Confidential Questionnaire to be completed by all potential franchisees
*Please complete all questionaire fields - especially the contact info
Please Note: Completion of this document does not obligate either party in any way whatsoever.
Section 1: Getting to know you.
Nationality:
Identity no:
Surname:
First Name(s)
:
Age:
Health:
Postal Address:
Street Address:
Since when at this address:
Tel (Office or Cellular):
Tel (H):
e-mail address:
Educational background:
Personal interests and hobbies:
Your work history - If in employment, please state:
Company:
Current position held:
Employed since:
Annual gross salary:
Please list your previous two employers.
Company:
Position held on leaving:
Employed from – to:
Company: Position held on leaving:
Employed from – to:
If currently self-employed Company name:
Nature of business:
Gross annual turnover:
Established since:
Number of employees:
Directorships held in other companies
:
Please provide the names of two unrelated persons for reference purposes.
Name:
Tel no:
Name:
Tel no:
Your bank details:
Bank:
Account no:
Contact name:
Tel no:
Section 2: Financial Details Cash available for investment purposes:
Do you have access to “soft loans” (if yes, state amount):
What is the value of the equity in your home (sale value minus mortgage):
State total amount of liabilities:
How much money do you need to meet your monthly obligations:
Section 3: Your License
Where do you wish to operate your business?
If this territory is no longer available, are you prepared to relocate?
Please answer
YES or NO
YES
or
NO
Do you plan to have a partner in the business?
Please answer
YES or NO
YES
or
NO
If you are accepted, when could you start training?
Additional comments you wish to make to strengthen your application (optional):
Declaration by Applicant:
I have completed the above to the best of my ability and belief to support my application for a License from your company. At this stage, I do not bind myself in any way whatsoever. I further understand that, should I be accepted on the basis of information contained herein and this information should turn out to be false in any material respect or that I have withheld essential facts this may cause termination of the License Agreement.
Name:
Date: