MANDATORY GRANT APPLICATION: ATR 2010/2011 & WSP 2011/2012 FOR LESS THAN 50 PERMANENT EMPLOYEES ONLY

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1 Page 1 of 8 MANDATORY GRANT APPLICATION: ATR 21/211 & WSP 211/212 FOR LESS THAN 5 PERMANENT EMPLOYEES ONLY Once completed in full either fax or or post or deliver this application to: DELIVER: 529 Belvedere Street, AgriSETA House, Arcadia, Pretoria, 83 (Not for postal purpose) POST: PO Box 2624, Arcadia, Pretoria, 7 NOTE: No original documentation required - fax or (scan) copies are sufficient Phone: / Fax: or / amandie@agriseta.co.za DO NOT DELETE OR CHANGE ANY PART OF THIS DOCUMENT! FINAL SUBMISSION DUE DATE: Thursday, 3 JUNE 24: No exceptions OR extensions This form is ONLY for Employers employing LESS THAN 5 PERMANENT Employees LESS THAN 5 ANNUAL TRAINING REPORT 21/211 Report of actual training completed from 1 April 21 up to 31 March 211 & WORKPLACE SKILLS PLAN 211/212 Planning of training to be completed from 1 April 211 up to 31 March 212 SDL No: L Organisation Name: A Le Roux t/a APPLE FARM CC The section below is for AGRISETA office use ONLY STATUS CAPTURED BANK DETAILS RECEIVED C E BD A COMMENTS

2 MANDATORY GRANT APPLICATION: ATR 21/211 & WSP 211/212 FOR LESS THAN 5 PERMANENT EMPLOYEES ONLY Page 2 of 8 ORGANISATION INFORMATION Registered & Trading name: Registration number: (If applicable) A LE ROU T/A APPLE FARM CC 1996/2562/42 SDL No.: L Physical Address: Company/Farm Street Appel Farm 123 Farm Road Town/City Pretoria Province Gauteng click Code: 1 Postal Address: Box/Bag PO Box 1234 Town/City Pretoria Province Gauteng click Postal Code: 2 Organisation Telephone number: Organisation Fax number: Organisation address: info@applefarm.co.za *No of permanent employees: (As on 1 April 211 ) 3 Grand Total *No of temporary/season/contract workers (As on 1 April 211 ) 1 = 4 (*This includes only those employees for whom SDL is paid to SARS) SIC Code: (Main business activity) Select ONLY ONE code Total Annual Payroll for the previous scheme year. (1 April 21 to 31 March 211) R 65. NEW: Total of ALL Temporary/Seasonal/Contract workers during 21/211 = 84 (Tip: Use the total of the month with the highest number) Name of contact person in org: (Other than SDF ) Position in company: (Other than SDF ) Contact persons Telephone/Cell number: Contact persons address: SDF Full name & Surname: Preferred name to be called: SDF Identification number: SDF address: SDF Telephone number: SDF Fax number: SDF Cell phone number: SDF address: CONTACT PERSON INFORMATION: Andre Le Roux Owner andre@applefarm.co.za SKILLS DEVELOPMENT FACILITATOR (SDF) INFORMATION: Elizabeth Catherine Smith Liza PO Box 1, Waverley, Pretoria, liza@sdf.co.za

3 ANNUAL TRAINING REPORT - 1 April 21 to 31 March 211 FOR LESS THAN 5 PERMANENT EMPLOYEES ONLY Page 3 of 8 A N N U A L T R A I N I N G R E P O R T 2 1 / Section C1: Training Profile Report for 21/211 Please complete the total number of all employees who received training since 1 April 21 up 31 March 211 (This include ALL permanent, temporary, seasonal and contract workers for whom SDL is paid over to SARS) African Coloured M F D M F D M F D M F D M F D In the table above: M=Male, F=Female, D=Person with disability All Employees Trained during Indian/Asian White Grand Total: Total 26 Indicate with an Section C3: ABET completed IN 21/211 Confirmation: No ABET completed in 21/211 Please complete if Adult Basic Education & Training (ABET) (namely LITERACY & NUMERACY programmes - ONLY) have been completed: ABET: LEVEL 1 ABET: LEVEL 2 ABET: LEVEL 3 ABET: LEVEL 4 Total no of employees who received ABET (Literacy & Numeracy )Training TOTAL trained in ABET: M F D Total In the table above: M=Male, F=Female, D=Person with disability Section C4: Amount spend on training during 21/211 Please complete the estimated amount that was spend on training from 1 April 21 to 31 March 211 +/- R 5.

