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Membership Application Form: IMPORTANT - Read First
Membership Application Form: IMPORTANT - Read First
Membership Application Form: IMPORTANT - Read First
PLEASE POST, FAX, E-MAIL OR DELIVER THIS FORM TO THE PROUDLY SOUTH AFRICAN
MEMBERSHIP DEPARTMENT
Application received on (day, month year) _________________________________ Delivered by Fax Post Hand
____________________________________________________________________________
1. COMPANY IDENTITY:
Name of Company/ Organisation:
Trading Name:
Start-up Date: Y Y Y Y M M D D
Certificate of registration /
Company Registration Number incorporation
If your company is owned by another company or Group, please give the name of that Company of Group:
___________________________________________________________________________________________________
2. TYPE OF ORGANISATION:
PYHYSICAL
ADDRESS:
Postal Code
POSTAL
ADDRESS:
Postal Code
BUSINESS TELEPHONE:
FAX:
WEBSITE:
E-MAIL:
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MEMBERSHIP APPLICATION FORM JUNE 2010
3. TYPE OF BUSINESS:
Please enter the Industry Sector and Sub-sector in which your organisation operates. Pease consult the chart of industry Sectors
referred to in Section 8 of this form for assistance in your selection.
INDUSTRY SECTOR:
DESCRIPTION________________________________________________________________________CODE___________
(If you cannot find a match, please enter a description of your own)
INDUSTRY SUB-SECTOR:
DESCRIPTION________________________________________________________________________CODE____________
(If you cannot find a match, please enter a description of your own)
4. SUMMARY DESCRIPTION
Please provide information of your organisation under the following headings:
4(a) Ownership of your organisation: *Please attach a complete table separately in the event of additional shareholders
Name: _________________________________________________________
Surname: _________________________________________________________ %
YES NO
4(b) Shareholders:
Name: __________________________________________________
Surname: __________________________________________________ %
4(d) Please give a description of your organisation’s customer base: (Provide us with at least 4 customers you engage with
regularly:
Customer Service Provided Product Produced / Customer
Supplied Contact
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MEMBERSHIP APPLICATION FORM JUNE 2010
This person want to receive communications on the following (please indicate one or more)
Marketing CEO/ Communications Billing
____________________________________________________________________________
PRODUCTS:
1. If you manufacture / fabricate physical products which will carry the Proudly South African logo, you shall list each one here. Please
include a complete list of products/services, including details of all variants and pack sizes. IF THE LIST IS TOO LARGE TO FIT ON
THIS SHEET, ATTACH IT TO THIS APPLLICATION SEPERATELY.
2. For services/product to qualify for endorsement with the Proudly South African logo, a minimum of 50% of the cost of those products
must be made up of materials, components and labour of South African origin.
3. DO NOT LIST IMPORTED PRODUCTS – They may not carry the Proudly South African logo.
SERVICES:
1. If you provide services/product which will be endorsed with the Proudly South African logo, you shall list each here. IF THE LIST IS
TOO LARGE TO FIT ON THIS PAGE, PLEASE ATTACH IT SEPERATELY TO THIS APPLICATION.
R
TOTAL TURNOVER OF LISTED PRODUCTS / SERVICES
Please Note: 1. All fees are based on the turnover reflected in Section 3 – fees are inclusive of vat
2. You will be invoiced for your annual membership, in full, once your application has been approved
3. Your membership will only be confirmed once payment is received
4. Members have an option to take (3) year membership (At discounted fee)
Business Membership – Products or Services………………………………………………………….R
Fee is based on 0.1 percent of annual sales to a maximum fee of R500 000.00. Minimum Fee R500.00
Churches ……………………………………………………………………………………………….....FREE
NGO, non-profit organisation, health……..……………………………………………………………R 500 per annum
Sports Teams……………………………………………………………………………………………….R 500 per annum
Local, provincial or national government departments……..………………………………...……R10 000 per annum
IMPORTANT GUIDLINES
It may be useful in fast tracking your membership application if you add comments which explains your ‘yes’ and ‘no’ answers. Answering ‘no’ does not automatically mean that your
application will be rejected. The questions and answers help to give total picture of your organisation on which base the direction. It will speed ease your application if you attach the
required information which will be relevant to any of the categories below and which may help us understand you business and make an informed decision. As list of the types of
documents we may want to see is provided, as a guide, in Section 7. It will be useful if you take a look at the list and forward the types of documents that will be useful in processing
you application.
1. PRODUCTS (MANUFACTURING)
Is at least 50% of the cost of your product/supplies made up of South African raw materials and components?
