MANDATORY GRANT APPLICATION - 2014/2015Less than 50 Employees

Name of Organisation:Trading as:

Annexure 2 due date 30 April 2014. No extensions will be granted.

W&RSETA Date Stamp Seta Office Use

(Annual Training Report 01 April 2013 – 31 March 2014 & Workplace Skills Planning Grant 01 April 2014 – 31 March 2015)

Skills Development Levy (SDL) Number:

Skills Development Levy (SDL) Number to be linked to main number (if applicable):

The grant application form is to be used in conjunction with the guidelines on the web-site: www.wrseta.org.za

Captured By

Table of Contents

2 ATR FORMS2.1 Section D: Number of actual beneficiaries of Training2.2 Section D5: Actual Spent on Training

2.4 Section H: Variance Report

2.5 Section I: Vacancies difficult to fill3 WSP FORMS3.1 Section A2: Banking Details3.2 Section B: Employment Summary3.3 Section C1: Planned Beneficiaries of Training3.4 Section D: Total Projected Bugdet

Apdx A – Contact details for W&RSETA

2.3 Section F1: Pivotal Number of actual beneficiaries of Training (this will read from Section D Number of actual Benefeciaries of training)

3.5 Section E1: Pivotal Planned Beneficiaries of Training (this will read from Section C1 Planned Beneficiaries of Training3.6 Section G: Authorisation and Stakeholder Support (WSP, ATR, Banking Details and PIVOTAL Report) Declaration

OFOOccupationID MunicipalityID InterventionIDOFO Occupation Geography Intervention

Leave Empty Leave Empty Leave Empty111203 Mkhomazi Wilderness Area Bursary862925 King Sabata Dalindyebo Credit Bearing Short Courses

ProgrammeName SocioEconomicStatusID AfricanMaleProgramme Name Socio Economic Status African Male

Leave Empty Leave Empty Leave EmptyProgramme Name 1 Employed 1Programme Name 2 Unemployed 0

AfricanFemale AfricanDisabled ColouredMale ColouredFemale ColouredDisabledAfrican Female African Disabled Coloured Male Coloured Female Coloured Disabled

Leave Empty Leave Empty Leave Empty Leave Empty Leave Empty0 1 1 1 11 1 1 1 1

IndianMale IndianFemale IndianDisabled WhiteMaleIndian/Asian Male Indian/Asian Female Indian/Asian Disabled White Male

Leave Empty Leave Empty Leave Empty Leave Empty1 1 1 10 0 0 0

WhiteFemale WhiteDisabled Age1 Age2White Female White Disabled Age Group - Less than 35 Age Group - 35 to 55

Leave Empty Leave Empty Leave Empty Leave Empty1 1 7 00 0 0 3

Age3 NQFNonAligned NQFLevel1Age Group - Greater than 55 NQF Non Aligned NQF Level 1

Leave Empty Leave Empty Leave Empty0 7 00 3 0

NQFLevel2 NQFLevel3 NQFLevel4 NQFLevel5NQF Level 2 NQF Level 3 NQF Level 4 NQF Level 5

Leave Empty Leave Empty Leave Empty Leave Empty0 0 0 00 0 0 0

NQFLevel6 NQFLevel7 NQFLevel8 NQFLevel9 NQFLevel10NQF Level 6 NQF Level 7 NQF Level 8 NQF Level 9 NQF Level 10

Leave Empty Leave Empty Leave Empty Leave Empty Leave Empty0 0 0 0 00 0 0 0 0

Actual Spent on Training form

Actual Spent On Training (R)

Please attach the summary sheet of the amounts spent on training to this submission

Please ensure you use the W&RSETA Training intervention spreadsheet template - download from W&RSETA website: www.wrseta.org.za

Please ensure you use the W&RSETA Training intervention spreadsheet template - download from W&RSETA website: www.wrseta.org.za

Variance Report

Total Total Planned Total ActualBeneficiaries of TrainingPivotal Beneficiaries of Training