4 ANNUAL TRAINING REPORT - 1 April 21 to 31 March 211 FOR LESS THAN 5 PERMANENT EMPLOYEES ONLY Page 4 of 8 A N N U A L T R A I N I N G R E P O R T 2 1 / Example 7 Driver & Operator Skills x 2 Life Skills x Mark with an 1 Admin & Computer Related Skills 2 Agricultural Maintenance Skills Learning Programmes: Major Cluster Community & Social Development Skills 7 Driver & Operator Skills 8 Early Childhood Development 9 1 Export Readiness 11 Financial Skills 12 Food Processing Skills Marketing & Sales Skills 24 Occupational Health & Safety Skills 25 Ornamental Horticultural Skills Section C2: Learning Programmes completed during 21/211 Please list all Learning Programmes that have been completed during 21/211 (Proof of these learning programmes (SAMPLE ONLY) must be submitted to AgriSETA with this application) Animal Production Skills Artisan & Technical Skills Basic Business Skills Engineering Skills Food Safety & Security Skills Game Farming Skills General Agricultural Skills Hospitality Skills Human Resources & Training Industrial Relations Skills Labour/General Worker Skills Life Skills Logistics Skills Management & Supervisory Skills Packing and/or Processing Skills Plant Production Skills Quality Control Research & Development Skills Tractor Driver; Drivers Licence HIV/Aids Specify type of training completed MS Office Forklift Operator Pastel; VIP Payroll First Aid; Health & Safety Representative Safety & Security Skills Science & Technology Skills REMEMBER to attach SAMPLE PROOF OF TRAINING COMPLETED as stated above to the ATR1/11 & WSP11/12 and OR FA OR POST OR DELIVER it to AgriSETA (PS: No original documents required - copies/scans will be sufficient)

5 WORKPLACE SKILLS PLAN - 1 April 211 to 31 March 212 FOR LESS THAN 5 PERMANENT EMPLOYEES ONLY Page 5 of 8 W O R K P L A C E S K I L L S P L A N / Section D1: EMPLOYMENT PROFILE (As on 1 April 211) Please complete the total number of people currently employed as on 1 April 211. (This include all permanent, temporary, seasonal and contract workers!) Total number of current employees as on 1 April 211 (Inc.: All Permanent / Temporary / Seasonal / Contract workers for whom SDL is paid to SARS) African Coloured Indian/Asian White Total Total per Age Group M F D M F D M F D M F D M F D < > Grand Total: 4 4 Section D2: Panned Training Profile for 211/212 Please complete the total number of people who will received training from 1 April 211 up to 31 March 212 (This include all permanent, temporary, seasonal and contract workers!) Planned employees TO BE trained in 211/212 African Coloured Indian/Asian White Total M F D M F D M F D M F D M F D In the table above: M=Male, F=Female, D=Person with disability Grand Total: 33 Section D4: Budget amount for training in 21/211 Please complete the estimated amount that you plan to spent on training from 1 April 211 up to 31 March 212 +/- R 1.

6 WORKPLACE SKILLS PLAN - 1 April 211 to 31 March 212 FOR LESS THAN 5 PERMANENT EMPLOYEES ONLY Page 6 of 8 W O R K P L A C E S K I L L S P L A N / Section C3: Planned Learning Programmes TO BE completed during 211/212 Please list all Learning Programmes that you plan to attend to or completed during 211/212 Example 7 Driver & Operator Skills x 2 Life Skills x Mark with an Learning Programmes: Major Cluster Artisan & Technical Skills General Agricultural Skills Life Skills Plant Production Skills Admin & Computer Related Skills Agricultural Maintenance Skills Animal Production Skills Basic Business Skills Community & Social Development Skills Driver & Operator Skills Early Childhood Development Engineering Skills Export Readiness Financial Skills Food Processing Skills Food Safety & Security Skills Game Farming Skills Hospitality Skills Human Resources & Training Industrial Relations Skills Labour/General Worker Skills Logistics Skills Management & Supervisory Skills Marketing & Sales Skills Occupational Health & Safety Skills Ornamental Horticultural Skills Packing and/or Processing Skills Quality Control Research & Development Skills Safety & Security Skills Science & Technology Skills Tractor Driver; Drivers Licence HIV/Aids Specify type of training to be completed Fitter & Turner Pruning HIV / Aids Cane Cutting

