Buyer Sign-Up — JoziGrow (Pty) Ltd

01 Buyer Information

Company Name

Regulatory Licence Number

Registered Address

Primary Contact Name

Position / Title

Company Registration Number

Company VAT Number

Contact Email

Contact Telephone

Issuing Regulatory Authority

Licence Expiry Date

02 Business Activity & Intended Use

Nature of Business

Pharmaceutical Manufacturer Extractor / Processor Wholesaler / Distributor Research Institution Other

Intended Use of Product

API / Extraction Finished Medicinal Product Research & Development Export Other

Products of Interest

03 Regulatory Confirmations

I confirm that our company holds a valid licence or permit to receive, handle, and/or process medicinal cannabis in our jurisdiction, and that this licence remains current and in good standing. I confirm that we will use the purchased product solely for the intended purpose declared in this registration, and will not divert, resell, or repurpose the product without prior written approval from JoziGrow. I confirm that we will notify JoziGrow immediately and in writing of any change in our licence status, regulatory standing, or business ownership that may affect our eligibility to purchase medicinal cannabis.

04 Declaration & Authorisation

Declaration by Customer: I, the undersigned, confirm that the information provided in this Customer Onboarding Form is accurate and complete to the best of my knowledge. I understand that JoziGrow (Pty) Ltd reserves the right to decline or suspend supply if any information is found to be materially inaccurate, if the customer's regulatory licence lapses, or if the intended use of product changes without prior written notification. Supply remains conditional upon receipt and acceptance of this form by JoziGrow.

Authorised Signatory Name

Date

Capacity / Role

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