Alternative Funding

Application Form

Strictly Confidential
Type of application Please tick (✓)

Start-up Business

Existing Business

All the information requested in this application must be provided and filled in for the application to be considered

Absa Bank Limited Reg No 1986/004794/06

Authorised Financial Services Provider Registered Credit Provider Reg No NCRCP7 Absa 3449 EX (A) (13/07/2018)
Background of business
Name of the business

Address of business

Telephone Cell

Fax Email

How long have you been in the business? months/years

Type of business Sole Proprietor Pty (Ltd) CC Other

Registration number of business Tax number for the business

Do you have a tax clearance certificate? Yes No

If No, please explain why not

VAT registration number

Amount of funding you require R

Please provide breakdown of funding required:

Bridging finance (Contract): R

Acquisition of Business Assets R

Working Capital R

How long would you need to pay off this amount? months

How much can you contribute? R

Detailed utilisation of funds

Item Costs Supplier(s) Availability of goods or services

Good Poor Not sure

Please provide quotes or other evidence for these expenses

Are you able to contribute any of your own funds? Yes No

Where will your contribution come from:

1 Profit from previous contracts

2 Borrowed from elsewhere

3 Personal savings

4 Other, please explain

Describe the business in short

Personal details (per individual member/shareholder)
Title Mr Mrs Miss Gender Male Female

Surname

First name(s)

Place of birth Date of birth D D M M C C Y Y

Ethnic group ID number

SA citizen Yes No Other nationality

Residential address

Postal code

Telephone (H) Period of residence years months

Residential property is Owned Rented By: Self Spouse

Marital status
Single Yes No Widow(er) since

If married COP ANC with accrual ANC without accrual Tribal

If divorced Final Yes No Date final D D M M C C Y Y

Other

(Include copy of marriage certificate contract if married ANC or copy of divorce decree)
If married please supply the following additional information about your spouse

First name(s)

Place of birth Date of birth D D M M C C Y Y

Nationality ID number

Name of employer

Employer’s address

Postal code

Employer’s telephone Present position

Annual income Number of dependants

Number of children Their ages

Contracting history and current contractual requirements
Are you registered with the relevant contracting bodies? Yes No Which ones? CIDB Other

Other (provide details)

How many government contracts have you completed in the past 2 years?

How many private sector contracts have you completed in the last 2 years?

What type of contracts were these?

1 Construction Yes No
2 Maintenance and repairs, e.g. of vehicles Yes No
3 Services e.g. cleaning, gardening, catering Yes No
4 Supply of goods e.g. stationery, furniture and computers Yes No
5 Other

Were they completed on time? Yes No If No, please explain what delayed the process

Have you ever lost retention fees because of non-performance? Yes No If “Yes”, what were the circumstances?

How many subcontracting jobs have you done in the past 2 years?

What type of sub-contracts were these?

1 Construction Yes No
2 Maintenance and repairs, e.g. of vehicles Yes No
3 Services e.g. cleaning, gardening, catering Yes No
4 Supply of goods e.g. stationery, furniture and computers Yes No
5 Other

Who did you sub-contract for?

Contact person

Contact details

Were they completed on time? Yes No If “No”, please explain what delayed the
process

Have you had any other sources of income coming into your business over the past 12 (twelve) months besides these Yes No
contracts/subcontracts?

If “Yes”, what was the value of the work done? R

Are you busy with any other contracts at the moment? Yes No
If “Yes”, please provide the following:
Monthly income Total value of Starting date When will Amount
Contracting authority Private Govt
from the contract the contract of contract contact end still due
1
2
3
4
5
Contracting finance
Please provide a copy of all the contract documents which you require funding for

Name of contracting authority Contract number

Telephone (Telkom) Cell

Contact person Their position

Date contract approved D D M M C C Y Y Starting date of contract D D M M C C Y Y

Value of contract: R Term of contract months

Brief description of contract and work to be done

1 Has your business done this kind of work before? Yes No

2 Is this contract bigger than the previous contracts that you have done before? Yes No
If “Yes” to (1) or (2), please explain how you plan to cope with the changes in the capacity of your business.
a) Equipment

b) Staffing – numbers, skills and training

c) Project management

d) Other

Explain how you have priced this tender

Did you include cost of capital in your figures? Yes No

Terms and conditions of the contract(s) that you need to fund through this application
Starting date D D M M C C Y Y
Completion date D D M M C C Y Y
Payment periods

Retention guarantee R

Quality control process

If applicable, how will you finance preparation and groundwork for the contract?

1 Customer will pay upfront Yes No

2 Have enough capital to tide me over Yes No
3 Not sure

Will the contracting authority deduct tax before paying you? Yes No
Pre-conditions of the contract and confirmation that they have been adhered to

Is a cession of the contract available? Yes No

What procedure(s) must you follow to request payment for work done?

Will work be certified and by whom?

How often can you request payments?

What percentage can you claim each time? %

Are there any penalty clauses for late delivery? Yes No

If “Yes”, what are these?

What guarantees are required?

