Fillable SEFA Product Application Form Online- Nov17 (South Africa Office of the Chief Justice)

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SEFA Product Application Form Online- Nov17 (South Africa Office of the Chief Justice)

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  • 5 signatures
  • 110 check-boxes
  • 481 other fields

Country of origin: SOUTH-AFRICA
File type: PDF

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Accessible Development Finance
sefa Product Application Form
01
LICENSED CREDIT PROVIDER (NCRCP 160) PAGE OF 11
LOAN APPLICATION FORM
SECTION A: COMPANY INFORMATION
(To be completed by borrowing legal entity)
COMPANY DETAILS
CIPC Registered Name
Trading Name
Type of Business Industry (Sector)
Registration Number Registration Date D D M M C C Y Y
Telephone Number Fax Number
E-mail Address
VAT Registration Number Tax Reference Number
Physical Address
Province Code
Postal Address
Province Code
Should sefa contact you for telemarketing purposes?
Ye s No
Period in Business (Years) Number of Current Employees
New jobs expected to be
created
How did you hear about sefa?
(Tick applicable box)
Roadshow Radio Word of Mouth Outdoor Advertising (e.g. Billboard, Pamphlet, etc.)
Print Media (e.g. Magazine, Newspaper advert, etc) Other (please specify)
Indicate how you would prefer to receive copies for your legal documents. (Tick applicable box)
Collecting in person at sefa’s ofces?
Post Fax ( ) - E-mail
CONTACT PERSON/COMPANY REPRESENTATIVE
Title (Prof/Dr/Mr/Ms) Surname First Name(s)
Contact Number(s) Cell ( ) - Te l ( ) - Fax ( ) -
E-mail
MEMBERS/SHAREHOLDER DETAILS
Full Name(s) and Surname Percentage Shareholding
COMPANY BRIEF BACKGROUND INFORMATION (Should you require more space please attach a separate page)
02
LICENSED CREDIT PROVIDER (NCRCP 160) PAGE OF 11
FINANCIAL INFORMATION
1
Total Finance Required
Owners’ Contribution (Unencumbered) Source of Funds
Financial Year End of Business D D M M C C Y Y
PERIODIC ABRIDGED FINANCIAL STATEMENT (Not applicable to Start-up businesses)
(Less means a negative value that must be preceded by a minus sign. e.g -1200 without any spaces or characters)
Current
Financial Year
Previous
Financial Year
Previous
Financial Year
Previous
Financial Year
Previous
Financial Year
Gross Turnover R R R R R
Gross Prot R R R R R
(Less) Gross Operating Expenses R R R R R
Net Prot
R R R R R
ASSETS AND LIABILITIES
Total Value of Fixed Assets R R R R R
Total Value of Current Assets R R R R R
(Less) Total Value of Current Liabilities R R R R R
(Less) Total Value of Long Term Liabilities R R R R R
Networth
R R R R R
REFERENCES
BANKING DETAILS OF THE COMPANY
Name of Bank
Branch
Type of Account
Account Number
Facilities
Security Held by Bank
1 Pleaseattachnancialstatements-ifavailable
TRADE ACCOUNTS
Title & Name of Contact Person Title & Name of Contact Person
Name of Business Name of Business
Contact Numbers Cell ( ) - Contact Numbers Cell ( ) -
Te l ( ) - Te l ( ) -
Fax ( ) - Fax ( ) -
E-mail Address E-mail Address
Type of Account
Cash Credit Type of Account Cash Credit
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
03
LICENSED CREDIT PROVIDER (NCRCP 160) PAGE OF 11
PROFESSIONAL
Name & Surname of Accounting Ofcer Company Name
Contact Number(s) Cell ( ) - Te l ( ) - Fax ( ) -
E-mail
DECLARATION AND CONSENT
I/We, the undersigned declare that the information provided in this application form is to the best of my/our knowledge true and complete. I/We also
understand that any wilful misrepresentation of the information in this application form will disqualify my/our application and may lead to legal action against
me/us including the laying of criminal charges against me/us as sureties as well as against the entity I/we represent for furnishing false statement or information
to the Small Enterprise Finance Agency (SOC) Ltd (sefa).
