MANDATORY GRANT APPLICATION: ATR 2017/2018 & WSP 2018/2019 FOR LESS THAN 50 PERMANENT EMPLOYEES ONLY

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Randolph Osborne Haynes
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1 Page 1 of 11 MANDATORY GRANT APPLICATION: ATR 2017/2018 & WSP 2018/2019 DO NOT DELETE OR CHANGE ANY PART OF THIS DOCUMENT! FINAL SUBMISSION DUE DATE: MONDAY, 30 APRIL 24: NO exceptions OR extensions This form is ONLY for Employers employing LESS THAN 50 PERMANENT Employees LESS THAN 50 ANNUAL TRAINING REPORT 2017/2018 Report of actual training completed from 1 April 2017 up to 31 March 2018 & WORKPLACE SKILLS PLAN 2018/2019 Planning of training to be completed from 1 April 2018 up to 31 March 2019 SDL No: L 0 7 Organisation Name: Once completed in full preferable fax or the application to AgriSETA OR DELIVER: 529 Belvedere Street, AgriSETA House, Arcadia, Pretoria, 0083 (Not for postal purpose) OR POST: Mandatory Grants, PO Box 26024, Arcadia, Pretoria, 0007 NOTE: NO ORIGINAL DOCUMENTATION REQUIRED - Fax or (scan) copies are sufficient Phone: / Fax: or / amandie@agriseta.co.za

2 Organization Legal & Trade name: Registration number: (If applicable) Page 2 of 11 MANDATORY GRANT APPLICATION: ATR 2017/2018 & WSP 2018/2019 ORGANISATION INFORMATION SDL No.: Physical Address: Company/Farm Street Town/City Code: Postal Address: Box/Bag Town/City Postal Code: L 0 7 Province Municipality Province Municipality click click Organisation Telephone number: Organisation Fax number: Organisation address: *No of permanent employees: (As on 1 April 2018 ) *No of temporary/season/contract workers (As on 1 April 2018 ) (*This includes only those employees for whom SDL is paid to SARS) SIC Code: (Main business activity) (Tip: Use the total of the month with the highest number) 0 Select ONLY ONE code Total of ALL Temporary/Seasonal/Contract workers during 2017/2018 = = Grand Total Name of contact person in org (Other than SDF) Position in company (Other than SDF) Contact persons Telephone/Cell number Contact persons address Name & Surname of CFO Cell Phone number Fax Number address SKILLS DEVELOPMENT FACILITATOR (SDF) INFORMATION: SDF Full name & Surname SDF Identification number SDF Postal address SDF Telephone number SDF Fax number SDF Cell phone number SDF address CONTACT PERSON INFORMATION: ORGANISATION CFO CONTACT DETAILS: If the organisation do not have a Chief Financial Officer (CFO), a finance/admin person's details will suffice.

3 Page 3 of 11 ANNUAL TRAINING REPORT - 1 April 2017 to 31 March 2018 A N N U A L T R A I N I N G R E P O R T / Section C1: Training Profile Report for 2017/2018 Please complete the total number of all employees who received training since 1 April 2017 up 31 March 2018 (This include ALL permanent, temporary, seasonal and contract workers for whom SDL is paid over to SARS) All Employees Trained during 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: AET: LEVEL 1 AET: LEVEL 2 AET: LEVEL 3 AET: LEVEL 4 Section C3: AET completed IN 2017/2018 Please complete if Adult Education & Training (AET) (namely LITERACY & NUMERACY programmes - ONLY) have been completed Total no of employees who received AET (Literacy & Numeracy )Training Grand Total: In the table above: M=Male, F=Female, D=Person with disability M F D Total Indicate with an X Confirmation: No AET completed in 2017/2018 Section C4: Amount spend on training during 2017/2018 Please complete the estimated TOTAL amount that was spend on training from 1 April 2017 to 31 March /- R This amount includes all training costs but when sending sample of proof of training. DO NOT send any petrol/tollgate slips, catering/refreshment invoices, airline tickets, accommodation invoices, any quotations, any registration forms, programme information, booking forms, s with info, ID Copies, agreements or contracts, statements, proof of payment, receipt of monies received, etc. (This is NOT correct/acceptable forms of proof of training completed)

4 Page 4 of 11 ANNUAL TRAINING REPORT - 1 April 2017 to 31 March 2018 A N N U A L T R A I N I N G R E P O R T / Example Example Example 7 Driver & Operator Skills X 20 Life Skills X Learning Programmes: Major Cluster Admin & Computer Related Skills Agricultural Maintenance Skills Animal Production Skills Artisan & Technical 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 General Agricultural Skills Hospitality Skills Human Resources & Training Industrial Relations Skills Labour/General Worker Skills Life Skills Logistics Skills Management & Supervisory Skills Marketing & Sales Skills Occupational Health & Safety Skills Ornamental Horticultural Skills Packing and/or Processing Skills Plant Production Skills Quality Control Section C2: Learning Programmes completed during 2017/2018 Please list all Learning Programmes that have been completed during 1 April 2017 to 31 March 2018 Research & Development Skills Safety & Security Skills (Proof of these learning programmes (SAMPLE ONLY) must be submitted to AgriSETA with this application) Mark with an X Tractor Driver; Drivers Licence; Bell Operator HIV/Aids; Alcohol Abuse Specify the different types of training done Science & Technology Skills REMEMBER to attach SAMPLE PROOF OF TRAINING COMPLETED as stated above to the ATR17/18 & WSP18/19 and OR FAX OR POST OR DELIVER it to AgriSETA (PS: No original documents required - copies/scans/fax will be sufficient)

