New Retailer Application Form

As part of the application process, please download and complete the Personal Finance Document below and have it ready to upload when prompted it within the form.

Download Personal Finance Document

Please note that you will also need the following documents ready to upload as part of this process:
Certified copy of RSA ID, Personal CV, copy of passport and residence/work permit (if applicable), educational certificates, diplomas or degrees (if applicable), company registration documents (if applicable) and business partners CV (if applicable).

    PERSONAL DETAILS OF MAIN APPLICANT
    Gender
    Race

    What form of Identification do you hold?

    Your ID Number
    Upload a certified copy of your ID
    Are you of foreign nationality?
    Country of Origin
    Place of Entry
    Date of Entry
    Passport Expiry Date
    Please provide your work permit details
    Work Permit date of issue
    Work Permit date of expiry
    Permanent Residence Certificate Number
    Date of issue
    Please upload copies of passport, residence/work permit in one PDF file.
    Please list all the languages you speak.

    Are you an existing fuel retailer or new?
    How do you intend to trade?
    Please upload your CV (.pdf or .jpg format only)
    Please upload the completed Personal Financial Document that you downloaded at the beginning of this form. (.pdf format only)

    What is your marital status?
    Details of Spouse
    Of which Country does your spouse have Citizenship/Permanent Residence?
    CREDIT AND CRIMINAL OFFENCES
    Do you have a credit judgement?


    Please upload any supporting documents (.pdf format only)

    Have you at any time been convicted of a criminal offence (other than minor traffic offences) whether in the Republic or elsewhere?

    If yes, please provide details




    Please upload any supporting documents (.pdf format only)

    Are you aware of any criminal investigation that you are the subject of, whether in the Republic or elsewhere?

    If yes, please provide details

    Please upload any supporting documents (.pdf format only)

    Are you aware of any judgments, litigation, current or pending, against you or a company of which you are or have been a director or officer?

    If yes, please provide details

    Please upload any supporting documents (.pdf format only)

    EDUCATION AND REFERENCES

    Describe any training in sales, management or retailing you have had?

    Please provide the name and registration number of any professional bodies, associations and institutions of which you are a member:

    How many qualification do you have?

    Qualification 1



    Date Obtained

    Qualification 2



    Date Obtained

    Qualification 3



    Date Obtained

    Please attach copies of certificates, diplomas or degrees in one single PDF file


    REFERENCES
    Please give details of three personal & business references that Astron Energy can contact for further information about your application.


    Personal Reference 1:




    Personal Reference 2:




    Personal Reference 3:




    Business Reference 1:




    Business Reference 2:




    Business Reference 3:



    RETAIL, WORK AND BUSINESS EXPERIENCE
    Please detail your retail, work and business experience. This includes any businesses you have either owned, or had any share in, in the last 5 years. Please provide the Company name, address, the position you held, your supervisor, your duties and your reason for leaving. (PLEASE NOTE: For Companies or CCs, please give full registered name and registration number. Please list your most recent experience first.)

    If you prefer, please details the above in a word document and upload the file below.
    Are you applying in a personal capacity or as an entity?
    COMPANY DETAILS

    I have a registered company



    Please upload your Company registration documents
    Please upload your Company Profile
    Proposed or actual % ownership of business

    Do you have a partner or potential partner
    PERSONAL DETAILS OF PARTNER
    What is your partners Nationality?
    What form of Identification do you hold?

    Your partners Gender
    Your partners Race

    Your partners number of years experience in retail
    Does your partner have a credit judgement?

    Does your partner have a criminal record?

    Please upload your partners CV (.pdf or .jpeg format only)

    AREAS OF INTEREST

    What type of offering are you interested in?

    Preferred site location/region/area
    First Choice
    Second Choice
    BUSINESS OPERATIONS

    Number of years experience in retail

    Please describe your personal reasons and business objectives behind applying for an Astron Energy branded Service Station

    What annual personal salary do you personally expect to generate from the business?

    Do you have experience working with computers?

    What computer applications are you familiar with? (e.g. Excel, Word, Office, accounting packages, etc)

    Will you have access to the Internet on site?

    Have you had any business experience in the following areas?

    Please explain your experience with those you selected above.
    How would you describe your philosophy of customer service?

    OTHER INFORMATION
    Have you previously applied to Chevron South Africa/Astron Energy/Caltex, or any other petroleum retailer, for a franchise agreement?

    Have you ever been declared insolvent or your estate placed under administration or was a company in respect of which you are or were a director or member, liquidated?

    Have you ever been party to a personal lawsuit?

    Do you have, whether personally or through your spouse, an immediate family member, partner or associate, a direct or indirect financial interest in Chevron South Africa/Astron Energy/Caltex, or its subsidiaries or intend acquiring such an interest?

    Do you have, whether personally or through your spouse, an immediate family member, partner or associate, a prior or existing relationship (including employment) with the Government or its affiliates?

    Do you have, whether personally or through your spouse, an immediate family member, partner or associate, a prior or existing relationship (including employment) with Chevron South Africa (Pty) Ltd/Astron Energy/Caltex, or its subsidiary or associate companies?

    Are you or any close relatives or friends/business associates involved in the commercial carriage of passengers or in the freight transport industry?

    Have you ever been dismissed, discharged or asked to resign from any employment?




