KAUAI PROSPECTIVE FRANCHISEE APPLICATION FORM Application Form Page 1
SECTION A BUSINESS DETAIL Who would run the franchise (Full-time) Date available for training: Geographical preference 1 2 3 Do you intend involving a partner? Yes No If yes, such a person must also complete an application form. Name of partner/s Each partner to complete financial section individually State approximate shareholding Self % Partner Name % Note: Both parties must complete Section C Section F and both parties must sign the Application Form. Intended Financing (new franchisees cannot not be considered who have less than 50% own cash contribution) Means R Source Own cash Partners cash contribution Will you apply for a business loan? Yes No What is your understanding of what the type of Kauai will cost in terms of set up costs; R What amount do you have for working capital?; R Have you considered the lease deposit and if so how much?: If you apply for financing, how long do you feel this will take to be approved?; Application Form Page 2
SECTION B1 PERSONAL DETAILS OF THE MANAGING OWNER/OPERATING PARTNER Note: 1. This section is to be completed by the individual who will be responsible for the day-to-day management of the franchised store. 2. Please attach a copy of your I.D. Document. Surname First names Place of birth Date of birth Residential address Postal address Telephone (Business) Cell ID Number Permanent SA Citizen Yes No Fax no Telephone (Home) e-mail address Nationality At present address Years Months Residential Property is Owned Rented Code Code Marital Status Single Y N If Married In community of property If divorced Final Yes No Date Final If widow/er Out of community of property Other ANC without Accrual If married please supply the following additional information about your spouse First names Place of birth Nationality Date of birth ID Number Name of employer Employer address Employers telephone Present position Annual Income Number of dependents Number of children Their ages Code Does your spouse understand the business risks and potential rewards involved? Yes No Do your spouse and family understand the extra demands that a new business and the restaurant industry will make in relation to your time and effort, especially in the establishment phase of the business? Yes No Application Form Page 3
Employment history Employer From To Type of work Last position held Annual income 1. 2. 3. Education Highest standard passed. Do you have a degree or diploma Formal apprenticeships or pupilage? Do you have any formal business skills? Year If YES, specify If YES, specify If YES, specify Medical information What is your general state of health? Excellent Very Good Good Poor Is there any additional information regarding your general state of health that may impact on your ability to be a Kauai Franchisee? If yes, please give details. Details of next of kin Name and residential address of next of kin (not of the same address) Relationship: Name Telephone Code Application Form Page 4
Details of primary cheque/credit card/savings account Type of account Bank/Institution Account Number Date Opened Limits Self 1. Cheque 2. Credit card 3. Savings Spouse 1. Cheque 2. Credit Card 3. Savings Current accounts (If none, recently settled accounts) Institution/Business Branch Account Number Balance Present limit 1. 2. 3. 4. Credit record Have you ever had any judgments against you (are you blacklisted)? Yes No If YES, specify details Have you ever been sequestrated? Yes No If YES, specify details Have you ever been found guilty of a criminal offence Yes No If YES, specify details Date Application Form Page 5
Statement of Assets and Liabilities ASSETS (Amount in Rand) (A) 1. Fixed Property registered in your name City and Town property Owners Valuation Bank Use Erf no City/Township Purchase Price Date Purchased Fire Insurance Farm and Smallholding property Owners Valuations Bank Use Erf no Name of farm City/Township Purchase Price Date Purchased Fire Insurance Property bought under deed of sale Erf no Name of farm City/Township Purchase Price 2. Mortgage Bonds in own favor, i.e. where a bond is held over the fixed property of another person. State first or subsequent bond(s) and give a description of property. State the amount outstanding still receivable. 3. Personal items (specify) 4. Vehicles (State the model and year) 5. Miscellaneous movable property (specify) 6. Debtors (state the name) 7. Shares/Loans (specify) Listed on the JSE Unlisted shares/loans to private companies 8. Other investments and assets (specify) Application Form Page 6