YES. Please verify this by providing a breakdown of your local content
ITEM OF LOCAL (Rand) ITEM SUPPLIER / SERVICE PROVIDER Please sign this declaration:
CONTENT OF SUPPLIED LIST WITH CONTACT NUMBER
COST
Raw Material / I confirm that the information provided
Parts with regard to the percentage local
content is correct and understand that my
Labour Staff organisation’s membership may be
cancelled if this information is found to
Outsourced be substantially incorrect.
Labour costs
Operational
Production Name Signature Date
Equipment
Marketing and Please provide any additional relevant
Advertising information regarding the local content of
your business and a list of preferred
Marketing and suppliers / outsourced companies utilised.
This will be taken into account when
Advertising
evaluating your application. These details
outsourced may be attached as separate pages. This
will support your application positively.
Other cost
TOTAL
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MEMBERSHIP APPLICATION FORM JUNE 2010
This is for one specific product (please specify product) we will review abovementioned product/ service list:
______________________________________________________________________________________________________
2. SERVICES (If your company product is a service i.e. auditing, legal etc complete this table)
Is at least 50% of the cost of your services/ service providers / outsourced entities made up of South African inputs?
TABLE 5B.1
YES NO
Are your products, services Copy of Membership Certificate including Membership Number
or Organisation accredited
or affiliated by a relevant Copy of Recognition / Membership Certificate
industry / regulatory
institute?
Has your product/s been Approved SABS Test Reports related to the item/ product tested
tested by the South African
Bureau of Standards of Third party test reports related to the material / item / product tested
Third Party Inspection
Institute? Surveillance reports where applicable
Are documented procedures established to ensure the Standard Operating Procedures or Work Instructions as per required
effective planning, operation and control of your processes? activities
Has an overall process flow chart of the business been Documented process flow diagram from receipt of customer
developed? requirements to delivery
Is an Organisational Chart available to identify responsibility Displayed Organisational Structure (Organogram) *This should link
and authority? with letter of appointments or employee contracts
Do you determine the necessary competence for personnel Documented Skills Development Plan
performing work affecting product/ service quality?
Have you established and implemented the inspections or Documented inspection procedures in conjunction with inspection
other activities that specified customer requirements are met reports
Please provide three bona fide written customer testimonials Three bona fide written customer satisfaction feedback
and contact numbers
The PSA campaign is not solely based on the fact that products are locally-made .The PSA campaign has made a pledge to consumers that all
products and services that carry the PSA logo are made by responsible companies who care about the environment and workers' rights.
1. Do you comply with all relevant local, regional, and national environmental legislation?
Has an Independent Environmental institute conducted Environmental Impact Assessment Report, including recommendations
any environmental impact assessments at your
premises?
Is your organisation ISO 14000:1996 Certified Approved ISO 14000:1996 Certificate by an accredited institute
rd
3 Party Certification
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MEMBERSHIP APPLICATION FORM JUNE 2010
Are there any possible environmental threats identified Internal Environmental Audits
as a result of your institutions activities, manufacturing
products and/or providing services. If there has been a
Preventive Maintenance Procedures
past occurrence, what controls have you implemented
to preventing such an occurrence?
Number of full time employees: Maximum number of casuals at any time: Independent Sales Agents:
2. KINDLY TICK WHICH OF THE FOLLOWING LABOUR LEGISLATION YOUR ORGANISATION COMPLIES WITH AND PROVIDE
US WITH COPIES OF THE DOCUMENTATION AS APPLICABLE
YES NO
Copy of work permits and Home Affairs approval, if employing foreign workers
Employment Equity Copy of Employment Equity Policy and last submitted return to the Department of
REQUIREMENTS
(over 50 employees)
____________________________________________________________________________
1. MANAGEMENT COMMITMENT
Management and staff of the applicant organisation will, at all times:
a) Support the aims and objectives of the Proudly South African campaign.
b) Obtain prior approval from Proudly South African for any use of the Proudly South African logo. (Not specified in this application)
c) Abide by the terms and conditions in the Code of Practise.
d) Whenever possible, increase the level of local content in the applicant organisation’s product and / or business activities.
e) Practise fair and responsible standards including compliance with all labour legislation.
f) Maintain and improve the quality of the applicant organisation’s activities, products and services.
g) Practise sensible environmental behaviour.
h) Help to promote the Proudly South African campaign to the applicant organisation’s staff, customers, suppliers and Stakeholders.
