SMEs APPLICATION FORM
Welcome to the investment Clinic! (Note: This form sets out qualification and pre-qualification data to be filled by the applicant in order to ease our pre-selection process).
SME Contact Details
Contact information of the SME
Name of Institution
*
Your Company Name
Registered Business Address
*
Street Address
Street Address Line 2
District
Province
Postal / Zip Code
Business Phone Number
*
Please enter a valid current number in Rwanda.
Format: 0000 000 000.
Website Address
Official company website
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Business Registration Details
Company registration details
Date of Incorporation
*
-
Month
-
Day
Year
Date (mm-dd-yyyy)
Date of Business Commencement
*
-
Month
-
Day
Year
Date (mm-dd-yyyy)
Country of Incorporation
*
Rwanda
Other Country
Business Registration Number
*
Enter business TIN number
Tax Identification Number
*
TIN
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Business Information
Company legal structure and economic sector classifications
Business Legal Structure
*
Sole Proprietor
Private Limited Liability
Public Limited Liability
Non-Profit Entity
Economic Sector of Business (NISR Classification)
*
Please Select
Agriculture
Industry
Services
Agriculture Sub-sector of Business
*
Export crops
Food crops
Fishing
Forestry
Livestock & livestock products
Other
Industry Sub-sector of Business
*
Mining & quarrying
Manufacturing - Beverages & tobacco
Manufacturing - Textiles, clothing & leather goods
Manufacturing - Wood & paper; printing
Manufacturing - Chemicals, rubber & plastic products
Manufacturing - Non metallic mineral products
Manufacturing - Metal products, machinery & equipment
Manufacturing - Furniture & other manufacturing
Electricity
Water & waste management
Construction
Other
Services Sub-sector of Business
*
Maintenance & repair of motor vehicles
Wholesale & retail trade
Transport
Hotels & restaurants
Information & Communication
Financial services
Real estate activities
Professional, scientific & technical activities
Administrative & support services
Public administration & defense; compulsory social security
Education
Human health & social work activities
Cultural, domestic & other services
Other
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More Information
Operational details and other information
Current Number of Full Time Staff
*
Total number of full-time employees (non-contract and/or casual workers)
Brief Summary of Nature of Business
*
0/200
Is your business or any member of senior management or directors the subject of any current or future legal action?
*
Yes
No
If yes, provide details below (nature of action, potential financial impact, expectedproceedings start and/or conclusion, etc)
0/500
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Additional information
Participation authorization and technical assistance
Has your Board of Directors authorized your participation in this program?
Yes
No
If Yes, what date was this authorization confirmed (upload copy of board resolution)
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Are you currently receiving or started to receive any form of technical assistance?
Yes
No
If yes, provide details of support below:
Names of Support Partner
Start date
-
Month
-
Day
Year
Support start date
End date
-
Month
-
Day
Year
Support end date
Support Partner Contact Person for Confirmation:
Description of support
Description of support in details
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Provide Details of Senior Management below:
* Start with most recent years backward (eg. 2020 YTD, 2019, 2018, 2017, 2016, 2015) **First, Middle and Last Names
Rows
Year
Names of management staff
Position
Start date with firm
Year To Date (Current Year)
Year 1
Year 2
Year 3
Year 4
Year 5
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Additional information
Number of full years of operating history:
Number of full years of audited or unaudited financials:
Number of these with full years of audited financials
Average Annual Revenue:
Rows
Year
Revenue (RWF)
Audited (Choose appropriate)
YTD (Current year)
Yes
No
Full Year 1
Yes
No
Full Year 2
Yes
No
Full Year 3
Yes
No
Full Year 4
Yes
No
Full Year 5
Yes
No
Does firm belong to any recognized, local industry /trade organization
Yes
No
Name of Industry/Trade Organization:
Organization Contact Person for confirmation
Organization Contact Person Names
First Name
Last Name
Organization Contact Person Email
example@example.com
Organization Contact Person Phone Number
Please enter a valid phone number.
Format: 0000 000 000.
Position
Organization Contact Person position
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Authorized Representative details
Provide details of Senior Management Personal to represent your firm
Names
*
First Name
Last Name
Email
*
ex. myemail@example.com
Mobile Phone Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Position in the company
*
ex. Chief Executive Officer (CEO)
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