Application for the Mzansi Black Business Accelerator

Name

Please enter your name Your name should be at least 3 charachters in length Your name should only contain alphanumeric charachters

Surname

Your surname is required Your surname should be at least 3 charachters in length Your surname should only contain alphanumeric charachters

Cell Number

Please enter a South African cell number. Please enter a valid South African cell number.

Email Address

Please enter your email address. Please enter a valid email address.

Please attach your ID Number or Driver’s License

Please attach your ID Number or Driver’s License Please attach a valid file format (PNG, JPEG or PDF) Files larger than 6mb are not accepted

Age

Please enter your age. Only numbers allowed.

Gender

Please select your gender.

What ethnic group do you fall under

Please select your gender.

Do you have any previous experience in running or working in a small business?

Please select an option.

Explain your previous experience

Please explain your previous experience.

Which city do you plan on placing your vending machine? ** At this stage, the project is limited to the listed cities only.**

Please select the machine location option.

Will you be filling the machine yourself?

Please select an option.

Do you have access to a motor vehicle to restock your vending machine?

Please select an option.

How much do you have readily available to invest in the venture as a down payment? A minimum of R12,000 is required

Please select an investment amount.

How much of your current monthly income can you allocate to make monthly payments towards the venture?

Please select an option or specify your monthly income.

Please specify your monthly income

Please specify your monthly income.

What is your highest level of education achieved?

Please enter your highest level of education.

What is your employment status?

Please select your employment status.

If employed, who do you work for and what type of work do you do?

Please provide your employment details.

If you are employed, do you require your employer’s approval to pursue this opportunity?

Please select an option.

What is the monthly gross income (before deductions)? Please select monthly income range

Are you or any member of your family directly related to a PepsiCo employee, contractor, supplier, service provider, or customer

Please select an option.

Provide details

Please provide details.

What hours do you currently work per day or per week? (e.g. office hours, factory hours, shift work)

Please select an option or specify your working hours.

Where did you hear about the Mzansi Black Business Accelerator program?

Please select an option.

Provide us with a motivation as to why you should be considered to run a vending machine business and for funding (Grant/Debt financing). Max 200 characters

Please provide your motivation. Motivation to be no longer than 200 charachters.

Please attach your proof of banking note

Please attach your proof of banking note Please attach a valid file format (PDF) Files larger than 6mb are not accepted

Please attach your 6 months bank statement

Please attach your 6 months bank statement Please attach a valid file format (PDF) Files larger than 6mb are not accepted

Please attach your most recent Salary Slip

Please attach your salary slip Please attach a valid file format (PDF, JPEG, PNG) Files larger than 6mb are not accepted

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The information provided by you as included to this MBBA application form will be treated by PepsiCo and its affiliated and related entities both in South Africa and elsewhere, the Kgodiso Fund and FoodBev SETA as confidential information, will be kept safe and is to be processed solely in furtherance of your application to be considered for participation in the MBBA Programme and in accordance with the following Privacy Notice.

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