2. PROCUREMENT COMMITMENT
Management and staff of the applicant organisation will, at all times:
a) Give first preference to other Proudly South African companies when purchasing goods, materials and services required for the applicant
organisation’s activities.
b) Notify other Proudly South African members of such supply opportunities when they arise.
c) Wherever possible, purchase the materials, goods and services required for the applicant organisation’s activities from
Companies or suppliers operating in South Africa who use materials made in South Africa and labour which is South African.
d) Ensure that the applicant organisation’s buying and procurement policies and decisions reflect the applicant organisations commitment to the
Proudly South African campaign.
3. FURNISHING OF INFORMATION
Management of the applicant company agrees to furnish additional information, as may be required by the Proudly South African organisation, in
order for the Proudly South African to satisfy itself that the applicant organisation qualifies for membership. While
Proudly South African recognises the applicant organisation’s rights to withhold information it deems sensitive or private, failure to supply
information requested by Proudly South African may disqualify the applicant organisation from obtaining Proudly South
African membership and Proudly South African’s decision in this regard will be final.
4. COMPLIANCE CHECKING
Both before and after membership has been granted, Proudly South African may conduct certain compliance checks on member organisations.
The management of the applicant organisation agrees to provide full co-operation to Proudly South Africa or its representatives during the
process and conduct of these compliancy checks. Details of Proudly South African’s compliancy checks policy are available on request from
Proudly South African. It can also be viewed or downloaded from the Proudly South African web site.
Applicants operating in the Clothing and Textile Industry Members should please note the following: As imports of cheap raw materials, finished
products and poor labour practices are detrimental to the South African textile industry, the South African
Clothing and Textile Workers Union is concerned about the job losses in this sector. They would like to encourage job creation and will, as part of
the Proudly South African compliance check in this sector, approach management of the applicant company to ensure sound labour practice
copy of this questionnaire can be obtained from Proudly South African. It can also be viewed or downloaded from the Proudly South African web
site. Proudly South African cannot be held liable for defects, or inability of products to offer the purported performance and thus result in the
product or equipment being obsolete.
6. CANCELLATION
a) Proudly South African reserves the right to cancel any member organisation’s subscription at any time if compliance checks provide evidence
that the member organisation does not conform or is not operating in accordance with Proudly South African standards. In such a case any
refund of the subscription fee will be entirely at the discretion of Proudly South African.
b) The applicant organisation agrees in advance that , upon cancellation for any reason whatsoever, the member organisation will provide a
written confirmation to Proudly South African that the use of all Proudly South African materials and logos has ceased, or will cease to be used
within 30 days of the writing of the letter. In addition, the cancelled member organisation will return all unused materials to Proudly South African
at its own expense, including the current year’s membership certificate if that certificate’s period of validity is current.
7. DURATION OF MEMBERSHIP
a) Your membership will continue on an uninterrupted basis after the date of payment for 12 months (1yr). Your annual membership fee will be
invoiced to you when due.
I certify that the information supplied on this application is correct and agree that we will abide by all the terms and conditions
of membership as stated above.
____________________________________________________________________________
Signature of commitment from CEO, MD or other senior manager on both Service and
Product Models
List of preferred suppliers, service providers or outsourced entities utilised by the
Section 5 (A)
organisation
Local Content
Spreadsheet detailing what percentage of costs of production / service is incurred in
South Africa
Additional verification of local content percentages
Approved SABS Test reports related to the material / item / product tested
Third party test reports related to the material / item / product tested
Is your Organisation ISO 9001:2000 certified (Certificate + Audit Report)
Surveillance Assessment Reports where applicable
Section 5 (B.1)
Corrective Actions when applicable
Quality:
* Regulatory & Statutory ISO 9001: 2000 certificate
ISO 9001: 2000 Audit Report
Independent Institute Quality Audit Report
SETA Membership certificate including Membership Number
Industry Regulated Recognition / Membership certificate
Documented Quality Policy Statement signed by Top Management
Documented Quality / Business Objectives signed by Top Management
Completed Balance Score Card
Standard Operating Procedures or Work Instructions as per operational activities
Production / Service provision Verification checklists
Section 5 (B.2) Process flow diagram describing activities from receipt of customer requirements to
Quality: delivery of product / service.
* Your Company’s Internal Organisational Structure (Organogram) * This should link with letter of appointments
Quality Management System or employee contracts.