I/We hereby grant sefa consent to perform an entity/personal search and check on my/our records with any other party (e.g. credit bureau and/or a
government agency) relating to this application.
I/We further authorise sefa to disclose my/our personal information to these parties to obtain the information they require and acknowledge that sefa
will never disclose more information than they are required to.
sefa warrants that it will treat your personal information as condential and take all necessary steps to protect your information as required by the Protection
of Personal Information Act of 2013. We will only disclose your information if:
• The law requires us to do so;
• It is in the public interest to do so;
• Our interests require disclosure; or
• You have given us your consent.
Surname Surname
Full Name(s) Full Name(s)
Designation Designation
Signature Signature
Place Place
Date D D M M C C Y Y Date D D M M C C Y Y
click to sign
signature
click to edit
click to sign
signature
click to edit
04
LICENSED CREDIT PROVIDER (NCRCP 160) PAGE OF 11
MEMBER/SHAREHOLDER/PARTNER DETAILS
Surname First Name(s)
ID Number
Gender (tick applicable box)
Male Female Nationality (Citizenship)
Race
African Indian White Other Please specify:
Do you have any disability?
YES NO If YES, please give details:
Involvement in Business
Active Partner Silent Partner If Active - Operational Responsibility:
Physical Address
Province Code
Postal Address
Province Code
Number of Years at Residential Address
Previous Residential Address (if less than 5 years at current address)
Province Code
Contact details Tel (H) ( ) - Tel (B) ( ) - Fax ( ) -
Cell ( ) - E-mail
Marital Status (Tick applicable Box)
Single Married in community of property
Married out of community of property
with or without accrual
Other If other, provide details:
Number of Dependants Age
Next of Kin (not staying with you) Surname First Name(s)
Relationship
Contact Details Cell ( ) - Te l ( ) - E-mail
Residential Address
Province Code
PREVIOUS EXPERIENCE AND CAREER HISTORY
Employer Position Period
LOAN APPLICATION FORM
SECTION B: PERSONAL INFORMATION
(To be completed by each shareholder/trustee of the borrowing legal entity e.g. Pty Ltd, Ltd, Trust, etc.)
05
LICENSED CREDIT PROVIDER (NCRCP 160) PAGE OF 11
REFERENCES
PERSONAL TRADE ACCOUNTS
Name of Contact Person Name of Contact Person
Name of Business Name of Business
Contact Numbers Cell ( ) - Contact Numbers Cell ( ) -
Te l ( ) - Te l ( ) -
Fax ( ) - Fax ( ) -
E-mail Address E-mail Address
Type of Account
Cash Credit Type of Account Cash Credit
PERSONAL BANKING DETAILS OF APPLICANT / COMPANY REPRESENTATIVE
Name of Bank Name of Bank
Branch Branch
Type of Account Type of Account
Account Number Account Number
Facilities Facilities
Security Held by Bank Security Held by Bank
INCOME
Employed Self Employed (tick applicable box)
Name of Employer/ Name of Business
Physical Address
Province Code
Position Held/ Nature of Business
Salary/ Drawings R Period of Employment/ Period in Business
06
LICENSED CREDIT PROVIDER (NCRCP 160) PAGE OF 11
MONTHLY INCOME AND EXPENDITURE STATEMENT
Net Salary (Income) R
Other Income (please specify) R
Other Income (please specify) R
TOTAL INCOME
R
(LESS) EXPENSES
(all values must be preceded by a minus sign. E.g. -1200 without spaces or characters such as full stops (.) or commas (,))
Bank Charges R
Mortgage Bond(s) R
Donations R
Entertainment R
Clothing Account(s) R
Cellular Phone Contract(s) R
Domestic Worker R
Education Fees R
Groceries R
School Transport R
Water and Lights R
Rates and Taxes R
Subscriptions (TV, Papers, etc.) R
Investments R
Life Policies R
Petrol R
Short Term Insurance R
Landline Rental R
Alarm and Tracking Contracts R
Other (please specify) R
Other (please specify) R
(LESS) TOTAL EXPENSES
R
SURPLUS (DEFICIT)
R
STATEMENT OF ASSET AND LIABILITIES
Assets
R
Liabilities
R
Residential Property(ies) Mortgage Bond(s):
Motor Vehicle(s) Vehicle Finance:
Household Effects Personal Loans:
Equity in Businesses
Other Assets (please specify) Other Liabilities (please specify):
Net Equity
Total Assets R Total Liabilities R
0.00
0.00
R 0.00
0.00
0.00
07
LICENSED CREDIT PROVIDER (NCRCP 160) PAGE OF 11
PERSONAL RECORD
YES NO
(Tick applicable box)
