REGISTRATION AS AN EMPLOYER / CONTRACTOR IN THE ELECTRICAL INDUSTRY REGISTRATION DETAILS:Commencement date of business Date of registration with the NBCEI Employer Business Name: Trading As Business Name: Company Registration NO: PLEASE MARK THE CHECKBOX IN THE APPROPRIATE BLOCK AND GIVE THE RELEVANT DETAILSTEMPORARY EMPLOYMENT SERVICE (LABOUR BROKER)(Required)TEMPORARY EMPLOYMENT SERVICE (LABOUR BROKER)YesNoSELECT THE RELEVANT FIELD SOLE PROPRIETOR PARTNERSHIP COMPANY CLOSE CORPORATION FICA DOCUMENTATION REQUIRED:In terms of the Financial Intelligence Centre Act 38 of 2001 (FICA) and the Financial Sector Conduct Authority (FSCA), certain documentation and information is / are required. The information / documentation supplied will only be used as contemplated in terms of these Acts. All forms are to be completed and signed by the:- Director(s) / Member(s) / Trustee(s) / Partners or Sole Proprietor of the business. • Should the form be completed / signed by any other person other than the above, the Director(s) / Member(s) / Trustee(s) / Partners or Sole Proprietor of the business must issue a letter authorising the person to sign on behalf of the company. The ID document of this person must also be submitted. Certified Identity document/s of the Director(s) / Member(s) / Trustee(s) / Partners or Sole Proprietor of the business must be attached with the completed documents. PLEASE NOTE THAT SHOULD YOU BE SUBMITTING A COPY OF THE SMARTCARD ID, BOTH SIDES ARE TO BE COPIED. If registered as a Company / Close Corporation / Trust, the relevant registration documents, certificates as well as the Memorandum of Incorporation must be attached. n the event the business changes their name or changes from a Close Corporation to a Company, the Certificate of Name Change must be attached. Proof of physical and residential address to be attached. Proof of company banking details i.e. bank confirmation letter to be attached. SARS issued document confirming Income Tax and VAT registration numbers. Letter from Auditors confirming shareholding, if applicable All of the above documentation may not be older than three (3) months. Annual updates and changes to Personal and or Company information The employer shall be responsible to immediately provide to the Council (inclusive of the applicable supporting documentation), any changes to personal, personnel and or company information. In addition, the employer shall be responsible to provide an annual update in January of each year, all company, personal and personnel information, as required by the Council, to ensure its records are accurate and up to date in compliance with legislative requirements.COMPANY CONTACT DETAILS: Business Tel No:Cell No:Alt Cell No.:E mail address Physical Address Street Address Address Line 2 City Province ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Postal Address Street Address Address Line 2 City Province ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PROTECTION OF PERSONAL INFORMATION ACT (POPIA) PRIVACY NOTICE: The Council respects the confidentiality of your personal information as well as your privacy. The information provided to the Council is strictly confidential and will only be used for its intended purpose to fulfil its legal obligations. The Council will only process and share your and your employees’ personal information for lawful purposes, required in the execution of its legal duties to administer and enforce its collective agreements, in conjunction with the Labour Relations Act, the Pension Funds Act and the Financial Intelligence Centre Act (FICA).COMPANY BANKING DETAILS: Bank: Branch Code: Account Name: Account Number: Type of account: a) I declare that I am registered with the following institutions AND attach proof thereof:SARS Reg No: VAT Reg No: (if applicable) UIF Reg No COIDA Reg No Registration as an Electrical Contractor (D.O.L) Registered Person Licence No (A registered person is an Electrical Tester for Single Phase, installation Electrician or Master Electrician)b) I am/am not currently registered with the above mentioned institutions, but undertake to register within 30 days. c) If I fail to register with the above institutions, the Council may forward my information to all relevant institutions.Authorised SignatoryDate MM slash DD slash YYYY Δ