The Western Cape Premier s Entrepreneurship Recognition Awards 2015 Official Entry Form ABOUT THE AWARDS The Western Cape Premier s Entrepreneurship Recognition Awards 2015 is the third edition of an annual competition that recognizes the achievements and potential of some of the Province s most exciting entrepreneurs. By acknowledging and showcasing successful entrepreneurs, this Awards programme is helping to build a culture of entrepreneurship in the Western Cape and in turn, support the creation of opportunities by small and medium businesses. CATEGORY OF BUSINESS Best Emerging THE PRIZES PRIZE MONEY Best Emerging Regional with Global Reach Best Social Enterprise Best Emerging Tourism Best Emerging Agro- Processing Best Green Best Innovative Student Idea Best School Idea R50,000 (Winner) R20,000 (Winner) R10,000 (runner-up) Best Established Best Innovative Best Job-creating Overall winner: Entrepreneur of the Year TOTAL R100,000 (International Trip or Trade Fair) + R100,000 in cash to be used to develop the business. R1 880, 000 All of the above prizes are non- negotiable and non transferable
HOW TO ENTER You can enter the competition using this entry form, or on-line at www.wcpremiersawards.co.za The closing date is 14 September 2015. Late entries will not be accepted. Previous winners may not enter their businesses again. However, previous winners may enter a new or different business. Government employees (local, provincial and national government departments) are not permitted to enter the PERA competition. Please complete legibly with a black pen Make sure you answer all the required sections Make sure you sign the entry form where indicated If the space provided for answers is insufficient, you are welcome to use white A4 paper which can be attached to this entry. If you do, please indicate the relevant sections and questions. THE JUDGING PROCESS A panel of experienced and independent judges will evaluate all entries using a standard scoring system. All judges will be required to sign a confidentiality agreement in order to ensure the confidentiality of entrants information. Three finalists per category will be selected (with the exception of the following categories: Emerging Regional, Emerging Tourism, Emerging Agro-processing, Innovative Student Idea, and School Idea). We may conduct site visits to verify the information provided. Finalists will also be required to give a short presentation on their business or student idea to the judging panel, and answer questions from the panel. Failure to attend this presentation may result in a finalist not being considered, or being replaced by the next eligible finalist. Once the overall winner and finalists have been announced, the entrants will be sent a report which incorporates comments from the judges. These comments may assist you with your entry next year. HOW TO SUBMIT THIS FORM By hand: By fax: By email: drop off at your local Seda office or other nominated business organisations (list available on request) You can fax the completed entry form to 086 637 2212 Scan the completed entry form and email it to entries@wcpremiersawards.co.za By post: PO Box 16019, Vlaeberg, 8018 CONTACT INFORMATION For more information on the competition or the adjudicators: Website: Email: www.wcpremiersawards.co.za entries@wcpremiersawards.co.za Tel: 021 823 6868 Fax: 086 637 2212 Please indicate where you heard about PERA: 2
ENTRY FORM SELECT YOUR CATEGORY Please select the category you are entering by ticking the relevant box. You may not enter the same business in more than one category. Please carefully note the sections which you need to complete, depending on the category you enter. Emerging Please complete sections A, B, C, D, G A business in its initial growth phase operating in the Western Cape for 12 months or longer, but not longer than 2 years. Established business Please complete sections A, B, C, D, G Operating in Western Cape for 5 years or longer with an annual turnover of more than R10m and less than R50m. Innovative Operating in the Western Cape for 12 months or longer. This refers to an innovative solution or approach to an existing service or product. Job-Creating Operating in the Western Cape for 2 years or longer with an annual turnover of less than R10m and a indication of the number of permanent employees appointed over the last financial year. Emerging Regional Please complete sections A, B, C, D, G A business in the initial growth phase to be selected from areas outside the Cape Metropolitan area and operating in the Western Cape for 12 months or longer, but not longer than 2 years, with an annual turnover of more than R3m. This category will not be taken into consideration for the overall winner. with Global Reach Operating in the Western Cape for 5 years or longer with a turnover of less than R50m per annum. Social Enterprise Any business operating in the Western Cape for 12 months or longer, and which aims to address a social challenge through innovation. Emerging Tourism A business in its initial growth phase operating in the Western Cape for 12 months or longer, but no longer than 2 years. This catergory will not be taken into consideration for the overall winner. Emerging Agro-Processing A business in its initial growth phase operating in the Western Cape for 12 months or longer but not longer than 2 years. This category will not be taken into consideration for the overall winner. Green Operating in the Western Cape for 12 months or longer and actively using green technology/ concepts in the business. Innovative Student Idea Please complete sections A, F and copy of ID only Student defined in a narrow sense that is any full time student at a Western Cape tertiary institution including FET colleges, this refers to an innovative solution to a new problem or service. It could be an idea or concept. This category will not be taken into consideration for the selection of the overall winner School Idea Please complete sections A, (part of) B, F only Any high school in the Western Cape (Grade 8 to 12 learners or equivalent). This catergory will not be taken into consideration for the election of the overall winner. Learners could also apply on behalf of the school but the prize will be awarded to the school. 3
