Tshimologong Membership Online Application Form
First Name *
Your answer
Last name *
Your answer
Cell Number *
Your answer
Email *
Your answer
Please indicate your positioning in the company *
Company Name *
Your answer
Confirm Company Name *
Your answer
Describe your business paying special attention to how technology is applied in your business. Include links to websites or social media sites where relevant. *
Describe your business fully in 50 words
Your answer
Date the business was started *
MM
/
DD
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YYYY
What sector does your business primarily operate in? *
At what stage is your business? *
How is the business registered? *
Please indicate your BEE status
State the total number of full-time employees you currently employ *
This excludes yourself and other founders of the company
Your answer
State the total number of part-time employees you currently employ *
This excludes yourself and other founders of the company
Your answer
Average monthly turnover for the last 12 months *
Your answer
Average monthly profit for the last 12 months *
Your answer
How much funding has your business received to date? *
Your answer
Has your business partaken in any competitions or hackathons? Please elaborate. *
Please provide the name of the competition or the hackathon and whether you received any awards or honourable mentions.
Your answer
How did you find out about Tshimologong? *
Your answer
I authorise that the Responsible Party (as defined in the Protection of Personal Information Act, 2013, “POPI Act”) to store my relevant information and documentation. And I hereby authorise Tshimologong to capture my personal information and biometric details and to make my name, surname, biometric details, identity number and other relevant information available to create benchmarking reports for the applicant and Tshimologong and Tshimologong’s designated partners and to create anonymised annual reports which will focus on industry learning lessons but with no attributions. This personal information will not be shared with any third parties without my specific approval and will not be sold, distributed or leased to third parties unless you have my permission or are required by law to do so. *
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