Samsung EEIP Enterprise Development Program

Samsung, in collaboration with the Department of Trade, Industry and Competition (“Dtic”), hereby invites black owned South African

Mobile and Consumer Electronics Repair

to submit an application to participate in Samsung's Enterprise Development (ED) Program under the Equity Equivalent Investment Program.

The objective is to target black owned and black women owned high potential small enterprises in the ICT industry as described above.

For assistance with the form or application process please email ssa.eeip@samsung.com

All fields marked (*) are mandatory
Terms and conditions apply

First Name of Contact *

Last Name of Contact *

Email Address *

Gender of majority shareholder(s) *

Mobile Number *

Physical address of the enterprise *

Province*

City *

Postal Code *

Enterprise Name *

CIPC Registration Number *

VAT Registration Number (If not registered, please insert a “0”) *

Race of majority shareholder(s) *

Provincial location of business operations *

Shareholder details 1 *

Shareholder details 2

Shareholder details 3

Shareholder details 4

Shareholder details 5

How many years’ experience do you have in your industry? *

Are your company registered and classified as South-African? *

Are you a South African Citizen? *

What is your approximate annual revenue? *

Please enter latest annual revenue figure from AFS or Management Accounts *

Please select the size of your business *

Please select your BEE Level *

Please select your Black Ownership % *

Please select your Black Woman Ownership % *

Please select your Black Youth Ownership % (less than 35 years of age) *

Are you a supplier, partner, program beneficiary or have been doing business with Samsung over the last 5 years? *

If yes, kindly explain the relationship here

Are you aware of any conflict of interest that will affect your application? *

If yes, kindly explain here

Document checklist - please submit the following documents to the following e-mail address: ssa.eeip@samsung.com

Company registration document

VAT registration document (if applicable)

SARS Clearance Certificate or Letter of Good Standing

Company’s organizational structure

Last 2 years audited Annual Financial Statements or Management Accounts

B-BBEE Certificate and or valid Affidavit

Company profile and business overview

Office/Landline number *

I have read and agree to the terms & conditions also by completing and submitting this form I hereby confirm and/or declare that the information and details provided are both true and correct*

I have read and agreed to the Samsung's Privacy Policy *

I accept that Samsung will share my details with a 3rd party for the purpose of concluding submission review *