Business Development Organizations Application Form

Business Development Organizations Application Form
For DBJ Official Use Only
Date Received

Month Day Year
Date Hour Minutes AM/PM Option
Reviewed By:
Name

First Name Last Name
Job Title
Date Reviewed

Month Day Year
Date Hour Minutes AM/PM Option
Department

SECTION A
APPLICATION INFORMATION
NAME OF ORGANIZATION
ORGANIZATION TYPE

Government Organization Academic Institution Non-government Organization Business Development Support Organization
DATE OF FORMATION

Month Day Year
Date
COMPANY REGISTRATION NO.
ORGANIZATION'S MAIN AREA(S) OF FOCUS
MAILING ADDRESS

Street Address

Street Address Line 2

City State / Parish

Postal / Zip Code Country
REGISTERED ADDRESS

Street Address

Street Address Line 2

City State / Parish

Postal / Zip Code Country
OFFICE TELEPHONE NUMBERS
FAX NUMBERS
OFFICE E MAIL
example@example.com
WEBSITE
www.example.com
MAIN CONTACT
Please enter Full Name
POSITION
MOBILE NUMBERS
E MAIL
example@example.com
ALTERNATIVE CONTACT
Please enter Full Name
POSITION
MOBILE NUMBERS
E MAIL
example@example.com
Note: Pay attention to every detail in your application

BUSINESS DEVELOPMENT SERVICES AND TRAINING PROGRAMMES

Please list the services which you currently offer to your clients. These services may include training, rental of office space, hot desk, coaching, administrative services, rental of factory space etc.

SERVICES CURRENTLY BEING OFFERED
(E.g. Business Plan Development)

COST(J$)
(E.g. $15000 or $5000 per hour)

DURATION
(E.g. Range 7 days to 2 months)

Please list the professional/accrediting organizations with which you are associated:
Accounting Firms
Management Consultants
Business Incubators
Other Organizations
Note: Pay attention to every detail in your application

TEAM COMPOSITION AND TASK ASSIGNMENTS

Please provide information about your organization’s team members in the table below. The Team Leader’s educational qualifications will be assessed, as well as the qualifications of the full-time advisors

NAME OF STAFF
(E.g. John Brown )

QUALIFICATIONS
( E.g. BSc. Banking & Finance)

AREAS OF EXPERTISE
( E.g. Accounting)

POSITON ASSIGNED
(E.g. Consultant/Advisor)

Please attach CVs for all persons listed

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Please indicate the total staff complement of your organization, including administrative staff (both part-time and full-time)

TYPE OF STAFF
( E.g. Administrators)

NUMBER
( E.g. 2)

COMMENTS
(E.g. Assists with invoices and general administrative duties)

MSME REFERENCES

Please provide a list of five (5) MSME references that are able to confirm the quality of the business development services delivered to them by your organization:

NAME OF MSME REFEREE
(E.g. John Doe)

TELEPHONE NUMBER
(E.g. 876-942-5423)

EMAIL ADDRESS
(E.g. abc@email.com)

TYPE OF BUSINESS DEVELOPMENT SERVICE DELIVERED
(E.g. Coaching Services - Business Management)

DATE SERVICE WAS DELIVERED
(E.g. Nov 2012)

Note: The persons listed as referees will be contacted as part of the assessment of your application, therefore please ensure that current telephone numbers and email addresses are provided.
Note: Pay attention to every detail in your application

AUTHORIZED SIGNATORIES
I certify that the information contained in this application is correct to the best of my knowledge.
PRINT NAME
AUTHORIZED SIGNATURE

Clear
EMAIL
example@example.com
POSITION
TELEPHONE NUMBER
DATE

Month Day Year
Date
Note: Pay attention to every detail in your application

APPENDIX I
Services currently provided under the Voucher for Technical Assistance Programme
Note:

1. DBJ will pay to the BDO, the value of the voucher or 70% of the cost of the service whichever is lower.

2.The prices listed are inclusive of General Consumption Tax (GCT)
Note: Pay attention to every detail in your application

APPENDIX II
Click on the link below to download the Statutory Declaration of Applicant form. You are required to sign and upload the form before submitting.

Statutory Declaration of Applicant form *
Please upload signed Statutory Declaration of Applicant form

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Business Development Organizations Application Form

For DBJ Official Use Only

SECTION A

APPLICATION INFORMATION

SECTION B

ORGANIZATION DESCRIPTION

ORGANISATIONAL/OPERATIONAL STRUCTURE

BUSINESS DEVELOPMENT SERVICES AND TRAINING PROGRAMMES

TEAM COMPOSITION AND TASK ASSIGNMENTS

MSME REFERENCES

AUTHORIZED SIGNATORIES

APPENDIX I

APPENDIX II