You have real business experience and knowledge? You can manage a team and cope well under pressure? To become a dealer please get in touch. You must have JavaScript enabled to use this form. Name of site Province PERSONAL DETAILS Citizenship South Africa Namibia Botswana Lesotho Swaziland Angola Malawi Zambia Zimbabwe Mozambique Other First Name Surname Physical address Postal address Email What is your current job position Do you give permission for Total South Africa to perform a credit check? * Yes No CONTACT DETAILS Telephone number (Home) Telephone number (Work) Cellphone number Fax number South Africa ID number Attach a certified SA ID copy Click to upload or drag and drop Upload One file only.2 MB limit.Allowed types: jpg jpeg png pdf. Do you have the support of your immediate family? Are you prepared to accept long and irregular working hours? EDUCATIONS AND QUALIFICATIONS Name of high school Date attended Name University/College Graduation Date Other qualifications Attach Certificates Click to upload or drag and drop Upload One file only.2 MB limit.Allowed types: jpg jpeg png pdf. EMPLOYMENT/ WORK HISTORY Current employer If you are self employed, please describe the nature of your business Address Position/ title Current Salary (per annum) Annual bonus Other company benefits Previous employment Employers name Address. Previous position/ title Date commenced Date resigned Main responsibilities Do you have experience in the following areas? Handling Cash Yes No Staff management and Recruitment Yes No Analyzing cash flow Yes No Stock control Yes No Retail/ selling to the public Yes No Working with financial statement Yes No Working on weekends Yes No FINANCIAL INFORMATION What are your prime business objectives for applying for this Service Station? How much of your own capital do you intend to invest in the business? Attach proof of own capital contribution Click to upload or drag and drop Upload One file only.2 MB limit.Allowed types: jpg jpeg png pdf docx. From which source? What annual income are you expecting to earn? How many hours per day are you willing to spend at the service station? Will you be involved in other business ventures? If so, elaborate? Should your application for a TSA Dealership be unsuccessful, what are your future plans? Have you or you spouse been involved in bankruptcy and insolvency proceedings? If yes, give full details Have you or spouse ever had a judgement in respect of bad debt recorded against you? If yes, please provide full details Please provide the following Financial infromation Annual wage/ Salary after tax Annual bonus/ commision Annual dividends Annual property income Other annual income (Details) Total annual income Annual monthly bonds/rent repayments Annual monthly loan repayments Other annual repayments (Details) Total annual present expenditure Assets Cash in the bank Shares/ Investments Properties Motor vehicles Business value (If any) Other assets Liabilities Overdraft Total Creditors Total bond outstanding Hire purchases, lease repayments Other liabilities REFERENCES Please provide details of a business/work reference Name Job title Company name Address Contact numbers GENERAL INFORMATION Drivers licence Do you hold a valid South African drivers licence? Yes No if yes, please attached a copy Click to upload or drag and drop Upload One file only.2 MB limit.Allowed types: gif jpg jpeg png pdf doc docx. Criminal record Do you have any criminal records Yes No If yes, please provide full details Attach CIPC company documents Click to upload or drag and drop Upload One file only.2 MB limit.Allowed types: gif jpg jpeg png pdf. Attach company tax clearance certificate/pin Click to upload or drag and drop Upload One file only.2 MB limit.Allowed types: gif jpg jpeg png pdf. Attach updated resume/CV Click to upload or drag and drop Upload One file only.2 MB limit.Allowed types: gif jpg jpeg png pdf doc docx. Additional document Click to upload or drag and drop Upload One file only.2 MB limit.Allowed types: gif jpg jpeg png pdf doc docx xls xlsx. Additional document 2 Click to upload or drag and drop Upload One file only.2 MB limit.Allowed types: gif jpg jpeg png pdf doc docx xls xlsx. Additional document 3 Click to upload or drag and drop Upload One file only.2 MB limit.Allowed types: gif jpg jpeg png pdf doc docx xls xlsx. Commencement date Submit Working in our stations Working in our petrol stations Join us