1. Are you currently undergoing debt counselling or do you have a pending debt counselling application?
2. Are you undergoing debt restructuring?
3. Have you ever been sequestrated?
4. If so, have you been rehabilitated?
5. Have you ever been found guilty of a criminal offence?
6. Have you ever reached a compromise with creditors or had repayment problems?
7. Have you ever been summoned or had judgements taken against you?
8. Have you signed surety for anyone else?
Kindly give details in respect of any YES answers above:
DECLARATION AND CONSENT
I, the undersigned declare that the information provided in this application form is to the best of my knowledge true and complete. I also understand that
any wilful misrepresentation of the information in this application form will disqualify my application and may lead to legal action against me and/or the entity
I represent including the laying of criminal charges against me as sureties as well as against the entity I represent for furnishing false statement or information
to the Small Enterprise Finance Agency (SOC) Ltd (sefa).
I hereby grant sefa consent to perform an entity/personal search and check on my records with any other party (e.g. credit bureau and/or a government
agency) relating to this application.
I further authorise sefa to disclose some of my personal information to these parties to obtain the information they require and acknowledge that the sefa
will never disclose more information than they are required to.
sefa warrants that it will treat your personal information as condential and take all necessary steps to protect your information as required by the Protection
of Personal Information Act of 2013 (POPI). We will only disclose your information if:
• The law requires us to do so;
• It is in the public interest to do so;
• Our interests require disclosure; or
• You have given us your consent.
Surname Full Name(s)
Designation
Signature
Place
Date D D M M C C Y Y
SPOUSE’S DECLARATION AND CONSENT (If married in community of property)
I have obtained my spouse’s consent to enter into this Credit Facility and for credit check with any credit reference agency. I understand that I will be liable
for fraud should I falsely declare my spousal consent.
Surname Full Name(s)
Designation
Signature
Place
Date D D M M C C Y Y
click to sign
signature
click to edit
click to sign
signature
click to edit
08
LICENSED CREDIT PROVIDER (NCRCP 160) PAGE OF 11
MEMBER/SHAREHOLDER/PARTNER DETAILS
Surname First Name(s)
ID Number
Gender (tick applicable box)
Male Female Nationality (Citizenship)
Race
African Indian White Other Please specify:
Do you have any disability?
YES NO If YES, please give details:
Involvement in Business
Active Partner Silent Partner If Active - Operational Responsibility:
Physical Address
Province Code
Postal Address
Province Code
Contact details Tel (H) ( ) - Tel (B) ( ) - Fax ( ) -
Cell ( ) - E-mail
Marital Status (Tick applicable Box)
Single Married in community of property
Married out of community of property
with or without accrual?
Other If other, provide details:
Number of Dependants Age
Next of Kin (not staying with you) Surname First Name(s)
Relationship
Contact Details Cell ( ) - Te l ( ) - E-mail
Residential Address
Province Code
REFERENCES
TRADE
Name & Surname of
Contact Person
Name of Business
Contact Numbers Cell ( ) - Te l ( ) - Fax ( ) -
E-mail Address
Account Number
Type of Account
Cash Credit
LOAN APPLICATION FORM
SECTION C: SURETY FORM
(To be completed by the sureties of the borrowing entity)
09
LICENSED CREDIT PROVIDER (NCRCP 160) PAGE OF 11
BANKING
Name of Bank
Branch
Type of Account
Account Number
Facilities
Security Held by Bank
PROFESSIONAL
Name & Surname of Accounting Ofcer Company Name
Contact Number(s) Cell ( ) - Te l ( ) - Fax ( ) -
E-mail
PERSONAL RECORD
YES NO
(Tick applicable box)
