Entrepreneur application for funding / personal form

Congratulations on taking your first step towards obtaining finance for your business.

SECTION/A Kindly note the following:

Personal information
This section is to be completed by the
sole proprietor/partners/directors/
shareholders/members/trustees and any
person who is to sign as surety. (Separate
sheets to be completed and signed by
each of the above persons)
1. A business plan elaborating on the business venture, giving the background, the current
position and motivation for the need for finance, should accompany this application form.
2. We understand that some of the information requested in these documents may be
incorporated in the business plan. We do however request you to supply the information
as outlined in the documents for the sake of good governance and statutory requirements.
3. A raising fee is payable in respect of Business Partners’ preliminary work to determine
whether or not it is willing to make an investment in the business venture and approve
finance for the business, as well as for assessing and reviewing the documentation and in
arranging the investment and finance. The raising fee is only payable if the investment and
finance are approved and is payable upon approval. If the investment does not proceed or
if the finance is not taken up, for whatever reason, the raising fee remains payable.

Personal information
Surname Date of birth

Full names Identity number

Preferred name Citizen of which country?

(Please attach a certified copy of your ID book to this page)
Mr Mrs Ms Dr other

Postal address Residential address Plot No. House No.

Building

Street

Area/district

Postal code Town/city Postal code

Previous residential address Telephone (w) ( )

Telephone (h) ( )

Mobile number

Fax ( )

Postal code Email address

What is/will be your percentage equity/shareholding in the business?

In what capacity are you or will you be connected to the business?

Expected monthly salary from the business to be financed Present monthly salary

Highest educational, technical, professional qualification

Previous experience and career history (attach detailed CV)

Periods Employer/Business Position and responsibilities

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Personal information continued
Other interests (Companies, Close Corporations, Partnerships and Trusts)
Business Reg No. Shareholding % Capacity

Marital status single divorced married

If married ANC in COP Customary Other

Spouse’s details

Full names/surname

Occupation Identity number

Income Number of dependants

Contact number Email address

Give names and telephone numbers of at least two persons from whom references can be obtained (preferably work or business related)

Name Telephone

Name Telephone

Financial position
Have you ever been declared bankrupt or sequestrated? Yes No

If so, have you been rehabilitated? Yes No

Date of rehabilitation

If you have answered yes to any of the above, please give details

Have you ever been found guilty of a criminal offence?

If yes, please give details

Have you ever reached a compromise with creditors?

If yes, please give details

Have you ever been summonsed or had judgment against you?

If yes, please give details

Have you ever signed surety for anyone else?

If yes, please give details

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Personal assets and liabilities
Kindly complete the following statement of personal assets and liabilities or submit a detailed personal balance sheet with the
required information.

Assets
Fixed property Plot No. and suburb Market value

Details where applicable

Personal vehicles

Loans to others

Capital/Ioan account

Personal effects

Cash and fixed deposits

Unit trusts/shares in listed companies

Surrender value of life assurance and

endowment policies

Other (specify)

Total Assets

Liabilities
Bond/charge over fixed property Bond/charge holder(s) Registered amount Balance outstanding

Details where applicable

Debt on vehicles

Loans from others

Overdraft and/or credit card(s)

Taxation

Other (specify)

Total Liabilities

Net Assets/Liabilities

I declare that the above is true and accurate

Signature Full names Date

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 SECTION/B Kindly note the following:

