Purchase Order Finance Application Form Company DetailsCompany NameField is required!Field is required!Incorporation NumberField is required!Field is required!Nature of BusinessField is required!Field is required!Date of IncorporationField is required!Field is required!Vat No.Field is required!Field is required!Postal AddressField is required!Field is required!Physical AddressField is required!Field is required!Previous Physical AddressField is required!Field is required!Business Contact PersonField is required!Field is required!Tel - Work (+267..)Field is required!Field is required!Tel - Mobile (+267..)Field is required!Field is required!Tel - Home (+267..)Field is required!Field is required!Company Email AddressValid email address required!Valid email address required!Company Bank DetailsBank NameField is required!Field is required!Branch NameField is required!Field is required!Account NameField is required!Field is required!Account TypeSavingsCurrentField is required!Field is required!Branch CodeField is required!Field is required!Account No.Field is required!Field is required!Ownership and ManagementPlease provide the following details for each shareholder of the company. <p>Please provide the following details for each shareholder of the company.</p><br /> Field is required!Field is required!Shareholder's nameField is required!Field is required!National ID NumberField is required!Field is required!NationalityAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBrazilBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCentral African RepublicChadChileChinaColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCyprusCzechiaCôte d\\\\\\\\\\\\\\\'IvoireDemocratic People\\\\\\\\\\\\\\\'s Republic of KoreaDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFaroe Islands FijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People\\\\\\\\\\\\\\\'s Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia (Federated States of)MonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNiueNorth MacedoniaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRepublic of KoreaRepublic of MoldovaRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyrian Arab RepublicTajikistanThailandTimor-LesteTogoTokelau TongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited Republic of TanzaniaUnited States of AmericaUruguayUzbekistanVanuatuVenezuela (Bolivarian Republic of)Viet NamYemenZambiaZimbabweNationalityField is required!Field is required!DOBField is required!Field is required!PositionField is required!Field is required!Phone Number (+267..)Field is required!Field is required!Shareholding %Field is required!Field is required!Tender Issuer DetailsOrder/Principal IssuerField is required!Field is required!Tel - Office (+267..)Field is required!Field is required!E-mail AddressValid email address required!Valid email address required!FaxField is required!Field is required!- select issuer type -Central/Local GovernmentParastatalCorporatePrivate Company- select issuer type -Field is required!Field is required!Manufacturer / Supplier DetailsManufacturer/Supplier NameField is required!Field is required!Postal AddressField is required!Field is required!Physical AddressField is required!Field is required!Tel - Office (+267..)Field is required!Field is required!E-mail AddressValid email address required!Valid email address required!FaxField is required!Field is required!Manufacturer Bank DetailsBank NameField is required!Field is required!Branch NameField is required!Field is required!Account NameField is required!Field is required!Account TypeSavingsCurrentField is required!Field is required!Branch CodeField is required!Field is required!Account No.Field is required!Field is required!Transaction DetailsContract ValueField is required!Field is required!Total Amount RequiredField is required!Field is required!Proposed RepaymentField is required!Field is required!What is the purpose of the loan?Field is required!Field is required!Declarationl / we hereby declare that the information above is, to best of my/our knowledge and believe, true and correct. I / we further declare that the money shall be used solely for the purpose indicated above and that there is no legal impediment for the intended use.l / we hereby declare that the information above is, to best of my/our knowledge and believe, true and correct. I / we further declare that the money shall be used solely for the purpose indicated above and that there is no legal impediment for the intended use.Field is required!Field is required!Signature (authorised representative)Field is required!Field is required!Submit