1. Are you currently undergoing debt counselling or do you have a pending debt counselling application?
2. Are you undergoing debt restructuring?
3. Have you ever been sequestrated?
4. If so, have you been rehabilitated?
5. Have you ever been found guilty of a criminal offence?
6. Have you ever reached a compromise with creditors or had repayment problems?
7. Have you ever been summoned or had judgements taken against you?
8. Have you signed surety for anyone else?
Kindly give details in respect of any YES answers above:
DECLARATION AND CONSENT
I, the undersigned declare that the information provided in this application form is to the best of my knowledge true and complete. I also understand that
any wilful misrepresentation of the information in this application form will disqualify my application and may lead to legal action against me and/or the entity
I represent including the laying of criminal charges against me as sureties as well as against the entity I represent for furnishing false statement or information
to the Small Enterprise Finance Agency (SOC) Ltd (sefa).
I hereby grant sefa consent to perform an entity/personal search and check on my records with any other party (e.g. credit bureau and/or a government
agency) relating to this application.
I further authorise sefa to disclose some of my personal information to these parties to obtain the information they require and acknowledge that the sefa
will never disclose more information than they are required to.
sefa warrants that it will treat your personal information as condential and take all necessary steps to protect your information as required by the Protection
of Personal Information Act of 2013 (POPI). We will only disclose your information if:
• The law requires us to do so;
• It is in the public interest to do so;
• Our interests require disclosure; or
• You have given us your consent.
Surname Full Name(s)
Designation
Signature
Place
Date D D M M C C Y Y
10
LICENSED CREDIT PROVIDER (NCRCP 160) PAGE OF 11
ASSET FINANCE, BRIDGING AND TERM LOANS
1. Application Form
2. Surety Form (where applicable)
3. Certied copy of ID and that of Spouse (if married In Community of Property [ICOP])
4. Marriage certicate (where applicable)
5. Short CV of the members/directors/ shareholders/ trustees, etc.
6. Proof of residence – utility bill / sworn afdavit (not older than 3 months)
7. Valid Tax Clearance Certicate
8. Company Registration Documents e.g. CK2, Company Prole
9. Proof of CIPC/CIPRO annual fees
10. Six months latest bank statement (personal and business)
11. Loan Breakdown
12. Supporting quotations (with contact person and banking details of supplier)
13. Personal Income and Expenditure Schedule and Assets & Liability Statement
14. Proof of own contribution and source (if applicable)
15. Member’s resolution to apply (if applicable)
16.
If a judgment, notice, default is issued against the applicant, a letter or document to prove that arrangements are made to settle the
account or proof that the account is settled must be provided
17. Historic Financial statements (not less than 3 years – if applicable)
18. Up to date Management Accounts (if applicable)
19. Debtors Age Analysis (if applicable)
20. Creditors Age Analysis (if applicable)
TERM LOANS AND ASSET FINANCE
1. Business Plan
2. Cash ow projections
3. Lease agreement (if applicable)
4. Franchise Agreement (if applicable)
BRIDGING LOAN APPLICATIONS
1. Project plan and projections
2. Copy of Contract or Order
3. Completion certicate for previous work done (for construction projects only)
4. NHBRC and CIDB (for construction projects only)
5. Bills of quantities (for construction projects only)
LOAN APPLICATION FORM
ANNEXURE 1: CHECK LIST FOR NEW APPLICATIONS
11
LICENSED CREDIT PROVIDER (NCRCP 160) PAGE OF 11
QUALIFICATION CRITERIA
• The majority shareholder(s) must be involved in the day to day running of the business on a full time basis (owner - manager)
• The business must be registered in SA
• The major shareholder must be an SA citizen
• The business must be conducted with a prot motive and be economically viable
• The forecasted cash ow must show the ability to repay the facility (affordibility)
• The owner must display sufcient entrepreneurship, skills and experience directly related to the nature of the business
• Compliance with all relevant laws and regulations
• Demonstrate job creation (potential to create new jobs or sustain existing ones)
• Loan Range R50 000 to R5 million
EXCLUSIONS
• Manufacturing and selling of ammunition
• Tobacco, Liquor, Gambling and sex trade
• Non-prot organisations
• Political organisations
• Persons under debt review
• Un-rehabilitated insolvent shareholders and/or directors of applying entities
• Primary agriculture (except cash crops and the applicant must have an off take agreement)
• Speculative property development
LOAN APPLICATION FORM
ANNEXURE 2: QUALIFICATION CRITERIA
sefa Offices
Regional Ofces Contact List
Regional ofces are open from 08h30 to 17h00 from Monday to Friday with the exception of Public Holidays. Clients wishing to participate in consultations at any of the
co-locations are advised to secure an appointment with a sefa representative using the contact details provided below.