Comments

Vacancies difficult to fill

OFO Occupation Projected Number Of Staff NeededReason/s For The Scarcity

Vacancies difficult to fill

Number Of Qualified Persons Imported From Outside South Africa

Banking Details

Name Of Bank

Account Type

Account Number

Branch Code

The Company Banking Details Remain The Same As Listed Above

The Company Banking Details Have Changed And I Submit With The Report Proof Of New Banking Details(Stamped Letter From Bank)

OFOOccupationID MunicipalityID AfricanMale AfricanFemaleOFO Occupation Geography African Male African Female

Leave Empty Leave Empty Leave Empty Leave Empty111204 Mkhomazi Wilderness Area 1 0862924 King Sabata Dalindyebo 0 1

AfricanDisabled ColouredMale ColouredFemale ColouredDisabledAfrican Disabled Coloured Male Coloured Female Coloured Disabled

Leave Empty Leave Empty Leave Empty Leave Empty1 1 1 11 1 1 1

IndianMale IndianFemale IndianDisabled WhiteMaleIndian/Asian Male Indian/Asian Female Indian/Asian Disabled White Male

Leave Empty Leave Empty Leave Empty Leave Empty1 1 1 10 0 0 0

WhiteFemale WhiteDisabled Age1 Age2White Female White Disabled Age Group - Less than 35 Age Group - 35 to 55

Leave Empty Leave Empty Leave Empty Leave Empty1 1 7 00 0 0 3

Age3Age Group - Greater than 55

Leave Empty00

OFOOccupationID MunicipalityID InterventionIDOFO Occupation Geography Intervention

Leave Empty Leave Empty Leave Empty111203 Mkhomazi Wilderness Area Bursary862925 King Sabata Dalindyebo Credit Bearing Short Courses

ProgrammeName SocioEconomicStatusID AfricanMaleProgramme Name Socio Economic Status African Male

Leave Empty Leave Empty Leave EmptyProgramme Name 1 Employed 1Programme Name 2 Unemployed 0

AfricanFemale AfricanDisabled ColouredMale ColouredFemaleAfrican Female African Disabled Coloured Male Coloured Female

Leave Empty Leave Empty Leave Empty Leave Empty0 1 1 11 1 1 1

ColouredDisabled IndianMale IndianFemale IndianDisabledColoured Disabled Indian/Asian Male Indian/Asian Female Indian/Asian Disabled

Leave Empty Leave Empty Leave Empty Leave Empty1 1 1 11 0 0 0

WhiteMale WhiteFemale WhiteDisabled Age1White Male White Female White Disabled Age Group - Less than 35

Leave Empty Leave Empty Leave Empty Leave Empty1 1 1 70 0 0 0

Age2 Age3 NQFNonAlignedAge Group - 35 to 55 Age Group - Greater than 55 NQF Non Aligned

Leave Empty Leave Empty Leave Empty0 0 73 0 3

NQFLevel1 NQFLevel2 NQFLevel3 NQFLevel4NQF Level 1 NQF Level 2 NQF Level 3 NQF Level 4

Leave Empty Leave Empty Leave Empty Leave Empty0 0 0 00 0 0 0

NQFLevel5 NQFLevel6 NQFLevel7 NQFLevel8NQF Level 5 NQF Level 6 NQF Level 7 NQF Level 8

Leave Empty Leave Empty Leave Empty Leave Empty0 0 0 00 0 0 0

NQFLevel9 NQFLevel10NQF Level 9 NQF Level 10

Leave Empty Leave Empty0 00 0

WSP Section C6: Total Projected Bugdet

Total Projected Training Budget (R)

WSP CheckList

AuthorisationSignature Of Employer Representative Is PresentSignature Of Employee Representative Is PresentSignature Of SDF Or ISDF Is PresentBanking Details CapturedProof Of Banking DetailsLetter Stamped By Bank Is Attached

Proof of company registered less than 6 months ago

Form Emp 201 Attached

Levies ReceivedThe System Reflects Levies Up To December 2013

Authorisation

Declaration

Organisation DetailsLegal Name:Trade Name:SDL Number:

Signatories

Designated Signatory Date

AuthorisationCEO/Managing Director

Section G of the template, with the original signatures must be scanned and uploaded onto the Seta System as well as submitted online by 30 April 2014.