5 Page 5 of 11 ANNUAL TRAINING REPORT - 1 April 2017 to 31 March 2018 FOR LESS THAN 50 EMPLOYEES OFO Digit code Employment (Mark with a X) Complete the ALL employees who completed PIVOTAL training during 1 April 2017 to 31 March 2018 according to OFO, race, gender, age and municipality. Refer to the Mandatory Grant Info Manual & Step-by-Step Guidelines for more information. Please make use of the National OFO version 2015 only Skills Programme PIVOTAL Programmes (Mark with a X) Degree / Diploma Internship SECTION C5: PIVOTAL TRAINING C0MPLETED DURING PIVOTAL Programmes mean professional, vocational, technical, and academic learning programmes that result in occupational qualifications and may include a knowledge component that is normally delivered at a further education and training college or a university as well as structured learning in an accredited training centre or an approved workplace. Examples of the types of learning are, Professional Learning would be a BCOM for Accountants, Vocational learning would be the National Certificate Vocational obtained from an FET college, Technical learning would be N4 Electrical Engineering and Academic Learning would be the MBChB required for Medical Doctors that can only be studied at University EMPLOYED UNEMPLOYED Learnership Graduate Placement Artisan Entry (Level 1 to 3) LEVEL (Mark with a X) Intermediate (Level 4 to 7) Advanced (Level8 to 10) AFRICAN COLOURED TOTAL per age group M F D M F D M F D M F D M F D < >55 Municipality ASIAN/ INDIAN WHITE TOTAL Geography Total number of ALL EMPLOYEES: PIVOTAL TRAINING COMPLETED M + F + D = = Mark with an X Confirmation: No PIVOTAL Training completed during

6 Page 6 of 11 WORKPLACE SKILLS PLAN - 1 April 2018 to 31 March 2019 FOR LESS THAN 60 PERMANENT EMPLOYEES ONLY 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 2018) Please complete the total number of people currently employed as on 1 April (This include all permanent, temporary, seasonal and contract workers) African Total number of current employees as on 1 April 2018 (Inc.: All Permanent / Temporary / Seasonal / Contract workers for whom SDL is paid to SARS) Coloured Indian/Asian M F D M F D M F D M F D M F D < >55 White Total Total per Age Group Grand Total: Section D2: Panned Training Profile for 2018/2019 Please complete the total number of people who will received training from 1 April 2018 up to 31 March 2019 (This include all permanent, temporary, seasonal and contract workers!) Planned employees TO BE trained in 2018/2019 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: Section D4: Budget amount for training in 2018/2019 Please complete the estimated TOTAL amount planned for training from 1 April 2018 up to 31 March /- R

7 Page 7 of 11 WORKPLACE SKILLS PLAN - 1 April 2018 to 31 March 2019 W O R K P L A C E S K I L L S P L A N / Example Example Example 7 Driver & Operator Skills X 20 Life Skills X Section D3: Planned Learning Programmes TO BE completed during 2018/2019 Learning Programmes: Major Cluster Admin & Computer Related Skills Agricultural Maintenance Skills Animal Production Skills Artisan & Technical 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 General Agricultural Skills Hospitality Skills Human Resources & Training Industrial Relations Skills Labour/General Worker Skills Life Skills Logistics Skills Management & Supervisory Skills Marketing & Sales Skills Occupational Health & Safety Skills Ornamental Horticultural Skills Packing and/or Processing Skills Plant Production Skills Quality Control Research & Development Skills Safety & Security Skills Science & Technology Skills Please list all Learning Programmes that you plan to attend or completed during 2018/2019 Mark with an X Tractor Driver; Drivers Licence; Bell Operator HIV/Aids; Alcohol Abuse Specify the different types of training to be completed

