COMPANY REGISTRATION ONLINE APPLICATION Web Site COMPANY NAME In order to apply for a name reservation please provide three (3) proposed names for the company: 1 2 3 COMPANY ADDRESS Physical Registered Address Suburb City postal code Provinces Western Cape Eastern Cape Northern Cape North West Free State Kwazulu Natal Gauteng Limpopo Mpumlanga DIRECTOR DETAILS How many Directors will be appointed? 1 2 3 4 5 Director Information Is the Director an Incorporator? Yes No SHAREHOLDER DETAILS How many shares will be issued? 100 1000 Other How many Shareholders will be appointed? 1 2 3 4 5 Is a director a shareholder? Yes No Is the Shareholder a natural person or juristic person (e.g. trust or company)? Natural Person Juristic Person
