Shell Retailer Application Form

It is important you complete this application form accurately and honestly. Incomplete and/or inaccurate information will render your application null and void. Please refer to our Privacy Statement

1 Personal Details
2 Education
3 Work/Business Experience
4 Service Station Preferences
5 Financial Information
6 Credit Information
7 Employment References
8 Additonal Information
9 Document Upload
10 Declaration by Candidate
11 Summary

★ Please review all the details that you have provided.

★

Personal Details

Full Name*

Email*

Mobile Number*

Landline Number / Alternative Number*

Citizenship*

Current Address*

City*

Postal Code*

Province

Country*

Family Relationship

Position

Company

Work/Business Experience

Please fill either Business Experience or Senior Business Management Experience if applicable.

Business Experience*

Senior Business Management Experience*

What is your current employment status?*

How did you hear or come to know about the shell franchise opportunity?*

(Hold down the Ctrl (windows) / Command (Mac) button to select multiple options.)

Please select the industries you have had work experience within*

Write down the number of team members you currently manage*

What attracted you to Shell and the self-employed retail opportunity?

How will you deliver the needs and aspirations of Shell's customers?

What other self-employed opportunities are you currently operating, and/or, are considering?

Service Station Preferences

Same location cannot be selected . Select other location .

Financial Information

Annual Business Revenue *

Please state how you intend to fulfill this requirement

NOTE : Total unencumbered fund should be equal to Own Unencumbered funds

Total investment from securities*

Total Unencumbered Funds *

Please write down any additional information you would like to include

In support of your application, would you be able to submit proof of these funds should it be requested?*

Credit Information

Have you ever been declared insolvent?*

Please specify

Have you ever had a judgement against you or have a judgement that is pending?*

Please specify

Have you been a member of a Company or a Close Corporation that has been declared insolvent?*

Please specify

Are you currently involved in any legal disputes?*

Please specify

Will any other person or juristic person have an interest in the business?*

Please specify

Employment References

Reference 1

Full Name*

Position*

Company*

Email Address*

Phone number*

Reference 2

Full Name*

Position*

Company*

Email Address*

Phone number*

Additional Information

Have you previously applied to be a shell franchisee either as an individual or a company? If yes, please provide details

Please specify

Name of legal entity to operate the business

Name/s of shareholders (as listed on the Share Certificates)

Ownership Structure - shareholding % split

Do you have a relative working for Shell or operating a Shell service station? If yes, please provide details

Please specify

Document Upload

Please upload document less than 3MB of size

* You can upload only doc , docx , pdf format files.

Declaration by Applicant

Important note: incomplete and duplicate submissions will result in an automatic decline of the application.

This application form or acceptance of the Applicant to the next stage of the application process does not constitute an offer of a Service Station or a commitment to offer one.
Shell’s decision regarding this application by the Applicant is final and is not subject to appeal or arbitration.
Shell reserves the right to withdraw this application at any stage of the process as and when it deems appropriate to do so.
The franchise application process has various stages, the acceptance of the application and approval to proceed to the next selection stage does not constitute an appointment as a Shell Franchisee. In instances where the Applicant has been appointed as a Shell Retailer, Shell will formally communicate such an appointment.
Liability – To the fullest extent permitted by law, neither Shell nor their partners or agents shall be responsible for any loss, damage or injury whatsoever suffered by the Applicant (including but not limited to any direct, indirect, consequential, special, punitive or incidental loss or damages) or for any personal injury (whether physical or mental) suffered or sustained by the Applicant as a result of or in connection with the application process. Shell will not be held legally liable for any personal losses what so ever that the Applicant may incur in the process of applying for a Shell Service Franchise or rejection of their application at any stage of the selection process including after training.
Transformation – Shell has aspirations on transformation that seek to align its Retailer Profile to the Nationally Economically Active Population (NEAP) statistics. To achieve this, Shell will take steps and select prospective franchisees in line with its assessed gaps of its current Retailer profile and its programme to align it to the NEAP.
Costs –In the event that the Applicant makes it to the next stage of the application process, there will be costs payable by the Applicant. These costs include, but are not limited to, training in the event that the Applicant makes it to the final phase of the process. The above-mentioned costs are not refundable under any circumstances.
Assessments – Shell will do a number of assessments as part of the application process some of them will require payment by the Applicant. The successful completion of any of the assessment stages does not imply that the Applicant is entitled to a Shell Service station.

