Heritage Application Form - Non-Manufacturing Business
Name of Company (*)
Primary Sector (*)
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Company Registration Number (*)
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VAT Number (if registered for VAT)
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Number of Branches (*)
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Number of Employees (*)
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Other Facilities
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Postal Address (*)
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Physical Address (*)
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Telephone: (Code) number (*)
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Fax: (Code) Number (*)
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Primary e-Mail Address (*)
http://www. (*)
Personal Information of Applicant
Position Held (*)
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Title (*)
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First Name (*)
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Surname (*)
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e-Mail
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ID / Passport Number (*)
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Please provide details of the person in your company that has been designated as the Environmental Officer (the person responsible for managing this initiative)
Title (*)
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Surname
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First Name
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Job Title
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ID or Passport Number
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Direct Contact Number
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e-Mail
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DECLARATION • I/We understand that Qualitour (Pty) Ltd reserves the right to refuse to accept my/our application for membership of the Heritage Environmental Certification Programme. • I/We understand that participation in the programme is subject to: my/our establishment maintaining and applying the Environmental Charter of the Programme; the payment of all Membership Fees on demand; and the provision of information which may from time to time be requested by Qualitour (Pty) Ltd • I/We undertake to advise Qualitour (Pty) Ltd of any change of information contained in this application form within 14 days of such change.
Validation of Declaration (*)
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