SME FINANCE APPLICATION FORM

The SME Finance Scheme is targeted at emerging entrepreneurs within the context of previously disadvantaged groups seeking to start or expand small and medium sized businesses. Funding facilities considered under this scheme ranges between N$ 150,000 to N$ 3 million only. Please indicate the type of funding product required

Product Offering

Term Loan Instalment Sales Facility Preference Share Investment Equity Investment by DBN Trade Finance (Import & Export ) Other (Please Specify)

Kindly ensure that your submission includes the documents/information stipulated in the table below. Omission of relevant documents/information may delay the assessment of your application.
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Loan application form Feasibility study (where applicable) Business plan including financial projections: see attached business plan guide Financial statements: 3 years audited balance sheet, income statement, cash flow (for existing business) Certificates of Good Standing (Receiver of Revenue & Social Security Commission) Business Registrations Documents (Founding Statement or Memorandum of Articles of Association) Certified ID documents of the shareholders/ members/partners Certified Marriage certificates of shareholders/ members /partners (where applicable) Business bank statements for the past 12 month (where applicable) Promoters (Proprietor/members/shareholders) personal cheque account bank statements for the past 12 months Statement of Assets & Liabilities of shareholder/ member/ partner (including statement of monthly income & expenditure) Profile/CVs of promoters and key personnel Other Documentation (Please list)

SME FINANCE APPLICATION FORM

The Development Bank of Namibia recognises the development potential of these sectors: Agro-industry; fisheries; information communications technology; Manufacturing; mining; services; tourism; transport. The following are eligible for consideration within this scheme as single or syndicated loans viable start-up business with exceptional potential for sustainability expansion of existing business management buy-in, into existing business management buy-out (take-over) of existing business (including franchises) Namibian citizenship or permanent residence status majority Namibian ownership loan size: minimum N$ 150,000; Maximum N$ 3 million maximum term: 10 years. The criteria for possible qualification for a loan are as follows the business must be located within the jurisdictional boundaries of the Republic of Namibia the business must create or retain employment for Namibian citizens owners equity contribution of at least 30% will be required for start-up projects expansions may be financed with up to 100% debt reasonable collateral will be required as per project specifics and risk Interest rates and fees Interest rates for direct financing are determined by the Development Bank of Namibia reflecting cost of funds, risk exposure (premium), and funding margin. Commitment fees may be applicable. Loan application procedure Please complete the application form. List all supporting documentation accompanying the application (refer to Section 11 of this form). A receipt bearing the official stamp of the Development Bank of Namibia will be issued, which will serve as proof of submission of application. Applicants may be requested to submit additional information to the Development Bank of Namibia as part of the appraisal process. Applicants may be requested to make a formal presentation to the Development Bank of Namibia as part of the appraisal process. The Development Bank of Namibia will review the application in accordance with stipulated criteria and will inform applicants of one of the following outcomes: o application approved o application referred for further development in collaboration with the applicant. o application declined, and returned to the applicant The approval, decline, or referral of project proposals rests entirely with the Development Bank of Namibia; and that outcome is final.

SME FINANCE APPLICATION FORM SECTION A. RECEIPT OF SUBMISSION OF LOAN APPLICATION

Applicant name
(Business Registered name)

Business Registration Number Registered Physical Business Address Registered Postal Address Telephone Number Fax Number Dedicated Contact Person E-mail address Cell Phone

FOR INTERNAL USE ONLY

I, the undersigned, hereby certify that this page serves

as proof that the Development Bank of Namibia received the stipulated documentation. Signature Serial number DBN stamp

Private Enterprise Finance Application Form

SECTION B. BUSINESS PROFILE Please provide a brief description of the intended product or service, company history and future plans
Description of Business Activities

Intended Purpose of Borrowing /Use Facility Requested

Private Enterprise Finance Application Form

SECTION C. LOAN APPLICATION DETAILS

1. Region in which main operations are located
Caprivi Ohangwena Erongo Omaheke Hardap Omusati Karas Oshana Kavango Oshikoto Khomas
Otjozondjupa

