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We, the undersigned, do hereby apply for registration as an applicator for Cemcrete products.

We agree to offer our co-operation in the activities of CEMCRETE to further its objectives.

We further agree to abide by the statutory requirements of the Republic of South Africa particularly as it pertains to the CONSUMER PROTECTION ACT.

We accept that Cemcrete reserves their rights to contact clients for quality control purposes from time to time without prior notice.

FEES:

This is a free Cemcrete service designed to ease the communications between prospective clients and our Applicators. No leads will be sent to Applicators that are not registered.

COMPANY NAME :
FORM OF COMPANY :
COMPANY REGISTRATION NUMBER :
POSTAL ADDRESS :
Address 2 :
Address 3 :
STREET ADDRESS :
Address 2 :
Address 3 :
TELEPHONE :
CELLULAR :
FACSIMILE NO :
E-MAIL ADDRESS :
WEB ADDRESS :
 
NAMES OF DIRECTORS / MEMBERS / SOLE PROPRIETOR OF COMPANY
1 : ID No :
2 : ID No :
3 : ID No :
4 : ID No :
Number of years the company has been contracting or has applied Cemcrete products :
years
Details of types of application and preferred products: (walls, floors, swimming pools, other) :
WE WISH TO RECEIVE LEADS FOR THE FOLLOWING PROVINCES/AREAS :
NUMBER OF PERMANENT EMPLOYEES : No
OUR COMPANY IS COVERED UNDER :
(a) Workman's Compensation Act :
/
Policy No :
(b) Unemployment Insurance Act :
/
Reference No :
(c) Public Liability Insurance :
/
Policy No :
(d) SARS Registration :
/
Registration No :
OUR COMPANY IS A MEMBER OF:
(a) Building Industrial Council :
/
Reference No :
Number of Employees registered with the Building Industrial Council No.
(b) Master Builder's Association :
/
Number of years a member : years
References:
Please provide contactable references where work has been done within the last 12 months - either Cemcrete applications or general contracting. Include the type of work done:
(1)
Name:
 
Address:
 
Tel No:
Type:
(2)
Name:
 
Address:
 
Tel No:
Type:
(3)
Name:
 
Address:
 
Tel No:
Type:
(4)
Name:
 
Address:
 
Tel No:
Type:
(5)
Name:
 
Address:
 
Tel No:
Type:
Notes:
indemnity