BANK FUNDING APPLICATION

BANK FUNDING APPLICATION
1) Name*

First NameLast Name
Email*
example@example.com
Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2) Legal Status*
3) Date and Place of Incorporation*
4) Business Sector*
5) Location of Project*
6) Project Description in Brief: (2 to 3 page Executive Summary can be also attached)*
7) Humanitarian/Environmental impact (if any):*
8) Implementation/Construction Period from first receipt of funding:*
9) Please name any independent third party contractors appointed to*
10) Project Cost, Promoter's Equity Contribution, Funding Required (no less than US $5Million)*
Floor Cost US Total*
Please Provide a Spreadsheet showing Floor Cost Calculations in USD Using Template below for Spreadsheet setup*

PLEASE USE TEMPLATE BELOW TO SET UP THE SPREADSHEET TO DROP HERE
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Floor Costs USD - Template:

Item	Project Cost	Promoter's Equity	Funding Ruquired
	(a)	(b)	(c) = (b)-(a)

Preliminary & Pre-Operative Costs
Capital Expenditure
Land & Buildings
Plant & Equipment
Motor Vehicles
Office Equipment, Fixtures, & Fittings
Furnishings
Other (Specify
Total Capital Expenditure
Working Capital
Contingencies
Grand Totals

11) Funding Structure Desired: *Debt, Equity, Debt + Equity, Other (specify)*
12) Does the Funding Required and all aspects relating to it meet all of the regulations of the Applicant's country or such other relevant jurisdiction as is applicable, and is Confirmation of this Available if required?*
13) Term of the Loan and Grace Period Requested: (up to 10 years interest only) (3 years interest free?)*
14) Proposed terms for Equity Investor: *
15) Collateral & Guarantees (Other than Personal) available: *
Land and Buildings at *Cost/ValuationOther Fixed AssetsNet Assets of Existing BusinessInvestmentsGuaranteesOther
If yes to any of the Guarantee Questions above please enter specific information:
- Immediately
- On implementation
- Cost/Valutaion
If "Yes" to any of the Guarantee Questions above please enter specific information * Type, * Immediately, or *On Implementation, and * Cost/Valuation in this space*
YesNo
YesNo
If "NO" to above - please explain*
YesNo 2
Please Provide the Business Plan Here *

PLEASE USE TEMPLATE BELOW TO SET UP THE SPREADSHEET TO DROP HERE
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18) Any Adverse History or Outstanding Litigation against the Applicant or Officers? If so please explain *
19) Operating History of the Applicant (USD Millions)*
20) Financial Projections for the Proposed Project 3 year Minimum in USD Millions*
21) Is the Applicant prepared to meet Lender's reasonable cost of Due Diligence, including, inspection/survey and valuation?*
22) Main Bankers: a) Name and Address, b) Officer dealing with your Account c) Are you in good standing with your Bankers? If no please elaborate*
23) Which other Parties have been approached regarding this Application and with what result?*
24) Why are you using our Services instead of your our Corporate/Personal Banking Relationships?*
Yes
BY MY SIGNATURE BELOW:

I ATTEST THAT I HAVE THE AUTHORITY TO PROVIDE THE INFORMATION REQUESTED IN THIS QUESTIONAIRE.

AND;

I ACKNOWLEDGE THAT THIS APPLICATION IS NOT AN OFFER OF A SECURITY OR A CONTRACT. THIS APPLICATION SERVES AS AN INQUIRY FOR POSSIBLE FUNDING. IN ORDER FOR A TRANSACTION TO OCCUR THERE MUST BE EITHER A PRIVATE MEMORANDUM OR CONTRACT ISSUED, TO BE REVIEWED BY YOUR ATTORNEY OR TRUSTED FINANCIAL ADVISOR.
Signature*

Clear
Please verify that you are human*
Should be Empty: