Zambia Chamber of Small and Medium Business Associations

Details of Chief Executive / Proprietor

Surname Name

Other Name(s)

Mr.

Mrs.

Ms.

Dr.

 Dr.

Age

Sex

NRC Number

Qualifications

Nationality

Contact Details

Postal Address

Physical Address

Location

Province

Town

Mobile Phone

Telephone

Facsimile

E-Mail(s)

If registered under the companies act, provide details, e.g., Whether PLC, Ltd by guarantee, Sole, VAT clearance etc

Nature of business

1. Manufacturing 2. Processing 3. Plant and Machinery 4. Wholesale 5. Import 6. Export

7. Service 8. Retail

Sector and Sub-sector

Sector

(tick where applicable, and use blank space for others)

√

Sub-Sector

(tick where applicable, and use blank space for others)

√

1. Agriculture

2. Commerce

1. HIV Awareness

2. Crafts and artifacts

3. Health

4. Mining

3. Poultry

4. Rare minerals

5. Construction

6.

5.

6.

7.

8.

7.

8.

9.

10.

9.

10.

Main Activities of Business

Annual Turnover

Total value of Assets

No. of Employees

Male

Total

Female

How did you learn
about ZCSMBA

Date

Signature