SERIAL NO: 03774

GRANT APPLICATION FORM

Please use this form to apply for individuals, business and SMEs. Applications made are subjected to terms and
conditions and only submitted with full knowledge of the Individual/Company/ Organization Group enterprise

Applicant Details

Name of Individual/Company/Organization/group/Enterprise: ________________________________________

_______________________________________________________________________________________
If registered indicate business Registration no. : ___________________________________________________

If NOT Registered indicate individual Passport or National ID card No.: _________________________________

Address/Location: ______________________________________________________
___________________________________________________________________________________________

Does you or your organization have a recurring income stream? YES NO

Do you or your organization offer employment opportunities? YES NO

Are you or is the organization a member of Global Entrepreneurship Network (GEN)? YES NO

Contact Person Details

Full Names: _________________________________________________________________________________

Phone (s): __________________________________________________________________________________

Your Role in the Organization: __________________________________________________________________

Loan Details
Amount you wish to apply (USD5, 000 – USD500, 000):

_______________________________________

Has your organization applied for a grant within the last 12 months? YES NO

If yes please specify the intended use of the grant (the “Project”): _____________________________________

_______________________________________________________________________________________
Please specify the main town/suburbs in which the Project will occur: __________________________________

___________________________________________________________________________________________

Will the Project have an overall benefit for the community? YES NO

If the project will benefit a section of the community please describe that section (for example, the elderly,

people with disabilities, youth, families etc.): ______________________________________________________

If we are unable to fully fund your application would you accept partial funding? YES NO

What Amount of partial funding would assist? _________________________________________________________

Please attach:

▪ Clear passport photo:

▪ National ID card
▪ Business registration certificate if registered

If you or your organization have a recurring income stream do attach a copy of your bank statement.

Any Other information relevant to your application: ________________________________________________

___________________________________________________________________________________________

Declaration

I declare that the information given herein is true to the best of my knowledge and belief and acknowledge
that the decision of the Approval Board is final.

Signed: _____________________________________________________________

Full Name: _________________________________________________________

Date: _______________________________________________________________

NOTE: THIS FORM MUST BE DOWNLOADED, FILLED IN INK PEN AND SIGNED BEFORE IT IS SUBMITTED