SURNAME IDENTITY NAME & ADDRESS OF IN OTHER % OWNED TYPE OF BUSINESS OF & INITIALS NUMBER FIRM FIRM OTHER FIRM DECLARATION I, the undersigned hereby declare, in my capacity as and duly authorised thereto, that the information furnished is true and correct and I hereby indemnify the South African NRCS from any loss and/or damages howsoever caused that I or any other party may suffer as a result of the said information being incorrect. DULY AUTHORISED TO SIGN FOR AND ON BEHALF OF ENTERPRISE/ORGANISATION: Name: Signature: Date: Telephone Address:
SURNAME & INITIALS IDENTITY NUMBER NAME & ADDRESS OF FIRM IN OTHER FIRM % OWNED TYPE OF BUSINESS OF OTHER FIRM DECLARATION I, the undersigned hereby declare, in my capacity as and duly authorised thereto, that the information furnished is true and correct and I hereby indemnify the South African NRCS from any loss and/or damages howsoever caused that I or any other party may suffer as a result of the said information being incorrect. DULY AUTHORISED TO SIGN FOR AND ON BEHALF OF ENTERPRISE/ORGANISATION: Name: Signature: Date: Telephone Address:
SHAREPOINT%20SBD%20FORMS-%2028%20NOVEMBER%202017.docx