EQUITY OWNERSHIP DECLARATION FORM
1. Tender / Bid Information
- Tender / Bid Number: ______________________________
- Tender / Bid Description: ___________________________
- Procuring Entity / Institution: ______________________
2. Company Information
- Registered Company Name: Neftaly
- Trading Name (if applicable): Neftaly
- Company Registration Number: _______________________
- Tax Number: _______________________________________
- Physical Address: _________________________________
- Contact Number: 084 313 7407
- Email Address: sayprobiz@gmail.com
3. Equity Ownership Details
The table below reflects the full equity ownership structure of the company:
| No. | Full Name of Owner / Shareholder | ID / Registration Number | Citizenship | Gender | Race | HDI Status (Y/N) | % Owned by HDI’s | % Owned by Women | BEE Level | % Owned by Youth | Voting Rights (%) | % Owned by DIsabled |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. | Neftaly Malatjie | South African | Male | Black | Yes | 100% | 50% | BEE Level 1 | 100% | 100% | 20% |
Total Ownership: 100%
4. Black Ownership (If Applicable)
- Total Black Ownership (%): 100%
- Black Female Ownership (%): 50%
- Black Youth Ownership (%): 100%
- Black People with Disabilities Ownership (%): 20%
(Attach supporting documentation if required)
5. Management Control (Optional – If Required by Tender)
Indicate whether shareholders are actively involved in management:
| Shareholder Name | Executive Role (Yes / No) | Position Held |
|---|---|---|
| Neftaly Malatjie | Yes | CEO |
6. Declaration
I, the undersigned, hereby declare that:
- The information provided in this Equity Ownership Declaration Form is true, correct, and complete.
- The ownership structure disclosed reflects the actual and current shareholding of the company.
- I understand that misrepresentation may lead to disqualification of the tender or termination of any contract awarded.
7. Authorized Signatory
- Full Name: Neftaly Malatjie
- Designation: CEO
- Signature: _______________________________________
- Date: 27 January 2026
8. Company Stamp (If Applicable)
Official Company Stamp
📎 Supporting Documents (Attach if Required)
- Share Certificates
- Share Register
- ID Copies of Shareholders
- CIPC Documents / Company Registration Certificate
- B-BBEE Certificate or Affidavit