SADPMR Form PMJ - Application for jeweller's permit (s.9(1) Precious Metals Act)

1. For any enquiries, contact the office of the Regulator during office hours.

2. Complete the form in block letters and in black pen.

3. Where options are given mark the appropriate block.

4. Complete the form in English and do not use abbreviations.

5. Although the application forms are made available in electronic format, only a signed original hard copy shall be acceptable.

6. Ensure that all the required documentation accompanies the application.

7. The application must be submitted to the operational business premises of the Regulator. PART A : PARTICULARS OF APPLICANT

1. (a) In the case of a natural person, please provide the following: (i) Surname: (ii) First name(s): (iii) Identity number: *(A certified copy of the applicant’s identity document must be attached,) (iv) Has the applicant ever been convicted of a criminal offence in terms of the Act or any other law? (Yes/No) If yes, furnish particulars on a separate sheet of paper. (b) In the case of a person other than a natural person, please indicate: CC. Partnership/Joint venture ____ Co. Other (specify) (i) Name of company, close corporation, partnership or joint venture: (ii) Registration number of Co. or CC: __________________________________________________ <!-- page break --> (i) Full names of managing director or member (if applicable): (ii) Particulars of interest held (%) in the juristic person and name of the holder of the controlling interest: (iii) An indication of the metals/alloys/solders to be manufactured into jewellery: (iv) Source from which metals/alloys/solders will be obtained: (v) Description of the applicant’s manufacturing ability: *(In the case of a company or close corporation, a certified copy of the certificate of incorporation must be attached.) PART B: CORRESPONDENCE ADDRESS FOR THIS APPLICATION

2. Business address: (i) Building name: (ii) Building number: (iii) Street number: (iv) Street name: (v) Suburb: (vi) Town/City: (vii) Postal code: (viii) Province: (ix) Country: (x) Telephone number: (xi) Fax No: (xii) Cellphone No: (xiii) Email address: (b) Relevant postal address: (i) Postal address: (ii) Town/City: (iii) Postal code: _________________________ (Attach documentary proof of the registered business premises.) <!-- page break --> PART C: THE APPLICATION MUST BE ACCOMPANIED BY THE FOLLOWING:

1. A certified copy of the applicant’s identity document, if applicable.

2. A certified copy of the certificate of incorporation and articles of association or founding statement, if applicable.

3. A copy of the relevant resolution, if acting in a representative capacity.

4. A curriculum vitae or brief description of the applicant’s manufacturing ability.

5. A description of the intended business activities with an indication of the broad-based socio-economic empowerment charter developed in terms of section 100 of the Mineral and Petroleum Resources Development Act, 2002 (Act 28 of 2002), where applicable.

6. Documentary proof of the applicant’s registered business premises.

7. A non-refundable prescribed application fee. PART D: DECLARATION I, the applicant, , hereby declare that the contents of this application are true and correct. Capacity: Signed at on the day of SIGNATURE OF APPLICANT/REPRESENTATIVE (IF APPLICABLE) <!-- page break -->