FNB POGESS FUND APPLICATION FO BUSINESS FINANCING BUSINESS INFOMATION FO FNB USE ONLY FNB branch elationship Manager (M) receipt date M name E-mail Details of applicant Name of applicant Trading name Physical address Cellular telephone number e-mail address Business type Sole proprietor Partnership Close Corporation egistration No. Company egistration No. The business activity and assets must be situated in South Africa. Statutory registrations Income Tax Yes No SC LEVIES Yes No PAYE Yes No UIF Yes No VAT Yes No SDL Yes No Age of business Industry Telecommunications Information technology etail Automotive Manufacturing Tourism Contract services Mining Transportation Construction Professional services Wholesale / Distribution Engineering estaurant / Fast food outlet Other: Has the business ever reached a compromise with creditors? Yes / No If yes, full details should accompany this application First National Bank a division of Firstand Bank Limited. An Authorised Financial Services Provider eg No. 1929/001225/06 1
FNB POGESS FUND APPLICATION FO BUSINESS FINANCING Purpose of financing eason for application Financing needs Total financing required Start a new business Merger Amount of own capital contribution Amount of Bank finance required Term of financing required Utilisation of financing Land & buildings Plant & machinery Equipment Furniture, fixtures & fittings Stock Debtors Operating expenses Purchase of a business fixed assets Purchase of a business goodwill Empowerment finance Other Legal fees Bank fees Credit Indemnity Fees (if applicable) Expand an existing business Management buy-out BEE transaction Acquisition Months (minimum 36 months) - An annual Credit Indemnity fee (Khula or Ariz) may be payable in addition to other bank and attorney fees. Business banking details Bank Branch Overdraft limit Security Account number Branch code Other facilities First National Bank a division of Firstand Bank Limited. An Authorised Financial Services Provider eg No. 1929/001225/06 2
FNB POGESS FUND APPLICATION FO BUSINESS FINANCING Owner / Member/ Director/ Shareholder details (for the Financial Services Charter) Owners / Members/ Directors / Shareholders (full names) ID number Share holding 1 % 2 % 3 % 4 % 5 % Marital status Citizenship * Only SA Citizens qualify for a Khula Indemnity. The owner holding the controlling interest in the business must be a SA Citizen and managing the business fulltime Ownership % PDI * participation in: PDI * youth (ages 18-35) participation in: * PDI = Previously disadvantaged individuals i.e. African, Indian, Coloured Total number of employees that are expected to be employed in the business * ace Management % Employees % Ownership % Management % Employees % ** Customer and supplier references Name elationship Contact telephone no. 1 2 3 Details of leased premises Landlord Monthly rental (excl VAT) Area (square metres) Cellular number Monthly costs (excl VAT) Expiry date of lease First National Bank a division of Firstand Bank Limited. An Authorised Financial Services Provider eg No. 1929/001225/06 3
FNB POGESS FUND APPLICATION FO BUSINESS FINANCING Details of advisors and service providers Accountant/bookkeeper Life assurance broker Insurance broker Business broker The required documents to be attached to this application are advised on the next page. Note: - Incomplete and/or non-submission of the documents will result in delays with the processing of the application. - The application and supporting documents are to be submitted to a elationship Manager at a First National Bank branch that may be closely located and convenient for your business. - For any business plan and mentorship assistance you may contact: o Khula Enterprise Finance Ltd: 0800 11 88 15 or 012 394 5560 - www.khula.org.za o Sizanani Advisory Services: 083 572 7309 - www.sizananiadvisory.org.za o Enterprise SA: 011 795 1294 - www.enterprisesa.com or www.fnb.co.za The utilization of the above organisations does not guarantee the approval of the finance. All costs relating to the services provided by the above organisations are for the applicants own account. The Bank will not be held liable for any information provided by above organisations that results in adverse consequences to the applicant and/or the business entity. Applicant Signature: Date First National Bank a division of Firstand Bank Limited. An Authorised Financial Services Provider eg No. 1929/001225/06 4
FNB POGESS FUND APPLICATION FO BUSINESS FINANCING Documents to be attached: General Document/Item Finance Document/Item Business plan (guidelines available) Historical financial information (3 yrs) Detailed CV s of all shareholders, directors and key management Management accounts fin year to date (not older than 2 months) Copies of Shareholders and Directors ID VAT & Tax clearance certificates Copy of Antenuptial Contract/ Marriage Certificate/Divorce Decree (if applicable) Projected cashflow for next 3 years (financial model available) Memorandum & Articles of Association Business: Exposure to Firstand Group Certificate to Commence Business Business: Exposure to other banks Shareholders Agreement Major customers/age analysis Purchase & Sale Agreement Major creditors/security/age analysis ental Agreement Day 1 Balance Sheet Franchise Agreement Business valuation report Current contracts with clients Sworn valuation of business assets Trust deed Contingent liabilities description Proof of residential address of each shareholder/ surety and the business Copy of bank statements for the last 3 months (if not a First National Bank customer). Security offered per shareholder Stock list Latest SAS assessment per shareholder/ surety indicating no outstanding taxes Asset register (giving descriptions and serial numbers and values) Completed Shareholder Information forms Security valuation Insurance: business (details/quotes) Section 34 Adverts Insurance: life insurance (details/quotes) Personal balance sheets of shareholders/sureties First National Bank a division of Firstand Bank Limited. An Authorised Financial Services Provider eg No. 1929/001225/06 5