test For All Potential Partners:Reps, Franchisees, Investors, Website Partners & Store Owners.This questionnaire must be completed before Cannexus shares contracts, strategic information, or onboarding documentation. It ensures we only proceed with partners who are serious, professional, and aligned with the Cannexus mission.SECTION 1: PERSONAL INFORMATIONFirst Name *Last NameID / Passport Number: *Date of Birth: *Cellphone Number: *Email Address: *Street AddressApartment, suite, etcCityProvincePostal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweSECTION 2: PARTNERSHIP PATHWAY SELECTIONPlease select all Cannexus partnership models you are applying for:For Existing Cannabis Stores *Compliance Conversion – I have a cannabis store and want full legal conversion under Cannexus.Hybrid Store Upgrade – For stores currently selling both wellness products and greyarea cannabis items (flower/vapes/edibles) who want to become fully compliant medical dispensaries under the CannexusSection 21 Framework *Cannabis Lounge Partner – I run a cannabis lounge and want my members to become Cannexus partners/patients.Store-in-Store Model – I run a business selling other products and want to add a Cannexus micro-dispensary for extra income.For New Stores or Franchise Applicants *Cannexus Micro-Franchise (20–40 sqm) – Recommended model; low overhead, fast setup.Cannexus Full Franchise (60 sqm) – Larger-format dispensary.New Store Startup Support – I want to open a completely new compliant store.Other Partner Types *Investor / Multi-Store Owner – Funding, opening, or partnering on multiple Cannexus stores.Website Partner / Digital Services – Offering digital development, marketing, or online integration for Cannexus.Other (Please Specify)SECTION 3: BUSINESS & EXPERIENCE BACKGROUNDWhat is your current profession or business? *Do you have experience in cannabis, wellness, retail, sales, or medical industries? *Please selectNoYesHave you ever owned or operated a business before? *Please selectNoYesIf joining as a store, what type of store do you operate? *Please selectPlease selectWellness storeHybrid cannabis shopMedical dispensaryStarting new storeOtherIf joining as a rep, what territories can you cover? *SECTION 4: FINANCIAL READINESS (ALL PARTNER TYPES)Are you financially prepared to invest in the role you selected? *Please selectPlease selectNoYesIf applying as a franchisee or investor, what is your available budget range? *Under R50,000R50,000–R150,000R150,000–R300,000R300,000–R1 millionR1 million–R5 millionR5 million+If you claim investor backing, can you provide written proof? *Please selectPlease selectNoYesUpload Investor Backing Document *Choose FileNo file chosenDelete uploaded fileSECTION 5: PARTNERSHIP MOTIVATIONWhy do you want to join Cannexus? (Select all that apply) *To open a legal medical cannabis dispensaryTo become a Cannexus Sales PartnerTo invest in multiple storesTo access legal productsTo bring my store into complianceTo join a national cannabis brandOther (describe)What do you expect Cannexus to help you achieve? *SECTION 6: COMMITMENT & WORK ETHICHow many hours per week can you commit to Cannexus? *Are you comfortable with structured reporting and professional standards? *Please selectPlease selectNoYesAre you willing to follow the Cannexus Code of Conduct and Compliance Rules? *Please selectPlease selectNoYesHave you ever abandoned a business relationship or communication without notice? *Please selectPlease selectNoYes, (please explain)SECTION 7: COMMUNICATION & PROFESSIONALISM CHECKWhat communication style do you prefer? *WhatsAppEmailPhoneAll of the aboveHow quickly do you typically respond to business messages? *Within 1 hourWithin a few hoursSame dayNext day or longerSECTION 8: STORE-SPECIFIC QUESTIONSDo you currently operate a store? *Please selectPlease selectNoYesStore Name *Store Address *Number of employees *Current monthly turnover range *Current operational category *Are you selling any illegal or recreational cannabis products? *Please selectPlease selectNoIf yes, please explain (Cannexus may assist you in transition)Do you want to convert your store into a fully compliant medical dispensary? *Please selectPlease selectNoYesSECTION 9: INVESTOR-SPECIFIC QUESTIONS (IF APPLICABLE)How many stores do you want to invest in?What is your expected ROI timeframe?6 Months12 Months24 MonthsLong-termDo you prefer owning stores outright or partnering with existing operators?Please selectPlease selectOwning stores outrightPartnering with existing operatorsSECTION 10: REQUIRED UPLOADS (MANDATORY)ID or Passport *Choose FileNo file chosenDelete uploaded fileCIPC Registration Documents (if applying as a business or store)Choose FileNo file chosenDelete uploaded fileCompany Documents (if applicable)Choose FileNo file chosenDelete uploaded fileVAT Registration Certificate (VAT Number) *Choose FileNo file chosenDelete uploaded fileSARS Tax Clearance Certificate *Choose FileNo file chosenDelete uploaded fileInvestor Proof (if applicable)Choose FileNo file chosenDelete uploaded fileCV (optional but recommended)Choose FileNo file chosenDelete uploaded fileSigned NDA *Download NDA HereChoose FileNo file chosenDelete uploaded fileStore Photos (if store owner)Max 3 imagesDrag and Drop (or) Choose FilesKYC verification is completed once these documents are received and compliance fees are settled.SECTION 11: DECLARATIONDeclaration *I hereby declare that all information provided is true and accurate. I understand that:• This form determines my eligibility for Cannexus partnership.• Cannexus may require additional documents.• Dishonesty or unverifiable claims may result in disqualification.• Serious applicants must complete the Cannexus Partnership ScreeningFee, which includes mandatory compliance costs for legal andaccounting verification.SECTION 12: CONFIDENTIALITY & COMPLIANCE DECLARATIONCompliance Declaration *By signing this Questionnaire, I/We acknowledge and agree that:• All Cannexus information disclosed is proprietary and confidential.• I/We shall not circumvent Cannexus by engaging with suppliers, patients, orpartners introduced by Cannexus without written consent.• Mandatory compliance documents (VAT, Tax Clearance, CIPC, etc.) must besubmitted.• Breach of confidentiality or misrepresentation entitles Cannexus to injunctiverelief and damages.SECTION 13: MANDATORY COMPLIANCE CONSULTATION & AUDIT DECLARATIONAudit Declaration *• In accordance with Section 21 of the Medicines and Related Substances Act,1965 (Act 101 of 1965), FICA, POPIA, PAIA, and SARS requirements, allapplicants must undergo a Cannexus Compliance Team consultation.• Consultation fees: R 1,300.00 per hour (excluding VAT).• If non-compliance is identified, remedial consultations are billed at R 1,700.00per hour (excluding VAT), subject to the scope of compliance.• No partnership, franchise, or affiliation will be activated until compliance isverified and certified.COMPLIANCE FEE SCHEDULE ANNEXFee Schedule Declaration *• Legal Costs – Section 21 verification, SAHPRA alignment, advertising vetting.• Accounting Costs – Reconciliation of registers, invoices, discounts, audit preparation.• POPIA Costs – Policy adoption, staff training, privacy audits.• FICA Costs – Proof of funds verification, beneficial ownership disclosure, AML/CFT screening.• Tax Compliance Costs – Verification of VAT registration and SARS Tax Clearance Certificate.SECTION 14: MARITAL STATUS & SPOUSAL CONSENT DECLARATIONMarital Status Declaration The Applicant hereby declares their marital status as follows: *SingleMarried – In Community of PropertyMarried – Out of Community of Property (ANC without accrual)Married – Out of Community of Property (ANC with accrual)Divorced (attach divorce order & settlement agreement)WidowedSubmit
