Rebuild Together Application to Receive Support

Thank you for choosing us as your partner in rebuilding your business. Our approach is a straightforward one; we want to get as many small and growing businesses back on their feet as quickly as possible. We want to champion and drive shared value in communities, and we want to be part of the solution for gross inequality and unemployment in our country. Our strength has always been in building sustainable small businesses, and this has not changed. That’s why we believe that to rebuild our economy effectively, we must start with you, the entrepreneur. If you are interested in receiving support in the form of funding, equipment, business development or access to markets as a result of the recent looting, complete the form below. Please note: The Information you provide in this form will be treated in the strictest confidence. It will not be disclosed to any third party. ETTP reserves the right to request additional information documents or to perform audit procedures to substantiate or verify any of the answers provided on this application form.

Name & surname of Applicant

Name of Company

Registration Number

Core Services

Cellphone Number

Company Primary Email Address

Region

Company Residential Address

% Black Owned

Name & Surname - Contact 1

ID Number - Contact 1

Gender - Contact 1

Cellphone Number - Contact 1

Email Address - Contact 1

Residential Address - Contact 1

Name & Surname - Contact 2

ID Number - Contact 2

Gender - Contact 2

Cellphone Number - Contact 2

Email Address - Contact 2

Residential Address - Contact 2

Number of shareholder/s

Applicant's ID Number

Business aspect affected by riots

Further description of affected business aspect/s

Please provide a detailed breakdown of the affected business aspects in Rand value.

What type of support do you require?

Further description of required support.

Explain why you require the specific support. (less than 200 words)

Upload BBBEE Certificate/Affidavit and CIPC Document

Drop your files here

Consent Background Check

By Checking this box you consent to ETTP doing a background check on you and your business.

Consent - Marketing Information

By checking this box you give ETTP the permission to share marketing material with you.

Declaration

By checking this box you declare that the information provided in this application form is entirely true.

Send me a copy of my responses

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