APPLICATION FORM

1 APPLICATION form The Capital Projects Feasibility Programme Issued: 14 March 2008 The Enterprise Organisation Department of Trade and Industry Private Bag X86, Pretoria 0001 Website: Call Centre: 0861 843 384 the dti Campus: 77 Meintjies Street, Sunnyside, Pretoria 0002 Republic of South Africa SA CPFP APPLICATION form Page 1 of 14 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 SA CPFP APPLICATION form Page 2 of 14 Section 1: APPLICANT INFORMATION 1.

2 Registered Name of entity in full: 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 operations are located): 8. Where a study promoter represents a client: Name of client: Contact person: Postal address: Physical address: Telephone: Fax: Mobile: Email: 4. Business Registration number (Republic of SA company number): 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? FOR DTI USE ONLY Date Received: FS Registration No.: SA CPFP APPLICATION form Page 3 of 14 12 Title and description of the project 13.

3 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) SA CPFP APPLICATION form Page 4 of 14 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.

4 Possible linkages to existing or future projects SA CPFP APPLICATION form Page 5 of 14 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 Section 4: FEASIBILITY WORK SCHEDULE 21. Milestone Expenditure (excluding VAT) Start Date End Date SA CPFP APPLICATION form Page 1 of 14 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.

5 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. SA CPFP APPLICATION form Page 2 of 14 Section 5: FEASIBILITY STUDY COSTS 22. Activity Description of Activity Cost/R (excl. VAT) SA CPFP APPLICATION form Page 3 of 14 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.

6 - #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 SA CPFP APPLICATION form Page 4 of 14 Section 6: STUDY TEAM Name Qualification Role/responsibility Experience SA CPFP APPLICATION form Page 5 of 14 Section 7.

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 SA CPFP APPLICATION form Page 6 of 14 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.

8 This APPLICATION (with any addenda), if successful, will form part of your contract to the dti. Name of Applicant: Designation: Signature: Date: SA CPFP APPLICATION form Page 7 of 14 CONTACT DETAILS FOR ENQUIRIES For further information, please contact: Postal address: The Enterprise Organisation Private Bag X86 Pretoria 0001 Website: Call Centre: 0861 843 384 Physical Address: the dti Campus 77 Meintjies Street Sunnyside Pretoria 0002