BRICS SUMMIT EXHIBITION, DURBAN, 26 - 27 MARCH 2013 APPLICATION TEMPLATE (OTHER institutions)

Kindly complete the form and send to: Attention: Ms. Virginia Mbuyisa (tel 012) 394 5988 The dti Campus, 12 Esselen Street Block A, Ground Floor (Utangamiri Building) Sunnyside Pretoria, 0002
The following documentation must be attached to the application form: 1. Valid Original Tax Clearance Certificate (if applicable)

COMPANY NAME: CONTACT PERSON: DESIGNATION: POSTAL ADDRESS: PHYSICAL ADDRESS: TEL NO: FAX NO: PROVINCE TITLE:

E-MAIL:
COMPANY SPECIFY COMPANY PARTICIPATION Trade Investment PRODUCTS/ SERVICES:

WEBSITE:

Briefly give the main purpose of exhibiting at the BRICS Summit:

What products/services will you be exhibiting?

COMPANY PROFILE (Half a page): Date established, years in business, production capacity (if applicable), quality standards (if applicable).