Kunene

2. Economic sector
Agriculture & Forestry Electricity Water Tourism Fishing & Fish Processing Construction Transport Mining & Quarrying Retail Communication Manufacturing Other (specify) Hospitality Health Education

3. Business structure
Proprietary limited Close corporation Partnership Other (specify)

4. Business status
New business (start-up) Expansion of existing business Management buy-in (existing business) Management buy-out (existing business) Other

5. Ownership of the Business

(Proprietor, partners or shareholders with shareholding interest greater than 15%*) Name of shareholder/member/partner Position if in Management I.D. / Reg no. Percentage shareholding

*Please use attachment if necessary

Private Enterprise Finance Application Form

6. Funding Required
Product Offering Amount Term of Facility Repayment Frequency (Monthly /Quarterly, etc) Grace period Required ( in months)

Term Loan Instalment Sales Facility Trade Finance (Import & Export ) Other (Please Specify) TOTAL

7. Proposed financing sources

Amount (N$) Development Bank of Namibia Commercial Bank Owners equity * Other source/s (specify) TOTAL * Start-up projects require minimum 30% owners equity. Existing business can receive up to 100% debt financing as long as the debt does not exceed 70% of their capitalisation after the loan is granted. Percentage

8. Project uses of funds

Amount (N$) Property acquisition (land and buildings) Machinery and equipment Working capital Inventory/ trading stock Performance Guarantee Other (specify) TOTAL Percentage

9. Collateral / Security offered to DBN (describe items offered)*

Description of Security Item Value (N$)

TOTAL
*Please

indicate if any of the collateral is encumbered

Private Enterprise Finance Application Form

10. Empowerment impact on Previously Disadvantaged Individuals (PDIs)

Shareholding of overall PDI (% of total shares) Board of Directors from PDI (% of total directors) Women (% of total directors) Women as executives (% of total executives) Shareholding of women (%of total shares) Other PDI (specify)

Percentage of total Year One After Year One

11. Employment creation

Current Full time Part time Full time Part time Projected (one year)

SECTION D. BUSINESS BANKING DETAILS

Please complete and return a copy of this Contact List with your completed loan application Primary bank (commercial) Branch Name Account Manager Telephone Account number(s)

Private Enterprise Finance Application Form

SECTION E. RELEASE OF INFORMATION

Please sign and return a copy of this Release of Information with your complete loan application

To whom it may concern I / we hereby authorise you to release to the Development Bank of Namibia, for verification purposes, information concerning: employment history: dates, positions, responsibilities, etc. banking records: current, savings, and investment accounts loan payment records: opening dates, credit, payment account, loan balance, payment profile any other information of relevance to this business loan application.

This information is for the confidential use of the Development Bank of Namibia, in compiling a Business Loan Report. A copy of this authorisation (being a photographic or fax copy of the signature(s) of the undersigned) may be deemed to be the equivalent of the original document and can be substituted as a duplicate original. Your prompt reply will help expedite my / our loan application. Thank you:

Signature

Date

Name (print)

ID/ passport no.

Private Enterprise Finance Application Form

SECTION F. ACKNOWLEDGEMENT

Please sign and return a copy of this Acknowledgement with your completed loan application

My /our signature(s) below indicate that I / we understand what information is required to apply for a loan. I / we understand that additional, relevant information may be required during the loan application process and I / we agree to provide any additional information requested. I / we understand that the application for a loan does not constitute approval of my/our request nor does it imply that the Development Bank of Namibia will look favourably upon our request. I / we understand that no individual staff member of the Development Bank of Namibia has the authority to make any commitment of loan funds. I / we further understand that notification as to approval or disapproval of my loan request will be made by the Development Bank of Namibia in writing. I / we will not incur any expenses prior to the execution of legal documentation required for loan closing, should my application be approved. I / we further understand that the decision by the Development Bank of Namibia is final and that no other agency or individual can overrule this decision. I / we further understand that the Development Bank of Namibia may share the content of this application with other financial institutions for co-financing purposes in particular.