SECTION A: CONTACT DETAILS Contact details for the designated representative of the business (who must be a director or shareholder). Student/School entrants please also complete. Name: Designation: (business title) Email: Cell: Landline: Fax: SECTION B: BUSINESS DETAILS Student business idea entrants do not need to complete unless they have an existing business. School business idea entrants can just complete the address and website details. Website: BBBEE rating: Chamber: I confirm that the business operates in the Western Cape and is not a branch, franchise or subsidiary of a company whose primary operations are outside the Western Cape. Yes No SECTION C: BUSINESS DETAILS Student/School entrants do not need to complete this section. Core Nature of business (e.g. manfacturing, services, retail): Industry Sector: Legal name of business: Trading name : (if different) type: Pty Ltd cc Partnership Sole Proprietor Co-operative Main product or service: Please give a short description of the main business activity Registration number: Physical address: Other Describe when and how the business started. Postal address: What is the vision for the business over the next 5 years? Municipal region (e.g. West Coast District, Eden, etc): 4 turnover for the past one to three years.
Projected business turnover for the next three years. Achievements What have your three main achievements been as a business over the past one to three years? What will the main turnover drivers be? What geographic area does the business activities span? Innovation Please describe the role that innovation plays in your business. Is your business based on an innovation or are you planning to innovate in your industry sector? SECTION D: IMPACT PROFILE Student/School entrants do not need to complete this section. Employment How many people does the business currently employ? Full-Time Part-Time / Seasonal If your business grows according to plan, how many additional people do you believe you will be employing in the next three years, if any? Full-Time Community Part-Time / Seasonal Challenges How has the business positively impacted on the community in which it operates, in terms of social and economic development? What are the three main challenges that the business faces in the next three years, and how do you intend to meet these challenges? 5
SECTION E: SPECIAL CATEGORY with Global Reach How does your business make a difference in this regard? Who benefits and how? If you have entered the with Global Reach, please answer these questions. If not, please ignore. What percentage of your income comes from the export of goods or services (on average)? Name your primary export markets. What makes your business different or better than others operating in this same field? Do you plan to open an office/outlet in another country in the next three years? If so, please supply more detail. Green If you have entered the Green category, please answer these questions. If not, please ignore. What environmental, energy or ecological challenge or issue does your business aim to address? Social Enterprise If you have entered the Social Enterprise category, please answer these questions. If not, please ignore. What social challenge or issue does your business aim to address? How does the business contribute to environmental sustainability? 6
What makes your business different or better than others operating in this same field? How many of your employees were appointed during the last financial year? Most Innovative If you have entered the Most Innovative category, please answer these questions. If not, please ignore. Do you have any specific training programmes or internships to train unemployed people? If yes, please supply some detail. What specific innovative products, services, processes or technologies differentiate your business? Emerging Tourism If you have entered the Best Tourism Emerging catergory, please answer these questions. If not, please ignore. Are you promoting a previously under-visited site or region? What are the benefits and advantages of your innovation(s)? What makes your business different or better than others operating in this same field? Job-creating If you have entered the Best Job-creating category, please answer these questions. If not, please ignore. 7
Emerging Agro-Processing If you have entered the Best Emerging Agro- Processing category, please answer these questions. If not, please ignore. Please explain which products are being processed and describe the end product. Grade or year of study (if applicable): Please briefly describe what your entrepreneurial innovation/business idea is. Please explain how it will work on a practical level, ie how people can use it or how it will be delivered, produced or implemented? Where do you source the bulk of the agro products you process? How will your idea improve the current situation? Why do you think it is needed? What problem does it solve? What makes your business different or better than others operating in this same field? How did you develop this idea? What spurred you to come up with it? SECTION F: STUDENT AND SCHOOL BUSINESS IDEA SECTION To be completed only by student innovation and school business idea entrants. Please outline any development work, business planning or research you have done in working on this idea, if any? Educational institution 8
