Disaster Relief Application

Disaster Relief Application | Micro, Small & Medium Enterprise Assessment

A snapshot of your business’s status, used to assess the impact of the disaster and determine eligibility for Hollywood Foundation funding.

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SECTION A: ACKNOWLEDGEMENT & DECLARATION

Please review the following disclaimers carefully and indicate your acknowledgement by selecting "Yes" or "No" for each.

1. I understand that submitting this form does not automatically guarantee support for my business. *

Yes
No

2. I understand that this form is an initial assessment used to determine whether I am eligible for assistance. *

Yes
No

3. I confirm that all information provided in this form is accurate and complete to the best of my knowledge. *

Yes
No

4. What is your Name and Surname? *

5. What is your gender? *

Male
Female
Prefer not to say

6. What is your business's name? *

7. What is the nature of your business? Please select up to 3 core services or products your business provides. *

8. How old are you? *

18-24
25-34
35-44
45-54
55 and older

9. Is your business more than 51% women owned? *

Yes
No

10. Which business industry does your company operate in? Please select the option that best matches your main business activity - Business Industry (DTI-aligned Definitions) Please select at most 3 options. *

SECTION B: COMPLIANCE & DOCUMENTATION

This section collects required documentation to verify business registration, ownership, and regulatory compliance.

11. Please submit all six (6) required documents: CIPC registration document, valid B-BBEE sworn affidavit or certificate (no older than 12 months), ID document(s) of the owner(s), proof of address (Municipal/Eskom bill or lease agreement), financial statements/management accounts/bank statements, and images of damage. Submitting fewer than six will result in an incomplete application. **Maximum size per file 1MB** *

Click or drag files to this area to upload. You can upload up to 16 files.

SECTION C: OPERATIONAL IMPACT & RESILIENCE

Assessing the current state of your business and the steps taken to maintain continuity during recovery.

12. What motivated you to start your business? *

13. How long has your business been operational for? *

14. What is the function of your business? *

15. Which geographic areas does your business serve? *

16. Please explain how the natural disaster has affected your business operations. *

17. Is your business still fully operational after the natural disaster? *

Fully operational
Partially operational
Permanently closed

18. If your business is still operational, what actions have you taken to maintain business continuity and recovery after the disaster? (e.g. relocation, alternative suppliers, temporary repairs) *

19. Which area of your business has been negatively affected by the natural disaster? (Select all that apply) *

Trading Stock
Agriculture - Livestock farming
Agriculture - Crop farming
Infrastructure
IT Systems/Data
Equipment and machinery
Vehicles/Transport

20. Outline the estimated rand value of the damages you have selected above. (e.g. Agriculture-Maize-R20000) *

21. Describe the specific assistance or support your business requires at this time. *

SECTION D: WORKFORCE AND EMPLOYEE IMPACT

This section evaluates how the disaster has affected employment, income stability, and staff wellbeing.

22. Total number of employees employed before the disaster. *

23. Number of employees whose roles have been affected by the disaster (reduced hours, relocation, temporary suspension, etc.) *

24. Number of employees who lost their jobs as a direct result of the disaster. *

25. Are you currently able to pay full salaries to your remaining employees? *

Yes
No

26. If no, please explain the challenges you are experiencing in meeting payroll obligations. *

27. Have any employees received external support (e.g. UIF, relief grants, NGO assistance)? *

Yes
No