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Deloitte SA Technology Fast 50

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Disclaimer

Please note that unless otherwise requested, companies successfully nominated for 2012 Deloitte Technology SA Fast 50 will automatically be entered into the Deloitte Technology Fast 500 EMEA 2012 programme.

Any confidential financial data contained in this nomination form shall be used by Deloitte Touche Tohmatsu Limited and its member firms solely for the purposes of the Deloitte Technology SA Fast 50 and Deloitte Technology Fast 500 EMEA 2012 programmes and shall not be used for any other purposes unless stated otherwise. For those companies that are selected as winners of the Deloitte Technology SA Fast 50 and Deloitte Technology Fast 500 EMEA 2012 awards, their percentage of revenue growth over the last five financial years and an indication that their current revenue exceeds a certain threshold amount (both determined using information provided by such companies) will be published in the Deloitte Technology SA Fast 50 winners report and the Deloitte Technology Fast 500 EMEA winners report. No other financial information will be published without prior written consent.

Please note that Deloitte may use a third party to collate and telephone market SA Fast 50 information. This organisation is bound by a confidentiality agreement. Your information will be stored by them on a computer for the purposes of managing the responses to this programme and for no other purpose. This nomination form is subject to important restrictions, qualifications and disclaimers ("the Disclaimer") that must be accessed and read by visiting our website and viewing the webpage at the following address: http://www.deloitte.com/za/disclaimer. The Disclaimer is deemed to form part of the content of this nomination form in terms of Section 11 of the Electronic Communications and Transactions Act, 25 of 2002. If you cannot access the Disclaimer, please obtain a copy thereof from us by sending an email to ClientServiceCentre@Deloitte.co.za.

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