9. Life policies (surrender values, if known) Insurance Company Policy number Life cover Ceded to Surrender Value 10. Credit balances (e.g. savings accounts, fixed deposits, etc.) TOTAL ASSETS (A) Liabilities (Amounts in Rand) (B) Liabilities stated as on 1. Mortgage bonds (for amounts due under deed of sale) Erf no/ Name of farm Town/City Bondholder/Seller Interest Rate Installment Expiry date Amount 2. Term loans, personal loans (specify) Sub Total 3. Owing under installment sale agreements Type of asset e.g. vehicle, machinery, etc At which institution Installments Monthly 4. Income tax owing (state when due) 5. Owing to banks (state names and specify liabilities) 6. Owing in respect of credit cards (specify) 7. Other liabilities (describe and mention terms and conditions of repayment TOTAL LIABILITIES (B) VALUE A B NOTARIAL BONDS (state over which assets and in favor of whom) Application Form Page 7
CONTINGENT LIABILITY 1. Leases Item Financed by Outstanding amount Installment Date payable 2. Suretyship In Favor At Financial Institution Details of security provided Amount Monthly income Self Spouse Monthly Expenditure Gross salary R R Bond repayments/rent R Housing subsidy R R HP/Loan/Credit Card R Car allowance R R Insurance (Life and Short term) R Commission R R Domestic (water, lights, rates) R Overtime R R School and University Fees R Other (specify) R R Transport R Other (specify) R R Maintenance (if divorced) R Other (specify) R R Subtotal (fixed expenses) R Other (specify) R R Other (specify) R Other (specify) R R Other (specify) R Other (specify) R R Other (specify) R TOTAL INCOME R R Other (specify) R Less: Pension/Medical aid/paye R R Other (specify) R NET INCOME R R TOTAL EXPENSES R Description of security Type of security Available (x) Value Owned Bank Use First covering mortgage bonds residential Continuing covering mortgage bonds where another financial intuition or any other party holds prior ranking bonds. NB. Consent of existing bondholder is essential. Cession of listed shares on the JSE excluding any shares listed in the Development Capital or Venture Capital Sections of the JSE Pledged Kruger Rands Cession of fixed deposit Cession of unit trust Cession of life policy (Surrender value) Other (specify) 1. 2. 3. Application Form Page 8
References Note: By your signature to this form, you are authorizing Kauai to perform whatever credit checks they may consider necessary in their assessment of the application. Bankers Branch Telephone No. ( ) Contact Person/Manager Account No. Other references: 1. Name Telephone No ( ) 2. Name Telephone No ( ) 3. Name Telephone No. ( ) 4. Name Telephone No. ( ) 5. Name Telephone No. ( ) 6. Name Telephone No. ( ) Date Name Signed by: Managing owner/operating partner Application Form Page 9
SECTION B2 DETAILS OF OTHER STAKE HOLDERS Note: 1. Each partner to complete (who are not the Managing Owner of the business). Please make copies if more than one. 2. Please attach a copy of your I.D. Document. In what capacity is this section being completed? (tick one or more blocks as applicable) Fully active partner/member/shareholder Partially active partner/member/shareholder Investor Surname First names Place of birth Nationality Date of birth ID Number Residential address Code Postal address Code Telephone (Business) Telephone (Home) Cell e-mail address Permanent SA Citizen Fax no At present address Years Months Residential Property is Owned Rented Marital Status Single Y N If Married In community of property If divorced Final Yes No Date Final If widow/er Other Out of community of property ANC without Accrual If married please supply the following additional information about your spouse First names Place of birth Nationality Date of birth ID Number Name of employer Employer address Employers telephone Present position Annual Income Number of dependents Number of children Their ages Code Application Form Page 10
Does your spouse understand the business risks and potential rewards involved? Yes No Do your spouse and family understand the extra demands that a new business will make in Yes No relation to your time and effort, especially in the establishment phase of the business? Medical information What is your general state of health? Excellent Very Good Good Poor Is there any additional information regarding your general state of health that may impact on your ability to be a Franchisee? If yes, please give details. Employment history Employer From To Type of work Last position held Annual income 1. 2. 3. 4. Education Highest standard passed Do you have a degree or diploma Formal apprenticeships of pupilage? Do you have any formal business skills? Year If YES, specify If YES, specify If YES, specify Details of primary cheque/credit card/savings account Type of account Bank/Institution Account Number Date Opened Limits Self 1. Cheque 2. Credit card 3. Savings Spouse 1. Cheque 2. Credit Card 3. Savings Current accounts (If none, recently settled accounts) Institution/Business Branch Account Number Balance Present limit 1. 2. 3. 4. Credit record Application Form Page 11