SECTION G: DOCUMENTS AND ATTACHMENTS Please include the following documents, where required, which should be attached to or enclosed with your entry: Confirmation of company registration (not for student/school business idea) Copy of ID Tax clearance certificate (not for student/school business idea) Copy of at least one month s financial statements/management account (income statement only) not older than 6 months OR letter from accountant or auditors confirming company is trading profitably (not for student/school idea) IMPORTANT: You can submit your application without submitting these documents, and your entry will still be judged. However, you will not be able to be selected for or receive an Award without submitting the above documents before the closing date. If you would like to attach or include any information documents such as product pictures, leaflet copy, etc for the adjudicators, you are welcome to do so. Please note that these cannot be returned! COMPETITION RULES, TERMS AND CONDITIONS A. GENERAL CONDITIONS 1. By entering the Premier s Entrepreneur Recognition Awards programme ( the programme ), the entrant agrees to be bound by these terms and conditions, regardless of whether the entry form is fully completed, signed or not. proprietorship and the proprietor and business share a bank account. The organisers reserve the right to require and request proof that the bank account is that of the entered entity, and the consent of all directors to payment being made into such account. 2. Any entry which is found to be partially or fully incomplete, non-compliant with the Awards criteria, illegible or otherwise substantially deficient or ill-prepared; or which is submitted after the closing date and time, may be withdrawn from consideration, without notice and at the sole discretion of the organisers. 9. The organisers reserve the right to change, without prior or any notice other than on the programme website, the dates, entry forms and requirements, adjudication process, criteria, categories and any other programme feature and process, in the interests of fairness, transparency, or where operational circumstances require such change. 3. The entrant confirms that all information provided is true and accurate. Any entry containing false or misleading information may be withdrawn from consideration, without notice and at the sole discretion of the organisers. 10. ideas or existing businesses in the tobacco, firearms (excepting sporting use), alcohol, adult (sex) and gambling / wagering industries will not be considered for the Awards. 4. The decision of the adjudicators and organisers with regard to eligibility, scoring and the allocation of Awards shall be final. 5. Entrants are required to co-operate as far as reasonably possible with the organisers in respect of the provision and verification of information and site visits, and any failure to provide all reasonable co-operation may result in withdrawal from consideration. 11. A business which operates in the Western Cape, but is a branch, franchise or subsidiary of a company whose primary operations are outside the Western Cape is not eligible to enter. 12. All information shall be handled with the necessary confidentiality and care, subject to the Department s right to publish information about the winning entrants as set out herein before. 6. Entry may only be made by means of the official online or printed entry forms. 7. The entrant grants permission to the organisers of the programme to have their photograph taken and/ or be filmed, without prior notice, during site visits and attendance at any programme meeting or event; and for any such photograph or film to be used without payment of any consideration in printed, online (internet), video or other promotional or programme-related communication, press release or article, without prior notice. 8. Any cash prizes awarded shall only be paid into the primary bank account of the business entity which is being entered. No cash prizes shall be paid into any individual s bank account save where the business is a sole 9 13. Previous entrants may enter the programme. However, previous winners may not enter the same business, but may enter with a new or different business idea or business. 14. I confirm that any and all intellectual property which forms part of my/our business and my/our entry, is the property of the entering business and/or its owners and directors, or that any third-party intellectual property used in our business or entry is used with the permission of the owners thereof, and in this regard we indemnify the organisers and the Western Cape Government against any claim from any third party in relation to the unauthorised use of any intellectual property.
B. CONDITIONS RELATING TO BUSINESS FEEDBACK AND COMMENTARY FROM ADJUDICATORS 1. I/we understand and agree that the programme and its authorised adjudicators may provide me with certain comments and feedback on certain parts of my entry, and acknowledge and agree that: 1.1 Such feedback and comments represent the views and opinions of the individual adjudicators, in their personal capacities, and not those of the organisers or the Western Cape Government or its agents; 1.2 The feedback and comments are provided in good faith only, and on the basis of the information provided, for the purpose of assisting the entrant to improve, inter alia, their business concept, model, performance, processes and competitiveness; 1.3 The comments and feedback do not purport to be, and are not offered as, professional financial, legal or technical advice; 1.4 I/we should not under any circumstances make any decisions, or take any action, whether legal, financial, technical or of any other kind, without full and thorough consideration and without first obtaining appropriate financial, legal, technical or other professional advice; 1.5 In view of the fact that business models, plans, processes and performance are dynamic and subjective, no correspondence will be entered into with regard to the adjudicators comments, and the adjudicators will not be identified individually. I warrant that I am authorised to represent the business or entity being entered. I understand, accept and agree to abide by the rules, terms and conditions of the Premier s Entrepreneurship Awards, on behalf of myself and the business I represent. Please ensure you sign below! Signature Name: Date: 10