‘SIME Support Network Application Form for Business Mentorship Personal Details of the Entrepreneurs PARE RO Name Nationality WMeSs Ves & Gender EGmarce Age c oe SA. Mobile phone REVS 6&4 Email Address Mert se Meet. Co Physical Address (street name, town, | XWAECE CS Wy district, etc) \Wagareieg LELeaLeieg sais background and field of TEEMACD) KQGe} eG Business and entrepreneurship skills training attended in the last 3 years VSG Company Information Name of the company pw Aon ork QAME IS OLA MRAEAETWE Year and month of establishment “Rue NE LS Your roles in the company (e.g. owner, manager or owner/manager) OQuswTwe Economic sector in which the business operates (e.g., agriculture, tourism, - manufacturing, innovation or creative) YWARreC EACLE Start up capital of your company (Maloti) | | W\S SO. @<) ‘Annual revenue of your company (Malet) |_CV\ @O Geo ~ 8. Current capital of your company (Maloti) |_ 1A _~&¢ ea.8 = No. of employees on establishment. foal No. of employees currently = Company vision in five years lpecemdiye VQ MSN ctLsiIS Applicant's Signature 7. Lb. Y ae pate {GS \a \2)