Franchise Agreement Franchisee Info 6. FRANCHISEE INFORMATION arrowup6 PERSONAL INFORMATION Full Name and Surname: Identity Number: Contact Number: Email Address: Domicilium Address: Domicilium Address: Domicilium Address: Domicilium Address: City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Town of Residence: Town of Residence: Town of Residence: Town of Residence: City City State/Province State/Province Zip/Postal Zip/Postal Province of Residence: Eastern CapeFreestateGauteng SouthGautent NorthKwa Zulu NatalLimpopoMpumalangaNorth WestNorthern CapeWestern Cape Capacity: MemberDirectorTrusteePartner 6.2 ENTITY INFORMATION arrowup6 Entity Name: Entity Reg. Nr.: Entity Type: 20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980 Entity Type (Words): Vat Registration Number: Company Registered Address: Company Registered Address: Company Registered Address: Company Registered Address: City City State/Province State/Province Zip/Postal Zip/Postal Company Primary Business Address: Company Primary Business Address: Company Primary Business Address: Company Primary Business Address: City City State/Province State/Province Zip/Postal Zip/Postal Company Domicilium Addres: Company Domicilium Addres: Company Domicilium Addres: Company Domicilium Addres: City City State/Province State/Province Zip/Postal Zip/Postal Email Address: 6.3 MEMBERS/DIRECTORS/TRUSTEES/PARTNERS arrowup6 6.3.1 DIRECTOR 1 Name & Surname: Name & Surname: First Name First Name Last Name Last Name Contact Number: Town of Residence: Province of Residence: Eastern CapeFreestateGauteng SouthGautent NorthKwa Zulu NatalLimpopoMpumalangaNorth WestNorthern CapeWestern Cape 6.3.2 DIRECTOR 2 arrowup6 Name & Surname: Name & Surname: First Name First Name Last Name Last Name Contact Number: Town of Residence: Province of Residence: Eastern CapeFreestateGauteng SouthGautent NorthKwa Zulu NatalLimpopoMpumalangaNorth WestNorthern CapeWestern Cape 6.3.3 DIRECTOR 3 arrowup6 Name & Surname: Name & Surname: First Name First Name Last Name Last Name Contact Number: Town of Residence: Province of Residence: Eastern CapeFreestateGauteng SouthGautent NorthKwa Zulu NatalLimpopoMpumalangaNorth WestNorthern CapeWestern Cape 6.4 FRANCHISE INFORMATION (Office Use) arrowup6 Designated Territory Name: Franchise premises physical address: Franchise premises physical address: Franchise premises physical address: Franchise premises physical address: City City State/Province State/Province Zip/Postal Zip/Postal 6.5 TIMELINE arrowup6 Date of first consultation: Date Disclosure Received: Date Franchise Agreement Received: Effective Date (Minimum 14 days from the Date Franchise Agreement and Disclosure was received): Cool Off Period Expiry Date (Minimum 10 working days from Effective Date) Received by: Received by: First Name First Name Last Name Last Name Date Received: 6.6 TERRITORY arrowup6 Designated Territory Radius Numeric: Designated Territory Radius Words: Territory Description: 7. Franchise Info arrowup6 Initial Training: Working Capital: Set-up Cost: Total initial Investment: Submit If you are human, leave this field blank.