APPLICATION FORM

The Capital Projects Feasibility Programme

Issued: 14 March 2008

The Enterprise Organisation

Department of Trade and Industry the dti Campus: 77 Meintjies Street,
Private Bag X86, Pretoria 0001 Sunnyside, Pretoria 0002
Website: www.thedti.gov.za Republic of South Africa
Call Centre: 0861 843 384
 PLEASE NOTE THE FOLLOWING BEFORE COMPLETING THE FORM:

1. Be sure to have read the form fully and understood it.

2. The application form must be submitted before any activities applied for are
started.
3. Applications must be signed by the authorized representative of the company and
dated.
4. Before submitting your application, be sure to have attached all the required
documents
5. It is advisable to read through the document: Capital Projects Feasibility
Programme Application Guideline
http://www.thedti.gov.za/capitalprojects/CPFPguidelines.pdf.

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 FOR DTI USE ONLY
Date Received:
FS Registration No.:

Section 1: APPLICANT INFORMATION

1. Registered Name of entity in full:

1.1 Trading name (where applicable):
2. Postal address: 7. Study Promoter (or name of contact person in
applying company)
Name:
Designation:
Telephone: Fax:
Mobile:
Email:
3. Principal physical address (where the business 8. Where a study promoter represents a client:
operations are located): Name of client:
Contact person:
Postal address:

Physical address:

Telephone: Fax:
Mobile:
Email:
4. Business Registration number (Republic of SA company number):
4.1 Date of Registration:
5. Income tax reference number: 6. VAT Registration number:

9. Shareholder % Ownership Race Gender

Section 2: Project Background

10. Future owner of the Project

11. Is the owner Private of Public Sector client? What is their credibility at local level?

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12 Title and description of the project

13. Aims and objectives of the feasibility study

14. Outcome of the project (likely impact)

15. Location of the project (country, city)

16. Credit rating of the country

17. Political, economic and currency risks

18. Analysis of competition, potential or existing. Please also provide names of major
competitors, if any

19. Details of pre-feasibility study/ies (if conducted)

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 19.1 Cost of pre-feasibility study/ies conducted

20. Maximum financial exposure

Section 3: PROJECT INFORMATION

21. Brief description of the market and demand

22. Owner capacity, local knowledge and ability to operate

23. Capacity and knowledge of operator (if owner not operator)

24. Brief description of resources and infrastructure required for project and availability of these

25. Environmental impact of the project (likely or obvious impacts) and/or detail of Environmental
Impact Assessment/ Scoping studies completed

26. Possible linkages to existing or future projects

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27. Brief description of the engineering and technology requirements for the project

28. Estimated costs for the project, possible sources, structuring of funding for the project and ability
to secure finance- including any local financing, development funds, foreign finance, please also
indicate equity

29. If the local content is less than 50%, please indicate your BBBEE status-scorecard,
credentials etc attached

30. Description of any other requirements for project to be successful

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Section 4: FEASIBILITY WORK SCHEDULE

21. Milestone Expenditure (excluding Start End Date

VAT) Date
 Milestone Completion Schedule

Weeks 1 2 3 4 5 6 7 8 9

Milestone I ----------------------

Milestone II ------------------------------------------

Milestone III ----------------------

Final Report ---------------------------------

Instructions:

Please list each milestone to be completed. The duration (in weeks) of each milestone is to be graphically represented. For example, in the illustrative
schedule, Milestone I is to begin in Week 1 and end in week 3. Preparation of the Final Report begins in Week 6 and is completed in Week 9.

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Section 5: FEASIBILITY STUDY COSTS

22. Activity Description of Activity Cost/R

(excl. VAT)

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PROJECT COST ESTIMATES:
Cost breakdown: (sub totals) (totals) (sub totals) (totals)

RAND RAND % %
Budgeted project costs:
- manpower (details to be provided in Annexure) XXX XX
- materials (detailed list to be provided separately) XXX XX
- Travel XXX XX
- Capital Expenditure XXX XX
- Documentation XXX XX
- Patents XXX XX
- Application preparation Consultant fees XXX XX
- Marketing XXX XX
- Sub-contractors:

- #1 XXX XX
- #2 XXX XX
- #3 XXX XX
Sub-total XXX XX
Total project costs XXX 100

Minus qualifying costs:

- Marketing XXX
- Travel XXX
- Manpower XXX
- Production XXX
- Application preparation fee XXX
- Capital Expenditure XXX
Sub-total XXX

Qualifying project costs XXX

Applicant’s contribution XXX XX
Total project costs XXX 100

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Section 6: STUDY TEAM

Name Qualification Role/responsibility Experience

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Section 7: ADDITIONAL INFORMATION REQUIRED:

The following information must be attached to this application form:

1. Valid tax clearance certificate

2. Latest financial statements
3. 3 Company references
4. Letter of authorization from client, confirming appointment of Study Promoter to act on behalf of client
5. CV of study promoter

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Section 8: DECLARATION BY APPLICANT

DECLARATION: I hereby declare that the information in this application is a fair and true reflection of my intended project and that all relevant
information has been disclosed. I am aware of the contents of this application and I declare that the application has been completed in full, and
areas not completed, have been deleted, before me affixing my signature hereto. I am aware that the information which I have submitted above,
will have a material bearing on the adjudication of the application and if it subsequently transpires that any information in the application and addenda
was not correct, or that certain information was omitted, the Capital Goods Feasibility Study Panel shall be entitled to withdraw or amend its approval
and without prejudice to its rights, recover any amounts already paid or withhold further payments due.

This application (with any addenda), if successful, will form part of your contract to the dti.

Name of Applicant:

Designation:

Signature:

Date:

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CONTACT DETAILS FOR ENQUIRIES
For further information, please contact:

Postal address: Physical Address:

The Enterprise Organisation the dti Campus
Private Bag X86 77 Meintjies Street
Pretoria 0001 Sunnyside
Pretoria 0002
Website: www.thedti.gov.za
Call Centre: 0861 843 384

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