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BEE
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EMPOryERED
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B-BBEE COMPLIANCE AFFIDAVIT
ENTITY:
B-BBEE SCORE:
B-BBEE PROCUREMENT LEVEL:
BLACK BENEFICIARIES:
BLACK FEMALE BENEFICIARIES:
EMPOWERING SUPPLIER:
SCORECARD APPLIED:
FINANCIAL YEAR ENDING:
EFFECTIVE DATE:
EXPIRY DATE:
DEPONENT:
SIGNED:
NAME OF DEPONENT:
IDENTITY NUMBER:
DESIGNATION:
DATE:
I hereby declare, under oath, the following:
c I am a duly authorised representative of the entity with physical address as listed above
. The annual turnover for the financial period, Iisted above, is /ess fhan R10 000 000
t I know and understand the contents of this affidavit and I have no objection to take the prescribed oath and consider
the oath binding on my conscience and on the owners of the enterprise which I represent in this matter.
c I am aware that any misrepresentation herein constitutes a criilnd offence as sef ouf in the B-BBEE Act as amended.
COMMISSIONER OF OATHS:
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RE F N O : BEE/C510522115 (Version -01)
HALLI TRUST
(Co Reg No: 086-574-NPO)
17 Romulus Street, Rome Glen
Somerset West
7130
LevelOne B-BBEE Recognition Level
135o/o
750h
75o/o
Yes
Exempt Micro Enterprise -
Amended Codes of Good Practice
28 February 2015
27 August 2015
26 August 2016
SIGNED:
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lifu&rocE oF s
CAPACITY OF
COMMISSIONER:
DATE:
qer-ser. l*S
T: +27 21