Broad-Based Black Economic Empowerment Act, 2003 (Act No. 53 of 2003)

Regulations

Broad-Based Black Economic Empowerment Regulations, 2016

Regulating the Administration and Implementation of the Broad-Based Black Economic Empowerment Act and the Functions of the Commission

Schedules

Forms to Regulations

B-BBEE 17 : Application for Deviation/Exemption
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BROAD-BASED BLACK ECONOMIC EMPOWERMENT COMMISSION

 

FORM: B-BBEE 17

 

APPLICATION FOR DEVIATION/EXEMPTION

(in terms of Section 10(2) of the Act)

 

(Please complete the application in full. Use additional paper if necessary)

 

SECTION A: APPLICANT INFORMATION

 

Name:

 

Identity/Registration Number:

 

Address:

 

 

Telephone Number:

 

Email Address:

 

Indicate if Public entity/Private/Organ of state:

 

 

SECTION B: DETAILS FOR DEVIATION

 

INDICATE:

 

➢the elements that an organ of state or public entity requires to deviate from:

 

➢the extent of deviation:

 

➢proposed scorecard:

 

B-BBEE Element

Required scorecard

Scorecard below target

Proposed scorecard




 

 

SECTION C: DETAILS FOR EXEMPTION

 

INDICATE:

 

➢what an organ of state or public entity requires to be exempted from:

 

➢Give verifiable facts for exemption:

 

 

SECTION D: STATEMENT OF INTENT

(Briefly describe why deviation/exemption is needed)

 

 

SECTION E: ADDITIONAL REQUIRED INFORMATION

(Attach Business Plan or Motivation for exemption or deviation)

 

 

SECTION E: SIGNATURE(S)

(By signing below, you attest that the information is true and correct:

 

 

(1)        Full Names:                                               Signature                                         Designation