Have you ever had any judgments against you (are you blacklisted)? Yes No If YES, specify details Have you ever been sequestrated? Yes No If YES, specify details Have you ever been found guilty of a criminal offence Yes No If YES, specify details Date Statement of Assets and Liabilities ASSETS (Amount in Rand) (A) 1. Fixed Property registered in your name City and Town property Owners Valuation Bank Use Erf no City/Township Purchase Price Date Purchased Fire Insurance Farm and Smallholding property Owners Valuations Bank Use Erf no Name of farm City/Township Purchase Price Date Purchased Fire Insurance Property bought under deed of sale Erf no Name of farm City/Township Purchase Price 2. Mortgage Bonds in own favor, i.e. where a bond is held over the fixed property of another person. State first or subsequent bond(s) and give a description of property. State the amount outstanding still receivable. 3. Personal items (specify) 4. Vehicles (State the model and year) 5. Miscellaneous movable property (specify) 6. Debtors (state the name) 7. Shares/Loans (specify) Listed on the JSE Application Form Page 12
Unlisted shares/loans to private companies 8. Other investments and assets (specify) 9. Life policies (surrender values, if known) Insurance Company Policy number Life cover Ceded to Surrender Value 10. Credit balances (e.g. savings accounts, fixed deposits, etc.) TOTAL ASSETS (A) Liabilities (Amounts in Rand) (B) Liabilities stated as on 1. Mortgage bonds (for amounts due under deed of sale) Erf no/ Name of farm Town/City Bondholder/Seller Interest Rate Installment Expiry date Amount 2. Term loans, personal loans (specify) Sub Total 3. Owing under installment sale agreements Type of asset e.g. vehicle, machinery, etc At which institution Installments Monthly 4. Income tax owing (state when due) 5. Owing to banks (state names and specify liabilities) 6. Owing in respect of credit cards (specify) 7. Other liabilities (describe and mention terms and conditions of repayment TOTAL LIABILITIES (B) NET ASSET VALUE (A B ) NOTARIAL BONDS (state over which assets and in favor of whom) Application Form Page 13
CONTINGENT LIABILITY 1. Leases Item Financed by Outstanding amount Installment Date payable 2. Suretyship In Favor At Financial Institution Details of security provided Amount Monthly income Self Spouse Monthly Expenditure Gross salary R R Bond repayments/rent R Housing subsidy R R HP/Loan/Credit Card R Car allowance R R Insurance (Life and Short term) R Commission R R Domestic (water, lights, rates) R Overtime R R School and University Fees R Other (specify) R R Transport R Other (specify) R R Maintenance (if divorced) R Other (specify) R R Subtotal (fixed expenses) R Other (specify) R R Other (specify) R Other (specify) R R Other (specify) R Other (specify) R R Other (specify) R TOTAL INCOME R R Other (specify) R Less: Pension/Medical aid/paye R R Other (specify) R NET INCOME CC DRAWINGS R TOTAL EXPENSES R Application Form Page 14
Description of security Type of security Available (x) Value Owned Bank Use First covering mortgage bonds residential Continuing covering mortgage bonds where another financial intuition or any other party holds prior ranking bonds. NB. Consent of existing bondholder is essential. Cession of listed shares on the JSE excluding any shares listed in the Development Capital or Venture Capital Sections of the JSE Pledged Kruger Rands Cession of fixed deposit Cession of unit trust Cession of life policy (Surrender value) Other (specify) 1. 2. 3. Application Form Page 15
References Note: By your signature to this form, you are authorizing Kauai to perform whatever credit checks they may consider necessary in their assessment of the application. Bankers Branch Telephone No. ( ) Contact Person/Manager Account No. Other references: 1. Name Telephone No ( ) 2. Name Telephone No ( ) 3. Name Telephone No. ( ) 4. Name Telephone No. ( ) 5. Name Telephone No. ( ) 6. Name Telephone No. ( ) Date Name Signed by: Other shareholder Application Form Page 16
SECTION C General proposal overview Note: With all the shareholders having discussed the questions below, please insert your agreed response Why have you selected Kauai as a business opportunity and not any other franchise business? From your limited knowledge of the system, please give us your overview of the positive and negative aspects of our brand and system as you see it. What research have you undertaken? What was the outcome of your own investigation of the brand? Have you contacted any existing franchisees for input? If not, please specify why and if you have done so, what was the outcome of your discussions? How would you interpret the business risk associated with this proposal bearing in mind the information contained herein? Application Form Page 17
