I. PERSONAL DATA

FRANCHISING FOR (COUNTRY):

NAME:

COMPANY:

DATE OF BIRTH (DD/MM/YYYY):

GENDER:

CITIZENSHIP:

CITIZENSHIP NO.:

TELEPHONE NO. (OFFICE):

TELEPHONE NO. (MOBILE):

EMAIL ADDRESS:

ADDRESS:

II. EDUCATION BACKGROUND

HIGHEST EDUCATION ACHIEVED:

YEAR ACHIEVED:

SCHOOLS / INSTITUTION ATTENDED:

III. WORK EXPERIENCE & EMPLOYMENT HISTORY

TELL US ABOUT YOUR PAST WORK EXPERIENCE

COMPANY NAME:

DESIGNATION:

DURATION (YEARS):

IV. OWNERSHIP & OPERATIONS

WILL THE FRANCHISE OPERATIONS BE OWNED BY YOU OR A G UP?

AMOUNT OF AVAILABLE CAPITAL (PLEASE STATE CURRENCY)

SOURCES:

AMOUNT:

PLEASE STATE ANY OTHER AVENUE OF EXCWSS FUNDS APART FROM THOSE ABOVE:

V. REFERENCES

NAME:

DESIGNATION:

ADDRESS:

CONTACT NO.:

RELATIONS

V. REFERENCES

DESCRIBE YOUR CURRENT (FOOD &BEVERAGE) RETAILING BUSINESS SET UP AND EXPERIENCE?

DO YOU HAVE ANY OTHER BUSINESS INTERESTS? PLEASE SPECIFY

HAVE YOU, YOUR CURRENT OR PREVIOUS COMPANY OR YOUR SPOUSE EVER BEEN DECLARED OR FILED FOR BANKRUPTCY? PLEASE PROVIDE DETAILS;

HAVE YOU OR YOUR BUSINESS EVER BEEN PROSECUTED, OR BEEN INVOLVED IN A DISPUTE (I.E., COUNTY COURT JUDGMENTS ETC...)

HAVE YOU EVER BEEN INVOLVED IN A BUSINESS FAILURE? PLEASE PROVIDE DETAILS;

HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE? PLEASE PROVIDE DETAILS;

DESCRIBE WHY YOU BELIEVE THAT YOU CAN BE A SUCCESSFUL ASTROLABE LICENSEE?

DESCRIBE YOUR INVOLVEMENT IN THE COMMUNITY, AND ANY INTERESTS AND HOBBIES YOU HAVE OUTSIDE OF YOUR BUSINESS?

CAN YOU PLEASE PROVIDE EXAMPLES OF WHERE YOUR CURRENT BUSINESS HAS BEEN LOCALLY RELEVANT IN THE COMMUNITY?

HAVE YOU, EITHER AS AN INDIVIDUAL OR COMPANY PREVIOUSLY APPLIED TO BECOME A ASTROLABE FRANCHISEE?

V. REFERENCES

Astrolabe appreciates the time and effort you have put into the completion of this form and welcomes applications from all sectors of the community regardless of gender, marital status, disability, ethnic origin, race, color, nationality, sexual orientation, religion or belief.

Please sign below to indicate that the facts you have given are true to the best of your knowledge and belief and may be used by Astrolabe to assess your application and carry out such checks as are required to verify your information and your suitability as an extended Astrolabe licensee.

You agree that you will notify Astrolabe of any material changes to this information in writing and understand that omission or misrepresentation of information in this form may result in your removal from the Astrolabe program.