BROAD-BASED BLACK ECONOMIC EMPOWERMENT COMMISSION

FORM: B-BBEE 10

NOTICE TO INVESTIGATE COMPLAINT

(in terms of Section 13J of the Act)

Name of entity:

Address:

Date:

CONCERNING:

PLEASE TAKE NOTICE that on the                                                       , the complainant                                                filed a complaint against the entity named above.

The Broad-Based Economic Empowerment Commission intends to conduct an investigation in terms of Section 13J of the Broad-Based Black Empowerment Act.

The investigation may include an on-site visit to the entity, any other related entities and interviews of parties concern.

THE COMMISSION

I acknowledge receipt of the notification from the Broad-Based Black Economic Empowerment Commission, to conduct an investigation on the above mentioned entity.

Signature of an authorised person: