APPLY TODAY Business Funding EMAIL US Business Application Form SECTION A: AUTHORISED PERSON/ APPLICATION INFORMATION Full Name Email Contact Number Identification Type: ID Number Passport Number ID Number Passport Number Equity Code Black-African Black-Coloured Black-Indian White Other Specify Residential Address Residential Address Residential Address Residential Address City City Province Province Postal Code Postal Code Years in Enterprise (Applicant) Highest Level Passed Declaration: I have the authority to make submissions for and on behalf of Applicant/ Enterprise: Yes No SECTION B: BUSINESS INFORMATION Company Name (including trading name) Company Type Private (Pty)LtdPublic Company(Ltd)PartnershipPersonal Liability (Inc.)Business TrustSole Proprietorship Years in Operation Contact person (if different from above) Email address of Contact Person Designation Company Core Business Key Account Manager (if applicable) Business Email Address Contact Number 1: Alternative Contact Number : Fax number Funding Amount Required R Use of funds Date funding required Duration or Repayment Strategy 1 Strategy 2 Strategy 3 Physical Address Physical Address Physical Address Physical Address City City Province Province Postal Code Postal Code Postal Address Postal Address Postal Address Postal Address City City Province Province Postal Code Postal Code Does the Enterprise have more than 1 site? YesNo Is Enterprise registered for VAT? YesNo BEE Level 1234Non-Compliant Main Contributor: Black OwnershipWoman OwnershipPeople Living With Disability Total Number of Employees Business Website Shareholders and/ or Directors Name Surname ID Number Percentage Comments/ Additional Information plus1 Add minus1 Remove SECTION C: PROGRAMME INFORMATION Goals/ Objectives List 5 goals or objectives for your business are linked to funding request. Please write complete and full sentices? 1. * 2. * 3. * 4. * 5. * Coaching & Mentoring Priotisization In general, which area/s of your business would you require assistance? Please choose the top 5 areas Revenue Cost of Sales Expense Policy Other (Specify)Other (Specify) Targets Authorising Signature (Who warrants his/her authority) Date SECTION D: ATTACHMENTS Company registration documents from CIPC Drop a file here or click to upload Choose File Maximum file size: 33.55MB Certified ID copies (key representative/s) Drop a file here or click to upload Choose File Maximum file size: 33.55MB Valid tax clearance document Drop a file here or click to upload Choose File Maximum file size: 33.55MB I confirm the Company registration documents from CIPC are uploaded. * I confirm the Company registration documents from CIPC are uploaded. I confirm the Certified ID copies (key representative/s) is uploaded. * I confirm the Certified ID copies (key representative/s) is uploaded. I confirm a Valid tax clearance document is uploaded. * I confirm a Valid tax clearance document is uploaded. Bank statement bank (6-12months) Drop a file here or click to upload Choose File Maximum file size: 33.55MB Financial statements – Income statement and Balance sheet Drop a file here or click to upload Choose File Maximum file size: 33.55MB Organogram Drop a file here or click to upload Choose File Maximum file size: 33.55MB I confirm the Bank statement bank (6-12months). * I confirm the Bank statement bank (6-12months) are uploaded. I confirm the Bank statement bank (6-12months). * I confirm the Financial statements – Income statement and Balance sheet are uploaded I confirm the Organogram * I confirm the Organogram is uploaded. SECTION D: DECLARATION Full Name * I confirm the accuracy of the particulars herein given and agree that they form the basis upon which this application is to be considered and that any misrepresentation subsequently discovered may result in the withdrawal of application for the programme. Further I understand that Market Demand/ Lenda Legends will retain this application and supporting documents for the company’s records whether or not it is approved. Please note acceptance of an application form is not a confirmation that the applicant has been approved. * Submit If you are human, leave this field blank.