8 Page 8 of 11 WORKPLACE SKILLS PLAN - 1 April 2018 to 31 March 2019 W O R K P L A C E S K I L L S P L A N / Section D6: Planned AET for 2018/2019 If you plan to expose any of you workers in 2018/2019 to Adult Education & Training (AET) (namely LITERACY & NUMERACY programmes - ONLY) please complete the table below. Total no of employees who will receive AET (Literacy & Numeracy )Training M F D TOTAL AET: LEVEL 1 AET: LEVEL 2 AET: LEVEL 3 AET: LEVEL 4 Grand Total: In the table above: M=Male, F=Female, D=Person with disability Indicate with an X Confirmation: No planned AET for 2018/2019 Section D7: Scarce Skills A scarce skill refers to that skill which you consistently have difficulties in finding Please list a maximum of 3 (three) scarce skills PER OFO CODE in your sector and the reason for scarcity. 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 Skills or Documentation and Information Please list your 3 (three) most important Scarce Skills (ONLY) Reason for scarcity (Mark with X) Select only ONE (1) option No. Example No.1 No.2 No.3 SCARCE SKILLS (OFO CODE) Tractor Driver New/emerging occupation Lack of Skilled People X Replacement Demand Geographical Location Equity Considerations Replacement Demand PS: Select only one (1) reason for scarcity Indicate with an X Confirmation: No Scarce Skills

9 Page 9 of 11 WORKPLACE SKILLS PLAN - 1 April 2018 to 31 March 2019 W O R K P L A C E S K I L L S P L A N / Section D7: HIV / AIDS 1 Do you know of any staff living with HIV/AIDS? YES NO 2 If you know any, how many employees? No. of employees: 3 Do you provide any HIV/AIDS training in your company? YES NO 4 How often do you provide HIV/AIDS training, if yes above? 5 Do you want to do HIV/AIDS trainining in your company? YES NO 6 How many employees would you be able to train? No. of employees:

10 OFO Digit code Employment (Mark with a X) Degree / Diploma Internship Intermediate (Level 4 to 7) Advanced (Level8 to 10) Page 10 of 11 WORKPLACE SKILLS PLAN - 1 April 2018 to 31 March 2019 FOR LESS THAN 50 PERMANENT employees SECTION D8: PLANNED PIVOTAL TRAINING PIVOTAL Programmes mean professional, vocational, technical, and academic learning programmes that result in occupational qualifications and may include a knowledge component that is normally delivered at a further education and training college or a university as well as structured learning in an accredited training centre or an approved workplace. Examples of the types of learning are, Professional Learning would be a BCOM for Accountants, Vocational learning would be the National Certificate Vocational obtained from an FET college, Technical learning would be N4 Electrical Engineering and Academic Learning would be the MBChB required for Medical Doctors that can only be studied at University Complete ALL employees for whom PIVOTAL training is planned for during 1 April 2018 to 31 March 2019 according to OFO, race, gender, age and municipality. Refer to the Mandatory Grant Info Manual & Step-by-Step Guidelines for more information. Please make use of the National OFO version 2015 only EMPLOYED UNEMPLOYED Skills Programme PIVOTAL Programmes (Mark with a X) Learnership Graduate Placement Artisan Entry (Level 1 to 3) LEVEL (Mark with a X) AFRICAN COLOURED ASIAN/ INDIAN WHITE TOTAL per age group Geography M F D M F D M F D M F D M F D < >55 Municipality TOTAL Total number of ALL EMPLOYEES: Planned PIVOTAL training Mark with an X M + F + D = = Confirmation: No PIVOTAL Training PLANNED for ANY employees for

11 Page 11 of 11 SIGN OFF PAGE for 2018 MANDATORY GRANT APPLICATION: ATR & WSP : D E C L A R A T I O N & A U T H O R I S A T I O N COMPLETE AND SIGN IN FULL - ALL FIELDS ARE COMPULSORY 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) Full NAME & SURNAME of CEO/ Owner/ Managing Partner/ Trustee: 1 Title (Position in Org) E.g. CEO/Owner/MP/Trustee * Original Signature of CEO / Owner / Managing Partner / Trustee: Direct Contact Telephone number: Date Signed: 2 Full name & Surname of SDF: Direct Contact * Original Signature of SDF: Date Signed: Telephone number: * Original Signature means you cannot cut and past/insert an electronic version of their signatures. Print this page in order to sign it. Also note pp is not allowed! The relevant and correct persons as required must sign this document in full. 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. Registered Name Trading Name SDL number (L ) Name of Bank Name of Branch 3 Type of account: Please tick the appropriate box with an X Account Number Branch Code Current / Cheque Attach at least one of the following to confirm banking details (if not yet approved at AgriSETA): Date confirmed: Savings Copy of a Cancelled Cheque, Bank Confirmation Letter (stamped by bank) or Bank Statement (1 page only) (stamped by bank) 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. Please complete and sign this section in full to confirm the above banking details are current and correct. NAME & SURNAME of person confirming accuracy of the above mentioned bank details: Job Title of person confirming bank details: *Original Confirmation Signature: PLEASE OR FAX OR POST OR DELIVER THIS APPLICATION WITH REQUIRED PROOF OF TRAINING (If applicable) TO AGRISETA BY 30 APRIL 2018

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

Page 1 of 8 MANDATORY GRANT APPLICATION: ATR 2010/2011 & WSP 2011/2012 Once completed in full either fax or e-mail or post or deliver this application to: DELIVER: 529 Belvedere Street, AgriSETA House,