Have you applied for performance guarantees before? Yes No

If “Yes”, who supplied these and how much where they for?

Have you ever had a claim under a performance guarantee? Yes No

If “Yes”, please explain the circumstances which led to the claim.
Applicant’s background
What experience do you have in running this kind of business?

What support or training do you think you may need to enhance the way the business is managed?

Managing your business finances? Yes No Pricing Yes No

Making your business better known/marketing Yes No Growing your business Yes No
Staffing and HR Yes No Compliance Yes No
Other – please explain in detail

Have you had any formal business training? Yes No

If “Yes”, what training?

Finance Business management Marketing HR Legal Pricing

Stock control Project management

What level of education do you have?

Matric Left school before matric Diploma Degree Postgraduate degree

What degree or diploma did you study?

Finance and banking

Do you already have any loans for your business? Yes No
With whom did you take these loans?

a) A Bank

b) A microlender, e.g. Louhen, African Bank

(If the client selects any of these options, we should ask for futher detains on each one e.g. name of bank etc.)

c) A micro enterprise lender, e.g. Marang or SEF

d) Mashonisha Stokvel

e) Friends and relatives

f)

How much did you borrow? R

How much do you owe? R

How many months do you still need to pay? R

How much do you pay off each month? R

Have you ever been listed at a credit bureau? Yes No Don’t know If “Yes”, how long ago?

How much do you pay off each month? R Have you paid this back? Yes No
Suppliers
Do you have any outstanding debts with any suppliers? Yes No
If “Yes”, who do you owe money to?
1 R

2 R

3 R

4 R

Are any of your suppliers likely to withhold delivery or unable to supply you with what you need during the Yes No
course of the contract(s)?
How will this affect your business?

Do you have any outstanding payments to:

1 SARS? 2 VAT?

3 PAYE? 4 Other

If “Yes”, please provide details

Did you or the firm receive any legal demands in the past 24 (twenty four) months? Yes No
Are there any legal actions pending that you know of? Yes No

Declaration
1 All the information provided in this application is true and correct in all respects.
2 The information provided in this application relates to my/our business/proposed business, and is required by the Bank as a business plan or
otherwise in order to consider the financing of my/our business/proposed business from the Small Business Fund/Joint Fund.
3 This application is subject to the terms and conditions of the Small Business Fund/Joint Fund.
4 The criteria, rules and terms and conditions of the Small Business Fund/Joint Fund have been explained to me/us, at the time of this
application, and I/we have received a copy of such criteria, rules and terms and conditions, the meaning and content of which I/we
understand and accept.
5 This Application and the Small Business Fund/Joint Fund criteria, rules and terms and conditions, are in support of, and in addition to the
application for credit/a term loan, which I/we have applied for and signed at the Bank at the time of this application, the Pre-Agreement
Statement and the Quotation provided by the Bank in terms thereof as required by the National Credit Act, Act 34 of 2005 (“NCA”) if
applicable, the terms and conditions of which have been explained to me/us, a copy of which has been provided to me/us, and the content
and meaning of which I/we understand.
6 This Application and the application for credit/a term loan, are subject to approval by the Bank and any credit assessment as may be required
in terms of the NCA, if applicable.
7 The Bank may approve my/our application for credit subject to the specific conditions relating to the type of facility granted, the purpose of
the facility, pricing/interest rate, repayment period, security required, and such other conditions as may be required, all of which will be
disclosed to me/us in writing by means of a Facility Letter by the Bank, which I/we will be required to consider, and to sign my/our
acceptance in writing, if I/we accept such offer by the Bank.
8 The Facility letter together with such special conditions as may be contained therein, the Pre-Agreement Statement and Quotation in terms of
the NCA, if applicable, and the terms and conditions of the term loan and the Small Business Fund/Joint Fund provided to me on application as
stated above, will upon my/our acceptance thereof serve as the contract between me/us and the Bank.
9 Any transactional product applications by me/us for my/our business will be subject to separate terms and conditions.

Date completed D D M M C C Y Y Date handed to Bank D D M M C C Y Y

Signed at on

Signature Witness

Signature Witness

Signature Witness
Checklist

SMME Fund

Absa DCA
Khula
1 Fully completed application for contract funding (Absa 3449)
2 Minimum 12 (twelve)-month cash-flow projections (Absa 2376)
3 Copy of Contract/Order Document (Approved)
4 Copy of original bid specification documents
5 Quotations on all equipments and items to be purchased
6 6 (six) Months bank statements (personal and business)
7 Historical financial information
8 Income and expenditure of all members/directors/owners of the business (Absa 3684)
9 Statement of assets and liabilities of all members/directors/owners of the business (Absa 1752)
10 Detailed CV with employment record of all members/directors/owners of the business
11 Business profile
12 Detailed Business Plan
13 Business registration document (if applicable)
14 Copy of lease agreement (if applicable)
15 FICA verification documentation (personal and business)
16 Copy of identity documents of applicant(s)
17 Copy of marriage certificate if married ANC or copy of divorce decree