Please complete each of the four sections below:
Section 1:
Partner Company Details
Legal Entity Type (please tick):*
Partner Company Name: * Partner Company Trading Name:
Partner Company Registration Number: Partner Company VAT Number:
Physical Address Line 1 * Physical Address Line 2
City* Zip/Postal Code *
Province * Country *
Postal Address Same As Above?
Postal Address Line 1 * Postal Address Line 2
City * Zip/Postal Code *
Province * Country *
Telephone Numbers (Including Area Code)*
MPN ID No: E-Mail Address*
MPN ID Expiry Date
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Estimated Monthly Credit Limit * Credit Terms *
Holding Company Name Percentage Share Holding
Name of Auditors/Accounting Officer Street Address of Auditors
Telephone Number (Include Area Code) Date of Last Audited Financial Statement
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Please Supply Minimum Two Trade References: *
Details of Principals (Sole Owner / Directors) *
Section 2:
Partner Company Banking Details
Name of Account Holder*
Bank* Branch*
Account Number* Branch Code*
Type of Account* Date Account Opened *
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Section 3:
Additional Contact Information
Person Responsible for Account Payment:* Telephone Number*
Mobile Number* E-Mail Address*
Technical Contact Name & Surname: Mobile Number:
E-Mail Address:
Section 4:
Supporting Documentation
Please attach the relevant supporting documentation below. Please note that all requirements with an asterisk are mandatory
Upload Identity Documents of Directors * (1MB MAX) Upload Company Registration Documents (1MB MAX)
Upload VAT Registration Documents (1MB MAX) Upload Company Letterhead (1MB MAX)
Upload Proof of Banking * (1MB MAX) B-BBEE Certificate/Affidavit (1MB MAX)

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