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License Partner Application Form
Personal Details
Name:
Surname:
Email:
Mobile Number:
ID Number:
Address:
Street Address
Address Line 2
City
Province
Postal Code
Area applied for:
SA Citizen
Yes
No
Permanent Resident
Yes
No
Ethnicity:
Gender:
Home Contact Number:
Work Contact Number:
Email:
Employer:
Position:
Work Contact Person:
Contact Number:
Education & Training Related
School Attended:
Std Passed:
Year:
University / Technicon / College / Company Attended:
No of Years:
Course of Study / Education:
Education / Degree / Course / Qualification Conferred:
Year:
Other Qualifications relevant to the position applied for:
Year Qualified:
Current Studies:
Medical History
Are you aware of any working conditions, which could be detrimental to your health and/ or safety or of any medical condition, which may adversely affect your performance of the position being applied for?
Language Proficiencies
Write:
Read:
Speak:
Employment History #1
Name of Company:
Position:
Company Address:
Period From:
To:
Duties:
Reasons for Leaving:
Reference/Manager:
Contact:
Employment History #2
Name of Company:
Position:
Company Address:
Period From:
To:
Duties:
Reasons for Leaving:
Reference/Manager:
Contact:
Employment History #3
Name of Company:
Position:
Company Address:
Period From:
To:
Duties:
Reasons for Leaving:
Reference/Manager:
Contact:
Other Details
MEMBERSHIP DETAILS OF PROFESSIONAL ASSOCIATIONS RELEVANT TO THE POSITION APPLIED FOR:
Can you support yourself financially for the first 3 months?
Yes
No
Do you own your own reliable vehicle?
Yes
No
Do you possess good interpersonal skills?
Yes
No
Do you have your own personal computer?
Yes
No
Can you work on your own without supervision?
Yes
No
Do you have your own cell phone?
Yes
No
Are you incentive and profit motivated?
Yes
No
Are you goal oriented?
Yes
No
Anticipated date of commencement if application is successful:
MM slash DD slash YYYY
Do you have any previous experience in commission based sales, Business Broking or Real Estate – if so, kindly elaborate:
Please provide a short description of how you intend making a success of your career as a Renwick License Partner:
Declaration by Applicant
I am a South African citizen and I lawfully reside in the Republic of South Africa. If you indicated “Incorrect” provide a valid permit which has been issued by the Department of Home Affairs
Yes
No
In the preceding 5 years, I have not been found guilty of contravening either the Estate Agency Affairs Act, No 112 of 1976 or the Property Practitioners Act, No 22 of 2019.
Yes
No
I have not been found in any civil or criminal proceedings by a court of law in any country to have acted fraudulently, dishonestly, unprofessionally, dishonourably or in breach of a fiduciary duty, or of any other offence for which I was sentenced to imprisonment without the option of a fine.
Yes
No
I am not of unsound mind.
Yes
No
I have not within the preceding 5 years been dismissed from a position of trust by reason of improper conduct.
Yes
No
I am in possession of a valid tax clearance certificate.
Yes
No
I am not prohibited by any legislation from being a business broker or property practitioner, or from occupying a position of trust.
Yes
No
I have never been found guilty by any court of unfair discrimination.
Yes
No
I have not been found guilty of any act or omission in respect of which the Fidelity Fund had to compensate any person;
Yes
No
Have you ever been declared insolvent?
Yes
No
If Yes, supply details and date of rehabilitation:
I verify that all information contained herein is true and correct and if appointed I accept to abide by the rules and regulations of RENWICK BUSINESS NETWORK. I accept that any offer to enter a Licence Agreement will not, be deemed to be confirmed until all formalities have been satisfactorily complied with. In the event of the provision of false or misleading information or contravention of any of the conditions stipulated, RENWICK BUSINESS NETWORK reserves the right to terminate the Licence and take other appropriate legal action as required in law.
Signature
Date
MM slash DD slash YYYY
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