Credit Application – Shiman – Your Trusted Partner in Agricultural Remedies

Particulars of the person who completes the application form

Initials *

Full Name *

Surname *

ID Number *0 / 13

Copy of Identity Document of Individual *

No file chosen

Registered Legal Name *

Trading Name *

Company Registration Number

Copy of Registration Documents (if applicable) *

No file chosen

Property

Principal Address rented or owned by Customer?

Proof of address

No file chosen

Landlord Name *

How long have you occupied present premises?

Phone *

Bank Details

Bankers Name *

Branch No *

Account Name *

Type of Account *

Date Account Was Opened *

Account No *

Bank Account Confirmation Letter *

No file chosen

Auditors / Accountants of the Company/Corporation

Name

Phone *

Street Address *

City *

ZIP / Postal Code *

Country *

Province *

VAT Registration Number

Copy of VAT Registration Certificate *

No file chosen

Registered Business Address

Street Address *

City *

ZIP / Postal Code *

Country *

Province *

Physical Address

Same as Registered Address

Street Address *

City *

ZIP / Postal Code *

Country *

Province *

Delivery Address

Same as Physical Address

Street Address *

City *

ZIP / Postal Code *

Country *

Province *

Contact Details

Business

Telephone Number *

Email Address *

Accounts

Telephone Number *

Email Address *

Contact Person Name *

Orders

Telephone Number *

Email Address *

Contact Person Name *

Directors

Initials *

Full Name *

Surname *

ID Number *0 / 13

Copy of Identity Document of Individual

No file chosen

Members

Initials *

Full Name *

Surname *

ID Number *0 / 13

Copy of Identity Document of Individual

No file chosen

Individuals

Initials *

Full Name *

Surname *

ID Number *0 / 13

Copy of Identity Document of Individual

No file chosen

Partners

Initials *

Full Name *

Surname *

ID Number *0 / 13

Copy of Identity Document of Individual

No file chosen

Trustees

Initials *

Full Name *

Surname *

ID Number *0 / 13

Copy of Identity Document of Individual

No file chosen

Trade References

Name of Business giving Reference *

Approx Purchase *

Person giving Reference. *

Phone *

Payment Types *

Credit limit requested *

Monthly purchases *

Deed of Surety

Authorised Individual

Initials *

Full Name *

Surname *

ID Number *0 / 13

Copy of Identity Document of Individual

No file chosen

Signed Proxy Letter

No file chosen

Full Name *

ID Number *0 / 13

Registration Number *

Customer Name *

Signature *

I, the undersigned, . Identity Number hereby bind myself as surety and co-principal debtor in favour of SHIMAN (PROPRIETARY) LIMITED, with Registration
Number 2005/004200/07, any of its associated and subsidiary companies, divisions, nominees and assigns (“THE
COMPANY”) for the due and punctual payment of all amounts and sums of money which may now or in the future be or
become due, and for the fulfilment of all the obligations which may now or in the future be or become due by:-

Registration Number (“THE CUSTOMER”) to THE COMPANY. I waive and renounce all benefits to which I may be entitled to arising from the legal exceptions including, but not limited
to:-

Excussion - the right to require THE COMPANY to proceed first against THE CUSTOMER for payment of any
debt owing to THE COMPANY before proceeding against myself;
Cession of action - the right to require THE COMPANY to give cession of the action for payment of debts to me
before any action against myself may be taken;
The right to an accounting from THE COMPANY;
The benefit of simultaneous citation and division of debt – the right of a co-surety to be liable only for his pro
rata share of the principal debt.

I agree and declare that this Deed of Suretyship shall remain in full force and effect as a covering suretyship for so long
as any amount shall remain owing by THE CUSTOMER to THE COMPANY and will continue to be binding upon me
notwithstanding the fluctuation and temporary extinction of THE CUSTOMER’s indebtedness to THE COMPANY or the
fact that THE COMPANY without notice to myself varies the terms of any agreements concluded with THE CUSTOMER
or grants extensions of time to THE CUSTOMER for carrying out any of its obligations.

All admissions and acknowledgments of indebtedness by THE CUSTOMER will be binding upon myself.

The amount that THE COMPANY can claim from me shall not be limited by any credit limit granted by THE COMPANY
to THE CUSTOMER. Should THE CUSTOMER exceed this credit limit for whatever reason, I shall not be entitled to
claim liability only for the credit limit amount.

In addition, and to the extent permitted by the National Credit Act, 2005 (the Act) (where applicable), in the event of THE
COMPANY proceeding against myself for recovery of any amounts due in terms of this Deed of Suretyship, or proceeding
to enforce any of its rights arising here from, then I shall be liable for the legal costs incurred by THE COMPANY on the
attorney and own client scale, including Counsel fees (whether or not legal proceedings are instituted) as well as
collection costs, tracing fees and any other costs incidental thereto.

Subject to section 111 and 169 of the Act, for the purpose of proving any amount alleged to be due by me to THE
COMPANY, a certificate purporting to be issued by a person who describes himself/herself in such certificate as a director or credit manager of THE COMPANY, wherein the said person states that as at a date mentioned by such person in such certificate I am indebted to THE COMPANY in an amount stated in such certificate shall, upon its mere production in any Court of Law, whether by a witness or by a legal representative acting on behalf of THE COMPANY, be prima
facie proof of the truth of the contents of the said certificate.

I consent in terms of Section 45 of the Magistrate’s Court Act 1944, as amended, to the non-exclusive jurisdiction of the Magistrate’s Court having jurisdiction in respect of any action or proceedings which may be brought against me arising out of or relating to this Deed of Suretyship.

I hereby choose domicilium citandi et executandi for all purposes hereunder at the address set out below, and any notice that may require to be given to me hereunder shall be deemed to have been received by me one week after having been properly addressed and posted to me by registered post.

I attach hereto a declaration of my assets (Annexure A) and warrant that the information contained therein is true and correct. I further undertake to notify the COMPANY in writing of any additions, reductions or changes to my assets, which are recorded in the attached declaration, within 7 (seven) days from such addition, reduction or change occurring.

It is agreed that this Deed of Suretyship constitutes the whole of the agreement of suretyship between THE COMPANY and myself. No variation or cancellation of this Deed of Suretyship shall be of any force or effect unless both THE COMPANY and I sign such variation or cancellation.

It is agreed that each surety given, each paragraph, each clause, sub-clause and word in this Deed of Suretyship is severable, the one from the other. If any surety, paragraph, clause, sub-clause or word is found to be defective, unenforceable or unfair for any reason by any competent Court, the remaining sureties, clauses, paragraphs, clauses,
sub-clauses and words shall be and shall continue to be of full force and effect.

To the extent required in terms of the Act, the terms and conditions governing the principal debt (provided same qualifies
as a credit agreement under the Act) and secured by this Deed of Suretyship are incorporated by reference herein and
shall form an integral part hereof in compliance with the provisions of the Act regulating credit guarantees.

Consent of person authorised to complete agreement

Signed At *

Date *

Full Name *

Capacity *