Regional Ofce Ofce Type Address Telephone Number Ofce Hours
Free State
sefa
Regional Ofce
Bloemfontein
Ofce 4&5, Preller Square, Graaf Reinet Street, Dan Pienaar, Bloemfontein, 9301
051 436 0150
sefafs@sefa.org.za
08h30 - 16h30
Monday - Friday
Co-locations
Welkom
One Reinet Building, Reinet Street, Welkom, 9460
051 436 0150
sefafs@sefa.org.za
09h30 - 15h00
Trompsburg
53 Voortrekker Street, Khoisan Building, Trompsburg, 9913
051 436 0150
sefafs@sefa.org.za
10h00 - 14h00
Qwaqwa
Mampoi Road, Phuthaditjhaba, 9866
051 436 0150
sefafs@sefa.org.za
09h30 - 15h00
Sasolburg
Eric Louw Street, Boiketlong, Zamdela, Sasolburg, 1939
051 436 0150
sefafs@sefa.org.za
09h30 - 13h00
KwaZulu-Natal
sefa
Regional Ofce
Durban
21
st
Floor, Ofce 2102, Durban Embassy Building, Anton Lembede Street, Durban, 4001
031 368 3485
sefakzn@sefa.org.za
08h30 - 16h30
Monday - Friday
Co-locations
Port Shepstone
46 Bisset Street, Lot No 456, Port Shepstone, 4240
031 368 3485
sefakzn@sefa.org.za
08h30 - 17h00
Ladysmith
93/94 Murchison Street, Ladysmith, 3370
031 368 3485
sefakzn@sefa.org.za
08h30 - 17h00
Richards Bay
Lot 611237 via Verbana, Veldenvlei, Richards Bay, 3900
031 368 3485
sefakzn@sefa.org.za
08h30 - 17h00
Newcastle
28 Scott Street, Newcastle, 2940
031 368 3485
sefakzn@sefa.org.za
08h30 - 17h00
IDC Pietermarizburg
1
st
Floor ABSA Building, 15 Chatterton Rd, PMB, 3201
031 368 3485
sefakzn@sefa.org.za
08h30 - 17h00
Gauteng
sefa
Regional Ofce
Centurion (Head Ofce)
Eco Fusion 5, Block D, 1004 Teak Close, Witch-Hazel Avenue, Eco Park, Centurion, 0157
012 748 9600
helpline@sefa.org.za
talktous@sefa.org.za
08h30 - 17h00
Johannesburg
Umnotho House, Lower Ground, 56 Eloff Street, Marshalltown, Johannesburg, 2001
012 748 9600 |
sefagpsouth@sefa.org.za
08h30 - 17h00
Riversands (Diepsloot)
Riversands Incubation Hub, 8 Incubation Drive, Riverside View, Ext. 15, Midrand, 2191
087 288 6000
sefagpnorth@sefa. org.za
08h30 - 16h30
Monday - Friday
Co-locations
Tshwane
Block C, 4
th
Floor, Old Mutual Building, 536 Frances Baard & Steve Biko Streets, Pretoria
012 441 0480
sefagpnorth@sefa.org.za
08h30 - 16h30
Emfuleni
5 Moshoeshoe Street, VUT Science & Technology Park, Sebokeng, 1983
012 748 9600
helpline@sefa.org,za
08h30 - 17h00
Sandton
19 Fredman Drive, Sandown, Sandton, 2146
011 269 3000
helpline@sefa.org.za
08h30 - 17h00
Wednesdays only
Soweto
Shop 368 Maponya Mall, Thusong Centre, Chris Hani Road (Old Potchefstroom Road), 1809
011 938 4257
sefagpeast@sefa.org.za
08h30 - 17h00
Wednesdays only
Ekurhuleni
Ekurhuleni Business Facilitation Network, Cnr Voortrekker & Monument Road, Kempton Park,
1619
010 492 3655
sefagpeast@sefa.org.za
08h30 - 16h30