    UNDERSTANDINGS AND AGREEMENTS

    Do you agree to a credit check
    If you advance to the next stage do you agree to psychometric testing

    Accuracy of Application

    I verify that the information I provided in this application is true and complete and is based on my judgment alone. I understand that false or incomplete information in this application will be grounds for disqualification. I further understand that false or incomplete information in this application will be grounds for termination of any Retailer Agreements that I may subsequently enter into with Seven Bridges Trading 23 (Pty) Ltd t/a Eyona Energy as a result of this application.

    Background Information

    I understand that Eyona Energy or its representatives may confirm information in this application and assess my qualifications to become an Astron Energy Retailer or retailer of a Caltex branded service station or Astron Energy branded service stations by conducting a background verification audit and reviewing various reports, records and other information about me (which may include, but are not limited to, credit ratings and reports, employment records, school records, and police and court records). I further understand that failing to cooperate fully with Eyona Energy review of my background and qualifications will be grounds for disqualification. I authorise Eyona Energy or its representatives to obtain information about me from my previous employers, schools, references, and others. I authorise my previous employers, schools that I have attended, all references and others to disclose to Eyona Energy or its representatives such information about me as Eyona Energy or its representatives may request, personal or otherwise. I release all parties from any liability to me in connection with furnishing this information to Eyona Energy and all information (including but not limited to credit) may be shared by and among Eyona Energy, its subsidiaries and affiliates.

    Acknowledgement

    I acknowledge that there will be no obligation on the part of, or commitment by Eyona Energy to appoint me as a Retailer for this location or any other location, until such time as a formal agreement has been entered into between the applicant and Eyona Energy. Any expenditure incurred by me or loss suffered by me during our negotiations for this location, will be for my own account and I undertake not to bring any claim against Eyona Energy for any such expense or loss.

    I particularly acknowledge that I am aware that Eyona Energy is not responsible for any loss of salary or wages suffered by me during negotiations or training courses conducted by Eyona Energy and that any payment made by Eyona Energy in respect of the period of training are made as a contribution towards my expenses at the sole discretion of Eyona Energy and in no way binds Eyona Energy to meet any further expenditure.

    Retailer Training Program

    I am aware that to qualify to become an Eyona Energy Retailer of a Caltex/branded Service Station or Astron Energy branded service stations, I must pass Astron Energy's Retailer Training Program.

    Consent to Due Diligence Investigation

    Notwithstanding anything contained in the common law or in any privacy statutory enactment of the country of domicile of the applicant, the applicant by its signature hereto unequivocally agrees that Astron Energy (Pty) Ltd may undertake and initiate or instruct a duly appointed service provider on its behalf to undertake such due diligence investigation in respect of the applicant as Astron Energy (Pty) Ltd may in its sole discretion deem necessary.

    The applicant further acknowledges that this consent shall also constitute an authority to any third party/ies that may be in possession of any germane information pertaining to the applicant to provide such information to Astron Energy (Pty) Ltd as it may require in furtherance of its due diligence investigation.

    Consent to Due Diligence Investigation

    Notwithstanding anything contained in the common law or in any privacy statutory enactment of the country of domicile of the applicant, the applicant by its signature hereto unequivocally agrees that Eyona Energy may undertake and initiate or instruct a duly appointed service provider on its behalf to undertake such due diligence investigation in respect of the applicant as Eyona Energy may in its sole discretion deem necessary.

    The applicant further acknowledges that this consent shall also constitute an authority to any third party/ies that may be in possession of any germane information pertaining to the applicant to provide such information to Eyona Energy as it may require in furtherance of its due diligence investigation.

    Data Privacy Notice

    Personally identifiable information has been disclosed in this Application Form for the purposes of this application and the applicant hereby consents to the processing of this information by Astron Energy (Pty) Limited and disclosing such information to third parties for the purposes of this application, where necessary. All processing and disclosure will be done in compliance with the requirements of the Protection of Personal Information Act No. 4 of 2013. The applicant may request review, update or deletion of the personal information held by Astron Energy (Pty) Limited.

    In line with the Protection of Personal Information Act (POPI Act), Astron Energy's Privacy Statement may be accessible through the following link: Privacy Statement | Astron Energy

    Data Privacy Notice

    Personally identifiable information has been disclosed in this Application Form for the purposes of this application and the applicant hereby consents to the processing of this information by Eyona Energy and disclosing such information to third parties for the purposes of this application, where necessary. All processing and disclosure will be done in compliance with the requirements of the Protection of Personal Information Act No. 4 of 2013.

    No Breach of Obligations to Others

    I represent and warrant to Eyona Energy that I am free to submit this application and, if it is approved by Eyona Energy, to become an Astron Energy Retailer of a Caltex/branded Service Station or Astron Energy branded service stations without breaching any contract or other binding obligation I may have with another party.

    Note

    Eyona Energy reserves the right to accept or reject any application by an applicant at any time until a formal agreement is signed between the applicant and Eyona Energy.

    The applicant further acknowledges that Eyona Energy or its representative will not accept or incur any liability to an applicant for such rejection, and is under no obligation to furnish the applicant with reasons for the rejection. The decision of Eyona Energy is final and no correspondence of whatsoever nature will be entered into.

    I have read, understand and agree to what is stipulated in the above statements.

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