Signature

Date

Private Enterprise Finance Application Form

SECTION G. CERTIFICATION
This certification must be signed by the promoters or principals of the business. Application certification I / we hereby certify and affirm that the information contained herein and others supplied as part of this application is accurate, complete and current to the best of my / our knowledge. I / we further acknowledge that intentional material misrepresentation of facts may result in significant adverse action including, but not limited to, denial of any credit for which this application has been submitted. Credit investigation I / we hereby authorise the Development Bank of Namibia to conduct research, make inquiry into the companys history, including personal and company credit checks, contact financial institutions, and perform other due diligence efforts deemed necessary and proper in the reasonable and prudent evaluation of this loan application.

Signature

Date

Name (print)

Position

Private Enterprise Finance Application Form

BUSINESS PLAN GUIDE

START-UP VENTURES, EXPANSIONS, MANAGEMENT BUY-IN OR BUY-OUT, PLEASE SUBMIT: Covering letter Index (contents) Executive summary (using guidelines detailed below) 1. Company information 1.1. name 1.2. vision and mission 1.3. business location 1.4. description of business, range of products or services (current and future) 1.5. background (business strategy, regulations, sector analysis) 1.6. patents, patent protection and royalties applicable 1.7. funding required (for land, building, equipment or working capital) 1.8. sources of funding (borrower, DBN, government, commercial bank, donor etc) 1.9. strategy and future outlook 1.10. high level developmental objectives/goals/milestones Management plan 2.1. organisational structure 2.1.1 management (organogram) and personnel (waged and salaried) from year one to three 2.1.2experience and technical ability of management/applicants 2.1.3 ownership structure (shareholder agreements) 2.1.4 strategic alliances (if any) Marketing plan 3.1 Industry analysis 3.1.1 SWOT analysis 3.1.2 potential markets (target)/market share estimates 3.1.3 market segments 3.1.4 competition and/or substitute products 3.2 Marketing strategy 3.2.1 product strategy 3.2.2 pricing strategy 3.2.3 promotion and advertising strategy 3.2.4 distribution strategy 3.2.5 sales strategy (local vs export)

2.

3.

4.

Operations/manufacturing segment 4.1 business process (activity) description 4.2 existing assets (land, equipment, buildings) and capacities and costing 4.3 raw material supplies and costing 4.4 organisation of operations and outputs

5. Financial segment 5.1 Historical financial statements and income tax returns: three years 5.1.1 balance sheet 5.1.2 income statement 5.1.3 cash flow statement 5.1.4 income tax returns

Business Plan Guide: Private Sector Facility

Financial segment (continued) 5.2 Forecasts: budgeted / projected (Please provide electronic version of forecasts as well) 5.2.1 key assumptions 5.2.2 sales projections 5.2.3 income projections: profit/loss 5.2.4 break-even analysis 5.2.5 pro-forma balance sheet 5.2.6 cash flow projections 5.2.7 financial ratios: debt-to-equity, cash flow to capex, capex per jobs created, etc. 5.3 Sensitivity analysis of scenarios 5.3.1 tax regime 5.3.2 foreign exchange regime 5.3.3 return distribution: concession fees, royalties, dividends, repatriation of profit, etc. 6. Implementation plan 6.1 disbursement schedule 6.2 detailed action plan (activity schedule and timelines/time table) 6.3 resources: government role & regulations, approvals, license to operate, operating agreements e.g. with contractors, procurement, and concessions 6.4 repayment schedule/period: amortisation 7. Risk management 7.1 risk identification 7.1.1 business and industry risk (including regulatory framework) 7.1.2 financial risk 7.1.3 management risk 7.2 risk management plan 7.2.1 risk reduction and elimination mechanisms 7.2.3 risk transfer and/or retention 7.3 critical success factors 8. Environmental Impact Assessment (where applicable) 8.1 environmental impact assessment study results 8.2 environmental management plan 9. Economic and/or developmental impact 9.1 stimulation of targeted economic sectors and/or geographic area 9.2 projected job creation: primary 9.3 empowerment impact: ownership structure, capacity building, skills transfer, dollar value

Business Plan Guide: Private Sector Facility