We, the undersigned, submit this information in fulfilment of this entity’s legal obligation in terms of the skills development legislation and requirements. We declare that, to the best of our knowledge, the information contained in this Annexure 2 (WSP/ATR and Pivotal) Report including the Banking Details is accurate and up to date. We recognise that any inaccurate statement in this document may constitute fraud and be subject to the full penalty of the law.

Name and Surname

Telephone Number

Original Signature

The Person who completed WSP/ATR/ PIVOTAL Report

Apdx A – Contact details for W&RSETA

Region Tel ContactAddressGauteng North 012 – 430 4930 1267 Pretorius Street

Block B, Hadefield Office Park

Hatfield

PretoriaGauteng South 011 – 656 0085 Building 18, The Woodlands Office Park

Western Service Road

Woodmead

JohannesburgMpumalanga 013 – 690 1214 64 Mandela Street

202 Parkmed Centre

WitbankLimpopo 015 – 291 2237 Cnr. Hans van Rensburg & Jorrison Street

FNB Building, First Floor

Office Suite 001

PolokwaneNorth West 014 – 592 0483 49 Heysteck Street

Heysteck Office Park

Office Suit 9

RustenburgWestern Cape 021 – 442 6700 Third Floor, Old Warehouse Bldg

Black River Parkway

Fir Road, Observatory

Cape TownKZN Region 031 - 277 0500 Office 102B, 1st floor, Clifton Place

19 Hurst Grove

KZN Region 031 - 277 0500

Musgrave

DurbanFree State 051 - 447 8443 133 St. Andrew Street, Ground Floor,

Justitia Building,

BloemfonteinEastern Cape 043 – 722 3010 18 Surrey Street

Vincent

5247

East LondonNorthern Cape 053 – 831 4117 Shop 16B, Flaxley House,

24-28 Du Toitspan Road,

Kimberley

OFOOccupationID MunicipalityID111101 Abaqulusi111102 Aberdeen Plain111201 Aganang111202 Albert Luthuli111203 Amahlathi111204 Ba-Phalaborwa111205 Baviaans111206 Beaufort West111207 Bela-Bela111301 Benede Oranje111401 Bergrivier111402 Bitou112101 Blouberg121101 Blouberg121102 Blue Crane Route121103 Breede River121104 Breede River/Winelands121201 Breede Valley121202 Buffalo City121203 Bushbuckridge121204 Camdeboo121205 Cape Agulhas121206 Cape Town Metro121301 Cederberg121901 Central Karoo121902 Dannhauser121903 Delmas121904 Diamondfields121905 Dihlabeng121906 Dikgatlong121907 Dipaleseng121908 Ditsobotla122101 Dr JS Moroka122102 Drakenstein122103 eDumbe122104 Ekurhuleni Metro122105 Elundini122201 Emalahleni EC122301 Emalahleni MP131101 Emfuleni131102 Emnambithi-Ladysmith131103 Emthanjeni131201 eNdondakusuka132101 Endumeni132102 Engcobo132104 eThekwini Metro132105 Ezingoleni

132201 Fetakgomo132202 Gaints Game Reserve132203 Gamagara132301 Gariep132302 Ga-Segonyana132401 George132402 Govan Mbeki132403 Great Kei132404 Greater Giyani132405 Greater Groblersdal132406 Greater Kokstad132407 Greater Letaba132408 Greater Marble Hall133101 Greater Taung133102 Greater Tubatse133103 Greater Tzaneen133104 Hantam133105 Hessequa133106 Hibiscus Coast134101 Highlands134201 Hlabisa134202 Ikwezi134203 Imbabazane134204 Impendle134205 Indaka134206 Ingwe134301 Inkwanca134401 Intsika Yethu134402 Inxuba Yethemba134501 Johannesburg Metro134502 Jozini134503 Kagisano134504 Kai Garib134505 Kalahari134506 Kamiesberg134507 Kannaland134601 Kareeberg134602 Karoo Hoogland134603 Kgatelopele134701 Kgetlengrivier134702 Kh?i-Ma134703 Khara Hais134901 Kheis134902 King Sabata Dalindyebo134903 Knysna134904 Kopanong134905 Kouga134906 Kou-Kamma

