Broad-Based Black Economic Empowerment Act, 2003 (Act No. 53 of 2003)

Regulations

Purchase

BROAD-BASED BLACK ECONOMIC EMPOWERMENT COMMISSION

FORM: B-BBEE 1

COMPLIANCE REPORT BY SPHERE OF GOVERNMENT, PUBLIC ENTITIES, ORGANS OF STATE OR COMPANY LISTED ON THE JOHANNESBURG STOCK EXCHANGE

(in terms of Section 13G(1) and 13G(2) of the Act)

SECTION A: DETAILS OF ENTITY

Name of Entity/Organisation

Registration number:

Physical address:

Telephone number:

Email address:

Indicate Type of Entity/Organisation:

Industry/Sector:

Relevant Code of Good Practice:

Name of verification agency:

Name of Technical Signatory:

SECTION B: INFORMATION AS VERIFIED BY THE BROAD-BASED BLACK ECONOMIC EMPOWERMENT VERIFICATION PREOFESSIONAL AS PER SCORECARDS

B-BBEE Elements	Target Score Including	Bonus Points	Actual Score Achieved
Ownership	e.g. 25 points
Management Control	e.g. 19 points
Skills Development	e.g. 20 points
Enterprise and Supplier Development	e.g. 40 points
Socio Economic Development	e.g. 5 points
Total Score	e.g. 109 points
Priority Elements Achieved	YES/NO and specify them
Empowering Supplier Status	YES/NO and specify them
Final B-BBEE Status Level

*indicate how each element contributes to the outcome of the scorecard

SECTION C: FINANCIAL REPORT

1.	BASIC ACCOUNTING DETAILS:

•	Accounting officer's name:

•

Address:

•	Accounting policy: (are your accounts done weekly, monthly, other: specify)

•	Has the attached financial statements and annual report been approved by the entity?

2.	PLEASE ATTACH THE FOLLOWING:

(i)	COPY OF ANNUAL FINANCIAL STATEMENT INCLUDING BALANCE SHEET AND INCOME AND EXPENDITURE REPORT

(ii)	ANNUAL REPORT

Entity Annual Turnover: