SHELL FRANCHISE EXPO ONLINE SOUTH AFRICA RETAIL
APPLICATION FORM
A.
PERSONAL DETAILS:
Surname : ………………………………………………………………………………
First names in full : …………………………………………………………………….
Identity no:
……………………………………...................................................
Are you a RSA Citizen: Yes ( ) No ( )
Gender: Male ( ) Female ( )
Race: Black African ( ); Coloured ( ); Indian ( ); White ( ); Asian
Age:
Physical Address:
City/ Town of residence:………………………….
Province: ………………………..
Are you prepared to relocate: Yes ( ); No ( )
Telephone no: Home :………………………………..............................
Cell: ………………………………………………………….
E-mail address: …………………………………….......................
B BUSINESS EXPERIENCE:
List your educational and professional qualifications:
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Previous Work/Business experience: …………………………………….
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Current Occupation
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Do you have any existing condition, commitments or interests that Shell needs to be aware of
before entering into this agreement.by Shell?
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YES/NO
If yes, give details ………………………………………………………
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D
FUNDING:
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Are you prepared to contribute at least 10% of capital into the business?
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Have you ever been declared insolvent? Yes ( ); No ( )
Have you ever been convicted of a criminal offence ? If so, please give details and
outcomes………………………………
Are you prepared to work a 6 or 7 day week if necessary Yes ( ); No ( )
Kindly motivate why you think you are a suitable candidate for this franchise offer and why you believe
you can successfully operate a Shell Retail Site ?
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DECLARATION:
I …………………………………………………………….ID No ………………………………………
hereby certify that to the best of my knowledge, all information given by me in this application is true
and correct. I further acknowledge that any information I may have received from Shell in regards to this
application, particularly in regard to intended sales, volumes, turnover and/or site profitability, is not
information that I have relied upon in, or has induced me into, making this application. I further confirm
that no such information constitutes a representation, warranty or guarantee by Shell as to its accuracy or
correctness.
SIGNED AT ………………………………………… ………………………………….
ON THIS ……………………DAY OF …………………………..……………… 2014
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