134907 Kruger National Park134908 Kungwini134909 Kwa Sani134911 KwaDukuza134912 Laingsburg134913 Lekwa134914 Lekwa-Teemane134915 Lepele-Nkumpi134916 Lephalale141101 Lesedi141102 Letsemeng141103 Lowveld141201 Lukanji141202 Madibeng141203 Mafikeng141204 Mafube142101 Magareng142102 Makana142103 Makhado142104 Makhuduthamaga143101 Maletswai143102 Maluti a Phofung143103 Mamusa143104 Mangaung143105 Mantsopa143106 Maphumulo143107 Maquassi Hills143108 Maruleng143109 Masilonyana143901 Matatiele143902 Matjhabeng143903 Matlosana143904 Matzikama143905 Mbhashe143906 Mbizana143907 Mbombela143908 Mbonambi143909 Merafong City211101 Metsimaholo211201 Mhlontlo211301 Midvaal211401 Mier211402 Mkhambathini211403 Mkhomazi Wilderness Area211404 Mkhondo211405 Mnquma212101 Modimolle212102 Mogalakwena

212103 Mogale City213101 Mohokare213102 Molemole213103 Molopo213104 Mooi Mpofana213105 Mookgopong213106 Moqhaka213107 Moretele213108 Moses Kotane213109 Moshaweng213110 Mossel Bay213201 Msinga213202 Msukaligwa213203 Msunduzi213204 Mthonjaneni213205 Mtubatuba213301 Musina213302 Mutale213304 Nala213305 Naledi FS213306 Naledi NW213307 Nama Khoi214101 Ndlambe214102 Ndwedwe214201 Nelson Mandela Metro214202 Newcastle214301 Ngqushwa214302 Ngwathe214401 Nkandla214402 Nketoana214403 Nkomazi214404 Nkonkobe214405 Nokeng tsa Taemane214406 Nongoma214407 Nquthu214408 Ntabankulu214501 Ntambanana214502 Nxuba214503 Nyandeni214601 Okhahlamba214602 Oudtshoorn214603 Overberg214604 Overstrand214605 Phokwane214607 Phumelela214901 Pixley Ka Seme214902 Polokwane214903 Port St Johns

214904 Potchefstroom214905 Prince Albert214906 Qaukeni214907 Ramotshere Moiloa214908 Randfontein215101 Ratlou215102 Renosterberg215103 Richmond215104 Richtersveld215201 Rustenburg215202 Sakhisizwe215301 Saldanha Bay215302 Senqu215303 Setsoto215304 Siyancuma216101 Siyathemba216201 Sol Plaatjie216301 South Cape216302 St Lucia Park216303 Stellenbosch216304 Steve Tshwete216401 Sunday's River Valley216402 Swartland216501 Swellendam216502 Thaba Chweu216601 Thabazimbi216602 The Big Five False Bay216603 Theewaterskloof216604 Thembelihle221101 Thembisile221102 Thulamela221103 Tokologo221201 Tsantsabane221202 Tshwane Metro221203 Tsolwana221204 Tswaing221205 Tswelopele221206 Ubuhlebezwe221207 Ubuntu221208 Ulundi221209 Umdoni221210 Umhlabuyalingana221211 uMhlathuze222101 Umjindi222102 uMlalazi222103 uMngeni222104 uMshwathi222105 Umsobomvu

222106 Umtshezi222107 UMuziwabantu222108 Umvoti222109 Umzimkhulu222110 Umzimvubu222111 Umzumbe222112 UPhongolo222113 Utrecht222114 Ventersdorp222115 Vulamehlo222116 West Coast222201 Westonaria223101 Witzenberg223102223103223104223105224101224102225101225102225103226101226102226201226202226203226301226302226303226401226501226601226602226701226702226901226902226903226904226905226906226907231101231102232101232102232103

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InterventionIDGeneric, Diplomas, Degrees, CertificatesTechnical QualificationsTechnical ProgrammesInternshipArticlesLearnershipsApprenticeshipsSkills ProgrammesCredit Bearing Short CoursesContinuing Professional DevelopmentWork Experience for unemployed graduates (in scarce skills)Non-credit Bearing Short CoursesBursaryArtisan Trade TestingRecognition of Prior Learning

SocioEconomicStatusIDEmployedUnemployed