SECTION D Site/Premises Notes: 1. We strongly discourage potential franchisees from entering into any formal agreements relating to any premises until such time as we have perused and confirmed the Lease Agreement. 2. Kauai will accept no responsibility for any obligation, financially or otherwise, on the franchisee resulting from any agreements concluded without their consent or resulting from the possible decline of this application. Do you have any geographical location preferences? (Please be specific) 1 st Choice: 2 nd Choice: 3 rd Choice: Have you identified or secured premises or a site? Yes No If yes, please provide the following details: Are the premises available for immediate occupation? Yes No Expected date of beneficial occupation: Premises address: Size of premises: m 2 Landlord s Name: Landlord s : Landlord s Telephone Number ( ) Has the rental been negotiated? Yes No If yes, what is the anticipated monthly rental? R p.m. General motivation of the site: Application Form Page 18
SECTION E DECLARATION & DISCLAIMER Do you or have you ever had any interest in any other business Yes No If YES, please supply the following details: Name of business : Nature of business: Period of existence: Please attach a copy of your ID document with this application (this applies to owner manager and All investors) I submit the following information as a complete and true personal record at the time of the date shown below. I understand that Kauai is relying upon all the above information as a material factor in considering my application to become a franchisee of their group and therefore agree to promptly notify Kauai of any material change in any of the above information or any subsequent information provided by Kauai. Please include proof of payment of the R4 500.00 application fee. This amount, less expenses and/or disbursements, if any, incurred by Kauai will be refunded should we not proceed. Furthermore, by your signature to this application, Kauai Juice (Pty) Ltd and/or their duly appointed representatives are authorised to perform whatever credit checks they consider necessary in the assessment of the application. The undersigned certify that the information provided is true and correct. I acknowledge the fact that this application does not bind or obligate any party in any manner. Signed at on this day of 201 _ WITNESS: Signature of prospective franchisee Signed at on this day of 201 _ WITNESS: Signature of other Shareholder/s Application Form Page 19
SECTION E BUSINESS LOAN I intend to finance the complete set up cost of the franchise with my own funds Yes No I shall apply for a business loan myself at a financial institution of my own choice Yes No I request Kauai for guidance to which financial institution this application must be forwarded Yes No If yes, then you must sign the acknowledgement and consent hereunder Yes No If any of the finance options is applied for, the approval or refusal of the application is within the sole discretion of the financial institution. This financial institution will provide you with a facility letter or letter of approval setting forth the full details of the financing granted, security to be furnished, cost involved and related matters. Application Form Page 20
ACKNOWLEDGEMENT AND CONSENT BY APPLICANT (This consent is required in terms of the Code of Banking Practice relating to obtaining written consent for verification of information provided for during the lending assessment process). I hereby irrevocably: Authorize the financial institution selected by Kauai to contact any of the referees (including but not limited to banks or auditors), mentioned in this application form and to obtain any additional information which the financial institution, in it sole discretion, may deem necessary; I hereby declare the information provided in this application form is to the best of my knowledge true, correct and accurate in all material respects. I acknowledge that failure to disclose any information that are relevant to this application, or the furnishing/ provision of any untrue, incorrect or inaccurate information will render this application or any agreement or subsequent agreement entered into between the franchisor and myself (either personally or on behalf of any CC or Company) or myself and the financial institution, null and void. I herewith declare that the amount as stated in the application as own contribution has not been borrowed from any source where it is repayable in the future or where it may cause any financial liability to the business. I further acknowledge that this application does not constitute any form of agreement or contract whatsoever between the franchisor, the financial institution and myself, and is no way binding on either party. However, if any finance is granted to me as a result of this application, the information contained herein will throughout the duration thereof form the basis for such financing. I authorize the financial institution to disclose full particulars regarding the approval of my application. Signed at on this day of 201 _ WITNESSES: APPLICANT 1. 2. ll Application Form Page 21