2016 AAE Application

Please make only one submission per applicant. Note that incomplete submissions cannot be accepted. Please send any questions about the application to aae@africanleadershipnetwork.com.

Contact Details

Title (required)

Name [first name last name] (required)

Sex (required)
 Female Male

Your Email (required)

Website

Primary Phone Number (required) [Please include country code (e.g. +27)]

Business Information

AAE Category (required)

Company Name (required)

Name of CEO or Equivalent (required)

Name(s) of Founder(s) [if different from above]

Year of Establishment or Incorporation

Country of Establishment or Incorporation

Location of Headquarters (City)

Location of Headquarters (Country)

Is Company a Subsidiary?
 Yes No

Legal Structure [incl Sole Proprietorship, Limited Liability, Partnership, etc]

Briefly explain your company's governance structure (Board of Directors, Advisory Board, internal committees, etc.) including number of members on such committees and their backgrounds. (max 300 characters)

Is company listed on any stock exchange?
 Yes No

If yes, which stock exchange?

Industry/Sector (check all that apply)

2014 Revenue (in USD)

2015 Revenue (in USD)

Number of Full-time Employees

Number of Part-time Employees

In how many African countries do you currently operate?
 1 - 5 6 - 10 11 - 20 21 - 30 30+

Which African countries do you plan to enter in the next 1-2 years?

Has your company ever been declared bankrupt?
 Yes No

If you answered yes to the question above, please explain briefly

Have you ever applied for the Africa Award for Entrepreneurship?
 Yes No

If you answered yes to the above question, what year(s) did you apply?

Agreement & Signature

BY SUBMITTING THIS APPLICATION, I HEREBY CERTIFY THAT ALL SUBMITTED INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE AND THAT MISREPRESENTATION OF ANY KIND WILL BE SUFFICIENT GROUNDS FOR DISQUALIFICATION. I ALSO CONSENT TO ALL RULES AND REGULATIONS OF THE 2016 AFRICA AWARDS FOR ENTREPRENEURSHIP PROGRAM.

Name (required)

Date (required)