The award aims to recognise and promote community projects that are part of

Government’s strategic interventions in poverty alleviation. The award targets

emerging co-operatives, which operate in any sector of the economy within a rural

community. The award also focuses on the creation of sustainable job opportunities.

Co-operatives, entities, individuals, NGOs or NPOs quality for entry if they operate in

rural communities and if they contribute towards poverty alleviation by initiating

projects for the economic benefit of the community.

Name of Company/Organisation      

Business address      

Tax Clearance Certificate: (Verified)      Co-operative / NGO / NPO registration (Verified)

     

Owners/Directors /members: (Names on attachment)

     

Rural area(s) of operation      In the case of co-operatives, does the entity comply with the Co-operative Act, No.14 of 2005, particularly in the areas of governance and returns to the Registrar of Co-operatives? Please comment and provide evidence

     

Brief Product/ Service description:      

Contact Name      

Contact Number (cell and landline)      

Contact email address      

Based on a 3 year operating period – 1 Jan 2011 to 31 Dec 2013

Criteria Information required Information requiredProject Name Primary aim Sponsors

*Please provide supportive documentation

                 

Job creation Number of employees Percentageincrease/decrease*Please provide supportive documentation

Year 1: 2011            Year 2: 2012            Year 3: 2013            Poverty alleviation Number of people Percentage

increase/decrease*Please provide supportive documentation

Year 1: 2011            Year 2: 2012            Year 3: 2013            Does the company have a proven track record with creating job opportunities in rural areas?

Does the co-operative or project involve women, youth and/or people with disabilities?

Does the co-operative produce quality goods and services?*Please provide supportive documentation

                 Does the co-operative or entity demonstrate growth (in terms of employment and market share) and future sustainability?*Please provide supportive documentation

Please indicate measures to ensure sustainability in future.*Please provide supportive documentation

           

Play Your Part AwardIn addition to the above Award category, the Play Your Part Award celebrates enterprises that

excel in displaying active citizenship and nation building in South Africa.

The objective of the Award is to lift the spirit of our nation by inspiring all South Africans to contribute towards positive change.

Criteria Information required Information requiredHow has your enterprise played a part in community

Describe innovative community project(s) you

How did the project add value to the community?*Please provide supportive

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upliftment? were involved in documentation

                 

How has your enterprise been involved with youth development / empowerment projects and programmes?

State youth projects and programmes you have been involved with

How did the project or program impact on youth?*Please provide supportive documentation

                 Has your enterprise upheld values that build the community and nation?

Please share values that have been practised within your enterprise and community

           

I have read and agree to abide by the rules and regulations as stipulated in the criteria, entry rules and terms and conditions for the South African Premier Business Awards 2013/14. I declare that all the information supplied by me is true and correct.

Name & Surname:      

Designation:      

Signature:      

Date:      

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