CREDIT CHECKS

It is a Shell requirement that Credit Checks be done on the Applicant and by signature at the bottom of this form Shell is hereby authorised to do the checks.
The Applicant hereby authorises Shell to make enquiries and to use, exchange and disclose to any credit provider or Credit Bureaus, any or all information that it may obtain in the course of doing the credit checks.
It is the Applicant’s responsibility to maintain a healthy credit profile. Shell reserves the right to do credit checks on an on-going basis during the course of the application process.
In addition to Credit checks, the Applicant will be required to provide information related to proof of their Assets and Liabilities.

PERSONAL BACKGROUND CHECKS

Shell will as part of this application process conduct back ground checks on the Applicant that includes but not limited to criminal records, academic qualifications verification, Identity Document (ID) authentication, restrictions and listing on sanctions lists.
To effect the checks, Shell will utilise various sources of information at its disposal and reserves the right to re-do the checks at various stages of the application process as part of on-going risk management based on the outcomes of the checks, it will review any decision that it may have taken about the Applicant and their candidature.

ANTI-BRIBERY AND CORRUPTION (ABC) DECLARATIONS

The Shell Anti-Bribery and Corruption (ABC) policy requires that prospective Franchisees declare their Political Office responsibilities. The said responsibilities in terms of the ABC policy are outlined in the ABC Declaration section in this application form.
Shell is apolitical and in its business dealings. The ABC declarations enable Shell to manage and separate the political responsibilities of the Applicant from its business dealings with the Applicant.
Should the Applicant be successful, they are required at all times to maintain their ABC standing and when there is a change in their lives and take on a political office responsibility, such a change must be duly declared and prior authorisation by Shell obtained before it is accepted.
Shell reserves the right to withdraw or cancel any appointment at any stage of the application process on the basis of ABC information that may not be compatible with its policies or where new undeclared information arises during the process or after appointment as a franchisee.

TAX COMPLIANCE

The Applicant is required to comply with the relevant tax laws as part of the application process and on an on-going basis.
Shell requires that the Applicant furnishes Shell as part of this application process a valid Tax Clearance from the South African Receiver of Revenue (SARS).
Failure to provide a valid Tax Clearance certificate at any stage of the process will result in the withdrawal of the Applicant from the process. Shell will not refund nor be held liable for any costs that may have up to that stage been incurred by the Applicant.

INFORMATION HANDLING

Shell acknowledges that it will receive personal information relating to the Applicant.
The information in the possession of Shell will be handled in line with relevant legislation regarding the handling and protection of personal information. In addition to the legislated requirements, Shell has its own policies regarding safe guarding of such information. For more details on how Shell handles your information visit the Shell Privacy Policy on Privacy notices | Shell South Africa
Shell is duty bound by various legislation to report or pass on information to the relevant authorities where it encounters non-compliance with the laws of the Republic. In the event that Shell encounters such non-compliance or adverse information during this process, it will hand over such information to the relevant authorities.
The Applicant through their signature at the bottom of the application form hereby consents to Shell passing such information to the authorities as and when it picks it up.

Name:

Identification number:

I hereby declare and to the best of my knowledge that the information declared by myself on this application form is true and correct and I agree to the terms and conditions.

About Shell Retail, The Proposition And The Application Form

About Shell Retail, The Proposition And The Application Form

Personal Details

Education

Work/Business Experience

Service Station Preferences

Financial Information

Credit Information

Employment References

Additional Information

Document Upload

Declaration by Applicant