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Purchase Order Finance

Purchase Order Finance

Application Form

Company Details
Company Name
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Incorporation Number
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Nature of Business
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Date of Incorporation
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Vat No.
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Postal Address
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Physical Address
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Previous Physical Address
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Business Contact Person
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Tel - Work (+267..)
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Tel - Mobile (+267..)
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Tel - Home (+267..)
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Company Email Address
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Company Bank Details
Bank Name
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Branch Name
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Account Name
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Account Type
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Branch Code
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Account No.
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Ownership and Management

Please provide the following details for each shareholder of the company.


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Shareholder's name
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National ID Number
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  • Nationality
  • Afghanistan
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  • United Arab Emirates
  • United Kingdom of Great Britain and Northern Ireland
  • United Republic of Tanzania
  • United States of America
  • Uruguay
  • Uzbekistan
  • Vanuatu
  • Venezuela (Bolivarian Republic of)
  • Viet Nam
  • Yemen
  • Zambia
  • Zimbabwe
Nationality
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DOB
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Position
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Phone Number (+267..)
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Shareholding %
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Tender Issuer Details
Order/Principal Issuer
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Tel - Office (+267..)
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E-mail Address
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Fax
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  • - select issuer type -
  • Central/Local Government
  • Parastatal
  • Corporate
  • Private Company
- select issuer type -
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Manufacturer / Supplier Details
Manufacturer/Supplier Name
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Postal Address
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Physical Address
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Tel - Office (+267..)
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E-mail Address
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Valid email address required!
Fax
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Manufacturer Bank Details
Bank Name
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Branch Name
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Account Name
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Account Type
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Branch Code
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Account No.
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Transaction Details
Contract Value
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Total Amount Required
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Proposed Repayment
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What is the purpose of the loan?
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Declaration
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.
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Signature (authorised representative)
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