1. This section gives Business Partners consent to run credit references and access to
Consent confidential information.

1. I, the undersigned, hereby acknowledge and consent that 2. I further consent and undertake that if my or the business’ specific
Business Partners may: consent is required to enable Business Partners to make enquiries
in terms of paragraphs 1, to give such written consent whenever
a. perform a credit search on me and the business’ records and to
requested to do so.
receive any information concerning me/the business (including
but not limited to credit history, patterns of payment, defaults, 3. I acknowledge that should I fail to consent in terms of paragraphs 1
other credit agreements, accounts, financial history, income, and 2 my application will not be processed.
assets, debts, business history and personal, employment,
4. I hereby declare that the information provided in this application form
educational and professional details) from any registered credit
and its attachments is to the best of my knowledge true, correct and
bureau, creditor or other private or public body;
accurate in all material respects.
b. monitor my and the business’ payment behaviour by making
5. I acknowledge that:
regular enquiries during the period of finance about my/its credit
records and to receive information mentioned in (a) from any a. Business Partners conducts preliminary work assessing the
registered credit bureau, creditor or other private or public body; business in order to determine whether or not it is willing to
make the investment and approve the finance and assessing any
c. use any information and data obtained in (a) above in respect of
property to determine whether it has sufficient value as security;
future credit applications by me or the business;
b. any such valuation and assessment are for Business Partners’
d. transmit my and the business’ full names, identity/passport/
internal use only and need not be disclosed to me and is
registration numbers, dates of birth/incorporation, residential/
not necessarily intended to determine a market value of the
business addresses and details of my employer and place of
business or any property or the replacement cost of any
work or a statement that I am unemployed/self-employed to any
improvements;
registered credit bureau;
c. all preliminary work and assessments conducted by Business
e. report and transmit details to any registered credit bureau
Partners are solely for its own use, benefit and reliance and
relating to any of my accounts, of non-performance and how the
do not constitute a form of due diligence as regards to the
business and I have performed in meeting my/its obligations in
business;
terms of any agreement and how I/the business is conducting
the accounts with Business Partners; and that Business d. Business Partners in no way guarantees the viability, success or
Partners and the registered credit bureau may record, transmit debt repayment ability of the business and Business Partners
and share such information with other registered credit providers shall not be liable for any claims arising as a result of actions
and credit bureaus; taken or omissions by me/the business or any other person in
reliance on Business Partners’ assessments; and
f. request a report from any credit bureau where Business Partners is
verifying my educational qualifications and employment details; e. Business Partners shall not be liable for any actual or contingent
loss, liability, expenses, costs or damages incurred or suffered
g. contact any of the referees, creditors or other private or public
by me/the business or any other person as a result of, or
bodies (including but not limited to banks, other financiers or
which may be attributable to or caused by Business Partners’
auditors), mentioned in this application form and its attachments
preliminary work, assessments or mistakes, errors or omissions
and to access and receive any additional information which is
therein or originating therefrom.
necessary in order to process and confirm the details included in
this application and its attachments.

Signature Full names Date

Where did you hear about us? Please tick the relevant box below and add additional detail where applicable

Client Existing client Reapplication Referred by a client Existing tenant application

Referred by a tenant Other Detail

Marketing Initiatives Advertisement/advertorial Brochures/letters/newsletters Radio Business Partners website TV

Marketing workshop/seminar Network function Newspaper article Magazine article Other

Detail

Professional Referrals Accountants/auditors Professional industry consultants Banks Attorneys Franchisors

Mentors Property brokers/ agents/developers Other Detail

Client communication and client service are important to Business Partners. We communicate with clients or prospective clients by
way of letters, newsletters, invitations to relevant events, email and other means of communication. May we communicate with you in this way? Yes No

Business Partners often incentivises or rewards clients or prospective clients by facilitating access to entrepreneurial resources. This might
involve external parties managing the process. Do you object to these parties having access to your contact details for such specific purposes? Yes No

Your privacy is important to us. We will therefore not sell, rent or provide your personal information to unauthorised entities or other third parties, for their independent use.

Business Partners International Rwanda SME Fund Limited

P/4 Reg No.: 102317448 | www.businesspartners.rw | enquiries@businesspartners.rw
 Entrepreneur application for funding / business form
Congratulations on taking your first step towards obtaining finance for your business.

SECTION/C Kindly note the following:

1. A business plan elaborating on the business venture, giving the background, the current
Business information position and motivation for the need for finance, should accompany this application form.
2. We understand that some of the information requested in these documents may be
incorporated in the business plan. We do however request you to supply the information
as outlined in the documents for the sake of good governance and statutory requirements.
3. A raising fee is payable in respect of Business Partners’ preliminary work to determine
whether or not it is willing to make an investment in the business venture and approve
finance for the business, as well as for assessing and reviewing the documentation and in
arranging the investment and finance. The raising fee is only payable if the investment and
finance are approved and is payable upon approval. If the investment does not proceed or
if the finance is not taken up, for whatever reason, the raising fee remains payable.

