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Corporate Affairs Department
P.O Box 10, Isando, 1600
Tel: 011 571 1000
(Includes East & West Rand, Johannesburg central)
Corporate Affairs Department
P.O Box 274, Bloemfontein, 9300
Tel: 086 172 2256
(Includes Free State, Northern Cape, North West)
KickStart Alumini Registration Form
Only fully completed Forms will be accepted
Step 1
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Step 2
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Step 3
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Step 4
Team Leader's Details
Title:
Mr
Mrs
Miss
Dr
Prof
First Name:
Surname:
Email:
Re-type Email:
Password:
Re-type Password:
Website:
Physical Address:
City:
Region:
Egoli Region
East Cost
North
Western Cape
Eastern Cape
Central
Province:
Code:
Postal Address:
City:
Province:
Code:
Age:
16
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Gender:
Male
Female
ID No:
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Race:
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Contact Details
Telephone No(W):
Telephone No(H):
Fax No:
Cell No:
Please call me on my:
Work No
Home No
Cell No
Best time to call me is between:
1:00
2:00
3:00
4:00
5:00
6:00
7:00
8:00
9:00
10:00
11:00
12:00
AM
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and
1:00
2:00
3:00
4:00
5:00
6:00
7:00
8:00
9:00
10:00
11:00
12:00
AM
PM
Please Send me mail via:
Email
Fax
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Business Team
Name
Qualification
Practical Experience
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Name:
Qualification:
Practical Experience:
Attach CV:
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Alumini
Business Name:
Business Registration No:
Annual Turnover:
No. of employees:
Business Description:
Industry / Sector:
Year Started:
Year Entered Competition:
Region Entered:
Regional Grant Winner:
No
Yes
If Yes, Amount won:
National Grant Winner:
No
Yes
If Yes, Amount won:
Save
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