7 WORKPLACE SKILLS PLAN - 1 April 211 to 31 March 212 FOR LESS THAN 5 PERMANENT EMPLOYEES ONLY Page 7 of 8 W O R K P L A C E S K I L L S P L A N / Section D5: Planned ABET for 211/212 Indicate with an Confirmation: No planned ABET for 211/212 If you plan to expose any of you workers in 211/212 to Adult Basic Education & Training (ABET) (namely LITERACY & NUMERACY programmes - ONLY) please complete the table below. Total no of employees who will receive ABET (Literacy & Numeracy )Training ABET: LEVEL 1 ABET: LEVEL 2 ABET: LEVEL 3 ABET: LEVEL 4 TOTAL planned for ABET: In the table above: M=Male, F=Female, D=Person with disability M F D TOTAL Section D6: Scarce Skills AgriSETA is currently n the process of determining priority Scarce Skills in the Sector (A scarce skill refers to that skill which you consistently have difficulties in finding), to assist us, please list a maximum of 3 (three) scarce skills in your sector. For assistance please refer to the scare skills guide which contains a provisional list of scare skills. (You may add any other scare skill not appearing on the list. The list is available on our Skills Planning, Scarce & Critical Skill or ATR/WSP Downloads Please list your 3 (three) most important Scarce Skills (ONLY) Scarce Skills No.1 No.2 No.3 Fitter & Turner Indicate with an Confirmation: No Scarce Skills

8 MANDATORY GRANT APPLICATION: ATR 21/211 & WSP 211/212 FOR LESS THAN 5 PERMANENT EMPLOYEES ONLY 211: DECLARATION AND AUTHORISATION !!! ETREMELY IMPORTANT COMPLETE AND SIGN IN FULL!!! The Authorised Signatories and the Skills Development Facilitator hereby declare that this application for a Mandatory Grants is to the best of our knowledge true and correct. We understand that AgriSETA may independently verify the information. We also understand that it is an offence in terms of section 33(b) of the Act to knowingly furnish any false information in this application and that we may be fined or imprisoned for one year if we are found guilty of knowingly furnishing such false information. This organisation is up-to-date with levy payments to SARS. This is proof that consultation has occurred between employer and employee representatives (through the Training/Skills Development Committee) (if applicable) Page 8 of 8 Full name(s) & Surname of CEO/ Owner/ Managing Partner/ Trustee: Andre Johannes Le Roux Title (Position in Org) E.g. CEO/Owner/MP/Trustee * Original Signature of CEO / Owner / Managing Partner / Trustee: Direct Contact telephone number: Date Signed: Owner June 211 Full name(s) & Surname of SDF: Direct Contact * Original Signature of SDF: Date Signed: telephone number: Elizabeth Catherine Smith June 211 * Original Signature means you cannot cut and past/insert an electronic version of their signature. Print this page in order to sign it. Registered Name Trading Name SDL number (L ) Name of Bank Name of Branch BANK DETAILS OF ORGANISATION Please complete this section in full even if you have submitted banking details before. Organisations completing a consolidated grant submission must complete a separate banking details form (this page) for each SDL number where banking details differ. A Le Roux Appel Farm cc L ABSA PRETORIA CENTRAL Current / Cheque Savings Attach at least one of the following to confirm banking details: Type of account: Please tick the appropriate box with an Account Number Branch Code 1234 Copy of a Cheque, Original Cancelled Cheque or letter from bank confirming the company's bank details To whom it may concern: The Company/Entity authorizes AgriSETA to pay any amounts that may accrue to the Company/ Entity into the Company s/entity s account with the bank details reflected above. The Company/Entity understands that computer through a system known as the ACB ELECTRONIC TRANSFER SERVICES will process the credit transfers, which it has authorized. NAME of person confirming accuracy of the above mentioned bank John Nkosi Confirmation Signature: Job Title of person confirming bank details: Financial Manager Date confirmed: 1 June 211 PLEASE EITHER OR FA OR POST OR DELIVER THIS APPLICATION WITH REQUIRED PROOF OF TRAINING TO AGRISETA BY 3 JUNE 211