JOINT VENTURE VERIFICATION AFFIDAVIT

UNDERTAKING BY THE REPRESENTATIVE OF THE ENTITY (THIS MUST BE SIGNED FOR EACH COMPANY FOR BY AN

AUTHORISED REPRESENTATIVE

WE, the undersigned,

Joint Venture Agreement Name: ___________________________________________________

JV Tender Number: ___________________________________________________

Participating Entity Name: ___________________________________________________

Participating Entity Name: ___________________________________________________

Participating Entity Name: ___________________________________________________

WE HEREBY STATE UNDER OATH / SOLEMNLY AFFIRM:

1. We are party to a Joint Venture Agreement and are authorised to sign on behalf of the above entities for

the purpose of a Joint Venture Agreement B-BBEE Verification.

2. I hereby declare that the shareholding structure of this entity is as listed below:

Organization Shareholders Percentage

Holding BEE Rating

Operational Involvement

Voting Rights

Name % Level Yes/No %

Total Holdings %

4. We hereby declare that the information supplied in this affidavit is true and correct to the best of our

knowledge. We understand that providing false information or failing to provide the information required

constitutes a misrepresentation. We agree and accept that HARVEST CHARTERED ACCOUNTANTS may wish to

verify the correctness of the information we have provided.

SIGNED AT ________________ON THIS THE _________DAY OF__________________20____.

REPRESENTATIVE NAME: ____________________________ SIGNATURE: _______________________________________________

REPRESENTATIVE NAME: ____________________________ SIGNATURE: _______________________________________________

REPRESENTATIVE NAME: ____________________________ SIGNATURE: _______________________________________________

COMMISSIONER OF OATHS

I HEREBY CERTIFY that the representative has acknowledged that he knows and understands the contents of this

Affidavit.

Commissioner of Oaths: ___________________________________________

Place of signing: ___________________________________________ Date: ____________________________