Section A

124 Main Street Marshalltown
Johannesburg

GEP Contact Center:
087 057 2000
enquiries@gep.co.za

Step 1

Section A

Step 2

Section B & C

Step 3

Section D

Step 4

Section E

Purchase Order Funding Form

Please fill out the following form. You will receive an email notifying you that we have received your submission.

Should you not be satisfied or experience any technical glitches, kindly escalate to: mpillay@gep.co.za.

Section A

PERSONAL INFORMATION

Title

Surname

First Name

Race Classification

Additional Information

None Youth

Woman Disabled

ID Number

Citizenship

Date of Birth

ADDRESS DETAILS

Residential Address

Postal Address

How long at present address

Residential property is

Owned

Rented

Was previous residence

Owned

Rented

APPLICANT CONTACT DETAILS

Cellphone

Telephone (Business)

Fax

Telephone (Home)

Marital status

Married

Single

Divorced

Other

NEXT OF KIN DETAILS

Name of next of kin

Cellphone

Telephone

ACADEMIC DETAILS

Highest academic qualification obtained

Institution

Date

EMPLOYMENT HISTORY

Details of career history

Employer/Business

From

Type of work

Last Position

Annual Income

FINANCE DETAILS

Please state required finance amount

Please state any relevant experience related to the business for which finance is sought

In what capacity will you be employed in the business?

Do you have an interest in any other business?

Have you applied for financial assistance or loan from any Developmental Finance Institution?

Please state the type of Developmental Finance Institution

SEFA

SEDA

Department of Small Businesses Development

IDC

DBSA

Other

MARKETING

Where did you hear about GEP?

TV/Radio

Newspaper/Magazine

Word of Mouth

Billboards

Other Signage

Other

Please specify (if Other)

Reference No (if applicable)

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