Skills Development Plan
Inspection procedure/s supported by inspection reports
Procedure for handling customer complaints
Customer Satisfaction Index (Percentage – overall customers
Three bona fide written customer satisfaction feedback letters & contact
INDUSTRIAL MANUFACTURING (1) Educational services (D) MEDIA PRODUCTION SERVICES (19)
Engines and parts (A) Educational products (E) Film, video and TV production (A)
Servicing of engines and motors (B) Educational projects (F) Production services (B)
Industrial equipment (C) Other education organisations (G) Reproduction and print (C)
Servicing and refurbishing (D) COMMUNITY ORGANISATIONS Signage (D)
Fuel, lubricants and detergents (E) AND PROJECTS (10) Promotional items (E)
CONSTRUCTION ENGINEERING REPRESENTATIVE Printers and screen printers (F)SPORT
AND ARCHITECTURE (2) ORGANISATIONS (11) (20)
Architecture and design (A) Trades unions (A) Sports teams (A)
Construction (B) Professional bodies and associations (B) Sports organisations (B)
Building and construction products (C) Industry associations (C) Sports products (C)
Building and construction services (D) PROFESSIONAL SERVICES (12) Sports events (D)
Engineering and related services (E) Training services (A) Sports other (E)
Electronic products and systems (F) Management and consulting services (B) CULTURE, ENTERTAINMENT,
MANUFACTURERS (3) Personnel and related services (C) MUSIC AND RECREATION (21)
Chemical (A) Legal and related services (D) Performing bodies (A)
Electrical appliances and equipment (B) Other services (E) Entertainment services (B)
Hand and machine tools (C) GOVERNMENT (13) Recording companies (C)
Plastic products (D) National government body (A) Events and productions (D)
Automotive, aviation, marine and rail Provincial government body (B) TRANSPORT AND LOGISTICS (22)
products (E) Local government body (C) Freight, couriers and logistics (A)
Furniture and fittings (F) Statutory body (D) Other services (B)
Glass products (G) Government project (E) TOURISM, TRAVEL AND
Cleaning equipment (H) FINANCIAL SERVICES (14) HOSPITALITY (23)
Board, paper and stationery products (I) Short term and life assurance (A) Air, road, sea and rail transport (A)
Packaging products (J) Accounting and auditing (B) Hotels and accommodation (B)
Safety and security products (K) Banking, securities and investments (C) Tour operators (C)
Pool and garden products (L) Professional and financial services (E) Agents and organisations (D)
Household appliances (M) INFORMATION TECHNOLOGY AND Destinations and attractions (E)
Fabrics and textiles (N) TELECOMMUNICATION (15) EXPORT AND TRADE (24)
Clothing and footwear (O) IT hardware (A) Trading companies and agents (A)
Household consumer products (P) IT software (B) SERVICES (25
CRAFTS AND HOME INDUSTRIES (4) General services (C) Household services (A)
MINING AND BENEFICIATION (5) Internet and web products and Personal services (B)
Mining - metals and jewellery (A) services (D) Office services (C)
Mining - other resources (B) IT solution products (E) UTILITIES AND MUNICIPAL
Mining equipment and services (C) Telecommunication services (F) SERVICES (26)
Jewellery manufacture (D) WHOLESALE AND RETAIL TRADE (16)
Jewellery retail (E) National general retail chains (A)
AGRICULTURE (6) Specialist chains (B)
Dairy produce (A) Independent retailers (C)
Livestock farming and processing (B) Restaurant chains and outlets (D)
Viticulture and wineries (C) Distribution agents (E)
Agricultural equipment (D) PROPERTY AND REAL ESTATE (17)
Agricultural services (E) Estate agents (A)
General farming (F) Property and management services (B)
Marine and aqua-culture (G) Other (C)
Agricultural products (H) MEDIA MARKETING AND
FOOD PRODUCTS (7) PUBLISHING (18)
Wholesale food products (A) Television media (A)
Retail food products (B) Radio media (B)
Beverage products (C) Newspapers (C)
Snack products (D) Magazines (D)
HEALTHCARE (8) Media services (E)
Over the counter health products (A) Advertising, marketing, design and PR
Scheduled pharmaceuticals (B) agencies (F)
Health and lifestyle services (C) Out-of-home advertising (G)
Medical and hospital products (D) Events, conference and exhibition
Medical and hospital services (E) services (H)
Veterinary products and services (F) Specialised media programmes and
EDUCATION, DEVELOPMENT AND projects (I)
TRAINING (9) Book publishers (J)
Pre-primary, primary and secondary
schools (A)
Private colleges (B)
Tertiary institutions (C
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MEMBERSHIP APPLICATION FORM JUNE 2010