Consumer Co-operative Development Fund – Online Application Form
Please complete all sections and upload supporting documents to submit your application.
Co-operative Details
Name of Co-operative
*
Co-operative Registration Number
*
Province
*
Please Select
Eastern Cape
Free State
Gauteng
KwaZulu-Natal
Limpopo
Mpumalanga
Northern Cape
North West
Western Cape
Physical Address of Co-operative
*
Contact Person
*
First Name
Middle Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Governance
Total Number of Board Members
*
Number of Board Members that paid shares
*
Date of Last Board Meeting
*
-
Month
-
Day
Year
Date
How often does the board meet?
*
Weekly
Monthly
Quarterly
Value of one member share (R):
*
Number of members who have paid shares
*
Did you hold your first AGM
*
YES
NO
Provide date of last AGM or planned AGM
*
Upload Board Meeting Minutes (Last 3 Months)
*
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of
Project Proposal
Provide details of local suppliers secured to support the store, including the type of products they will supply, estimated quantities, and frequency of supply
*
Have you identified volunteers or members with retail or business experience? If yes, describe their skills and outline how they will contribute to store operations during the start-up phase?
*
How is your store linked to buying clubs and local production?
*
Latest Sales Reports / Buying Club Order Records for the Last 3 Months
*
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Budget
Total amount requested
*
Budget cost categories covered by this application
*
Stock
Renovations
Equipment
Other
Provide a budget summary for the selected cost categories
*
Explain the amounts and use of funds under Stock, Renovations, Equipment and/or Other. Stock must be at least 35% of the total budget and should include locally produced items where possible.
Upload Detailed Budget Breakdown
*
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Member Contribution
Total value of member share contributions towards opening the store(R)
*
Cash contribution amount (R) if applicable
*
In-kind contribution amount (R) if applicable
*
In-kind contribution types
*
Labour
Services
Materials
Equipment
Transport
Donation
Venue or space
Other
Describe the selected contribution details
*
Provide details about the items selected above.
Upload member share register
*
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Banking Details
Bank Name
*
Account Name
*
Account Number
*
Upload Bank Confirmation Letter
*
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Upload Last 3 Months Bank Statements
*
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of
Buying Club Activity
Number of active buying clubs
*
Name atleast one Whatsapp Group
Total number of active buying club members
*
Indicate the total number of members currently participating in buying club orders.
How many members are currently placing monthly buying club orders of at least R500 per month?
*
Only include members who place orders of R500 or more per month.
Average monthly value of orders per buying club (R)
*
Enter the average monthly amount in rand for one buying club.
Total monthly value of all buying club orders (R)
*
Enter the combined monthly value of all buying club orders in rand.
Average monthly value of orders per buying club (R)
*
Provide the average monthly value of orders for each buying club.
Describe your buying club activity
Upload proof of buying club activity (orders / records)
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Communication
Do you have an active WhatsApp group for members?
*
Yes
No
What is the name of the Whatsapp Group?
Store Site
Location of the proposed store
*
Physical Address of the Store
*
Enter the full physical address of the proposed store site.
Upload Pictures of Proposed Store Site(s)
*
Upload Photos
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Please upload clear photos of the proposed site, including the exterior, interior if available, and the surrounding area.
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Type of site proof
*
Lease Agreement
Rights to Occupy
Letter of Intent
Upload store site documentation
*
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Declaration
Do you confirm that all information provided is true and correct?
*
Yes
No
Full Name of Applicant
*
First Name
Last Name
Position in Co-operative
*
Date
*
-
Month
-
Day
Year
Date
If you have not convene your AGM, provide proposed date to hold AGM
-
Month
-
Day
Year
Date
Submit Application
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