NW Growth Fund 2025 Pledge Form

Company Name Directors / Owners

Name	Surname	Designation	Action

Email Address Telephone Company Address

Nature of Pledge (Select only one):

Funding through the NW Growth Fund Funding through Project Development Resource allocation to existing project/s Supply of specialised skills to projects Other (please specify):

Location of Investment Rand Value

Nature of Investment: Employment Supported Employment Created

Declaration

Please confirm the following:

I agree to sign the investment pledge made The information provided herein is true and correct I consent to being contacted by the NW Provincial Government I agree NWPG may use this info in the investment book

Electronic Signature Consent

By typing your initials & Surname and checking the box below, you are electronically signing this form. This electronic signature has the same legal standing as a handwritten signature in accordance with the Electronic Communications and Transactions Act and the DPSA Guidelines.

I confirm that this typed name serves as my legal electronic signature and that all submitted information is accurate. Typed Initials & Surname (E-signature) Date

NW Growth Development Fund 2025 Pledge Form