Monday - Friday
Western Cape
sefa
Regional Ofce
Cape Town
9
th
Floor, 2 Long Street, Cape Town, 8001
021 418 0126
sefawc@sefa.org.za
08h30 - 16h30
Monday - Friday
Co-locations
Bellville
2
nd
Floor, Louwville Place, Vrede Street, Bellville, 7535
021 418 0126
sefawc@sefa.org.za
08h30 - 17h00
Khayelitsha
Khayelitsha Training Centre Cnr Lwandile & Spine Road, Khayelitsha, 7784
021 418 0126
sefawc@sefa.org.za
08h30 - 17h00
Mosselbay
KKT Sentrum Nr. 7, Gericke Street, Voorbaai, Mossel Bay, 6506
021 418 0126
sefawc@sefa.org.za
08h30 - 17h00
Knysna
Thesen House, 6 Long Street, Knysna, 6571
021 418 0126
sefawc@sefa.org.za
08h30 - 17h00
George
Entrance A, 1
st
Floor Beacon Place, 125 Meade Street, George, 6530
044 803 4900
sefawc@sefa.org.za
08h30 - 16h30
Oudtshoorn
70 Voortrekker Street, Oudtshoorn, 6625
044 803 4900
sefawc@sefa.org.za
08h30 - 17h00
Beaufort West
Thusong Service Centre, 3 De Vries Street, Beaufort West, 6970
021 418 0126
sefawc@sefa.org.za
08h30 - 17h00
Hermanus
Shop No 44, Gateway Centre, Hermanus, 7200
021 418 0126
sefawc@sefa.org.za
08h30 - 17h00
www.sefa.org.za
Regional Ofce Ofce Type Address Telephone Number Ofce Hours
Western Cape Co-locations
Stellenbosch
1
st
Floor, Eikestad Mall, Andriga Street, Stellenbosch, 7599
021 418 0126
sefawc@sefa.org.za
08h30 - 17h00
Worcester
62, Cnr High & Stockenstroom Street, Worcester, 6850
021 418 0126
sefawc@sefa.org.za
08h30 - 17h00
Vredenburg
19 West Coast Centre, 11 Long Street, Vredenburg, 7380
021 418 0126
sefawc@sefa.org.za
08h30 - 17h00
Saldanha
Tonyn Street, Saldanha, 7395
022 714 1731
sefawc@sefa.org.za
08h30 - 16h30
Eastern Cape
(Western
Districts)
sefa
Regional Ofce
East London
Chesswood Ofce Park, 8-10 Winkely Street, 2
nd
Floor, Berea, 5241
043 721 1510
sefael@sefa.org.za
08h30-16h30
Monday - Friday
Co-locations
Port Elizabeth
No 68 Cape Road, Mill Park, Port Elizabeth, 6000
041 373 4153
sefape@sefa.org.za
08h30-16h30
Monday - Friday
Queenstown
Sasol Complex, Cathcart Road, Queenstown , 5319
043 721 1510
sefael@sefa.org.za
10h00 - 15h00
Mount Alyff
Disaster Management Centre, 188 Nolangeni Street, Mount Alyff, 4735
043 721 1510
sefael@sefa.org.za
10h00 - 15h00
Mthatha
7 Sissons Street, ECDC House, Fort Gale, Mthatha, 5100
047 504 2200
sefael@sefa.org.za
08h00 - 16h30
Northern
Cape
sefa
Regional Ofce
Kimberley
72 Long Street, Business Partners Building, Kimberley, 8301
053 832 2275
sefanc@sefa.org.za
08h30 - 16h30
Monday - Friday
Co-locations
Kuruman
Cnr Roos & Church Street, Kuruman, 8460
053 832 2275
sefanc@sefa.org.za
09h30 - 15h00
Upington
Cnr Scott & Upington 26 Street, Old Sanlam Building, 3
rd
Floor, Upington, 8800
053 832 2275
sefanc@sefa.org.za