Business details
Name of entrepreneur Mr Mrs Ms Dr other

Business type: Sole proprietor Partnership Company Trust

Name of business entity (full registered name of company)

Business trading name

Registration number VAT registration number

Contact details
Postal address Physical address (from where the business is/will be operating)

Plot No. House No.

Building

Street

Area/district

Postal code Town/city Postal code

Business telephone ( ) Business fax ( )

Mobile number Email address

Brief description of the existing / proposed business

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Particulars of accountant/auditor
Name Address

Telephone number ( )

Email address

Bank details
Name of bank Branch

Account number Contact person (if applicable)

Overdraft facilities Security

Environmental/health/safety impact
Could your operation be classified as objectionable in terms of legislation or local authority regulations? Yes No Maybe

Other details
How long has the business been in existence? How long, under present management?

Number of partners / shareholders / trustees / members

Current number of employees Estimated number of employees after investment

Has the business ever reached a compromise with its creditors? If ‘yes’ full details must accompany this application. Yes No

Amount of finance required from Business Partners

Purpose of finance Start-up Takeover Expansion Replacement finance

The cornerstone of the decision making process is the perceived viability of the business.
Supporting documents Business Partners requires information to be in a position to evaluate the viability. A
business plan with sufficient information will indeed assist in this process to ensure good
customer service. This business plan will include the background information on the
business (products, service, location, target market, competitive advantage and technical
details) as well as financial information (such as current financial statements, projections,
costing analysis, motivating the margins, supporting information such as the impact of the
funding on the business and age analysis).

In many instances other supporting information will be required such as agreements, for
example a buy and sell agreement, lease agreements, franchise agreements or licenses.

The entrepreneurs play a pivotal role in the success of a business. Curriculum vitae as well as
the experience and the expertise of the entrepreneurs and key management can also assist
to determine an opinion on the viability. It is essential to attach a certified copy of the identity
document of the entrepreneur/s.

To assist in preparing a business plan, you are referred to the Business Partners website
(www.businesspartners.co.za) for a free business plan framework.

Signature of principal/owner/authorised Full names of signatory Date

representative

Business Partners International Rwanda SME Fund Limited

P/2 Reg No.: 102317448 | www.businesspartners.rw | enquiries@businesspartners.rw
 Entrepreneur application for funding / declaration form
Congratulations on taking your first step towards obtaining finance for your business.

SECTION/D Definition of a politically exposed person:

A politically exposed person (PEP) is an individual who holds or has held a prominent public
Political declaration office in a particular country.
The following are examples in defining PEPs:

• Heads of States, Heads of Governments and cabinet ministers;

• Influential functionaries in nationalised industries and government administration;

• Senior judges;

• Senior political party functionaries;

This section is to be completed by the
sole proprietor/partners/directors/ • Senior and/or influential officials, functionaries and military leaders and people with
similar functions in international or supranational organisations;
shareholders/members/trustees and any
person who is to sign as surety. (Separate • Members of ruling or royal families;
sheets to be completed and signed by
each of the above persons)
• Senior and/or influential representatives of religious organisations (if these functions are
connected to political, judicial, military or administrative responsibilities).

• Families of PEPs should also be given special attention by accountable institutions. The
term “families” includes close family members such as spouses, children, parents and
siblings and may also include other blood relatives and relatives by marriage;

• Closely associated persons. The category of “closely associated persons” includes life
partner, close business colleagues and personal advisers/consultants to the PEP as well
as persons, who obviously benefit significantly from being close to such a person.

Politically exposed person

Are you or any of your immediate family members, as described above, considered to be a Politically Exposed Person? Yes No
If you have answered yes please also complete the politically exposed person record below.

Politically exposed person record

Name of PEP

Relationship to individual conducting transaction Self (individual conducting transaction) Immediate family member

If the person is an immediate family member please specify

Please explain the office or position held by the PEP

Does the PEP currently hold the office or position? Yes No

Please explain the source of funds to be used for the requested transaction

I declare that the above is true and accurate

Signature Full names Date

Business Partners International Rwanda SME Fund Limited
Reg No.: 102317448 | www.businesspartners.rw | enquiries@businesspartners.rw P/1