1. The contents of this statement are to the best of my knowledge a true reflection of the facts.
2. I am a Director of the following enterprise and am duly authorised to act on its behalf:
Enterprise Name:
Trading Name (If
Applicable):
Registration Number:
Enterprise Physical
Type of Entity (NPO,
Nature of Business:
Definition of “Black
As per the Broad-Based Black Economic Empowerment Act 53 of 2003 as
Amended by Act No 46 of 2013 “Black People” is a generic term which
means Africans, Coloureds and Indians –
(a) Who are citizens of the Republic of South Africa by birth or descent;
(b) Who became citizens of the Republic of South Africa by
naturalization-
Before 27 April 1994; or
On or after 27 April 1994 and who would have been
entitled to acquire citizenship by naturalization prior to that
3. I hereby declare under Oath that:
The Enterprise has ______________% Black Beneficiaries as per Amended Code Series 100
of the Amended Codes of Good Practice issued under section 9 (1) of B-BBEE Act No 53 of
2003 as Amended by Act No 46 of 2013,
The Enterprise has ______________% Black Woman Beneficiaries as per Amended Code
Series 100 of the Amended Codes of Good Practice issued under section 9 (1) of B-BBEE Act
No 53 of 2003 as Amended by Act No 46 of 2013,
The Enterprise has ______________% Black Designated Group Beneficiaries as per
Amended Code Series 100 of the Amended Codes of Good Practice issued under section 9
(1) of B-BBEE Act No 53 of 2003 as Amended by Act No 46 of 2013,
Based on the Financial Statements/Management Accounts and other information available on
the latest financial year-end of _________________, the annual Total Revenue/Allocated
Budget/Gross Receipts was R10,000,000.00 (Ten Million Rands) or less
Parent category: Legal
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