Do you regard yourself as someone who has the ability to share? *

Yes

No

Please feel free to make any other coments

Please read and confirm the following statements:

*

I understand that Raizcorp does not work with companies that have NOT yet traded.

I understand that Raizcorp does not provide funding for my business

Pty	CC
Sole Proprietor	Co-op
NGO	Other

Expression of Interest (EOI)

Company Information

Staff

Partners / Shareholders

Raizcorp Questions