09h30 - 15h00
De Aar
Cnr Main & Station Street, De Aar, 7000
053 832 2275
sefanc@sefa.org.za
09h30 - 15h00
Springbok
3 Rivier Street, Springbok, 8240
053 832 2275
sefanc@sefa.org.za
09h30 - 15h00
Upington
De Drift Plaza, Block 6, Olyvenhoutsdrift Settlement, Louisvale Avenue, 8801
053 832 2275
sefanc@sefa.org.za
09h30 - 15h00
Mpumalanga
sefa
Regional Ofce
Nelspruit
Corner Ferreira and Streak Street, 3
rd
Floor, Suite 301, MAXSA Building, Nelspruit,1200
013 755 3923
sefamp@sefa.org.za
08h30 - 16h30
Monday - Friday
Co-locations
Witbank
Cnr OR Tambo & Mandela Street, Shop L2-1A, Saveways, Crescent Shopping Centre,
Witbank,1035
013 755 3923
sefamp@sefa.org.za
08h00 - 17h00
Secunda
South Wing, Govan Mbeki Building, Lurgi Square, Secunda, 2302
013 755 3923
sefamp@sefa.org.za
08h00 - 17h00
Malelane
Lorenco Street, Rotunda Circle, Malelane,1020
013 755 3923
sefamp@sefa.org.za
08h00 - 17h00
Bushbuckridge
Shop 31, Twin City Shopping Centre, Bushbuckridge,1280
013 755 3923
sefamp@sefa.org.za
08h00 - 17h00
Limpopo
sefa
Regional Ofce
Polokwane
Suite 4, Biccard Park, No. 43 Biccard Street, Polokwane, 0699
015 294 0900
sefalp@sefa.org.za
08h30 - 16h30
Monday - Friday
Co-locations
Thohoyandou
Old Mutual Building, Old Group Scheme Ofces, Mphephu Road, Thohoyandou, 7950
015 294 0900
sefalp@sefa.org.za
08h30 - 17h00
Mopani
27 Peace Street, 1
st
Floor Prosperitas Building, Tzaneen, 0850
015 294 0900
sefalp@sefa.org.za
08h30 - 17h00
Mokopane
40 Retief Street, Mokopane, 0600
015 294 0900
sefalp@sefa.org.za
08h30 - 17h00
Sekhukhune
189 Vergelegen Street, Tlatlolang Centre, Jane Furse, 1085
015 294 0900
sefalp@sefa.org.za
08h30 - 17h00
North West
sefa
Regional Ofce
Rustenburg
32B Heystek Street, Sunetco Building, Rustenburg, 0299
014 592 6391
sefanw@sefa.org.za
08h30 - 16h30
Monday - Friday
Co-locations
Klerksdorp
West End, 2
nd
Floor, 51 Leask Street, Klerksdorp, 2570
014 592 6391
sefanw@sefa.org.za
08h00 - 17h00
Vryburg
8 Moffat Street, Vryburg, 8600
014 592 6391
sefanw@sefa.org.za
08h00 - 17h00
Mahikeng
1B Mikro Plaza, Cnr First & Bessemmer Streets, Industrial Sites, Mahikeng, 2745
018 397 9942
sefanw@sefa.org.za
08h00 - 17h00
For more information or assistance in completing the form:
Call us: 012 748 9600
Fraud Hotline Number: 0800 30 33 36 (Tip-offs Anonymous)
Email us: helpline@sefa.org.za or complaints@sefa.org.za
Visit us at a Regional Ofce near you
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SEFA Product Application Form Online- Nov17 (South Africa Office of the Chief Justice)

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Completed 27 January 2022

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