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    COVID 19 Finance Relief Application BR1 PDF

    Uploaded by

    Thembinkosi Mthimkhulu Zakwe
    This document is a common application form for COVID-19 financial relief for small, medium and micro enterprises (SMMEs) in South Africa. Applicants can select either a Business Growth/Resilience Facility or Debt Relief Finance. The form requests contact and company information, industry/sector details, funding requirements, existing credit information, suppliers, and compliance. Applicants must submit additional documents such as statutory documents, ID copies, bank statements, financial statements, and industry certifications. By signing, the applicant declares the information is true and consents to checks and sharing of personal information according to legal requirements.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    COVID 19 Finance Relief Application BR1 PDF

    Uploaded by

    Thembinkosi Mthimkhulu Zakwe
    79 views5 pages
    This document is a common application form for COVID-19 financial relief for small, medium and micro enterprises (SMMEs) in South Africa. Applicants can select either a Business Growth/Resilience Facility or Debt Relief Finance. The form requests contact and company information, industry/sector details, funding requirements, existing credit information, suppliers, and compliance. Applicants must submit additional documents such as statutory documents, ID copies, bank statements, financial statements, and industry certifications. By signing, the applicant declares the information is true and consents to checks and sharing of personal information according to legal requirements.

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    COVID-19-Finance-Relief-Application-BR1.pdf

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    This document is a common application form for COVID-19 financial relief for small, medium and micro enterprises (SMMEs) in South Africa. Applicants can select either a Business Growth/Resilience Facility or Debt Relief Finance. The form requests contact and company information, industry/sector details, funding requirements, existing credit information, suppliers, and compliance. Applicants must submit additional documents such as statutory documents, ID copies, bank statements, financial statements, and industry certifications. By signing, the applicant declares the information is true and consents to checks and sharing of personal information according to legal requirements.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    79 views5 pages

    COVID 19 Finance Relief Application BR1 PDF

    Uploaded by

    Thembinkosi Mthimkhulu Zakwe
    This document is a common application form for COVID-19 financial relief for small, medium and micro enterprises (SMMEs) in South Africa. Applicants can select either a Business Growth/Resilience Facility or Debt Relief Finance. The form requests contact and company information, industry/sector details, funding requirements, existing credit information, suppliers, and compliance. Applicants must submit additional documents such as statutory documents, ID copies, bank statements, financial statements, and industry certifications. By signing, the applicant declares the information is true and consents to checks and sharing of personal information according to legal requirements.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 5

    COVID-19 SMME COMMON APPLICATION FORM

    WHAT ARE YOU APPLYING FOR? PLEASE TICK ONE OF THE FOLLOWING:
    Business Growth /Resilience Facility Debt Relief Finance
    (complete and send to (complete and send to
    [email protected]) [email protected])

    1. CONTACT PERSON
    First name(s)
    Surname
    ID Number
    Telephone number (landline)
    Cell phone number
    Email address
    2. COMPANY INFORMATION
    SMME Database Reg No:
    Organisation Type:
    Company registered name:
    Registration number:
    Trading name:
    Date registered:
    Date started operating:
    Financial Year-end:
    CSD Registration Number:
    Physical address:

    Postal address:

    Town:
    District:
    Province:

    Covid-19 SMME Financial Relief Applications 1


    COVID-19 SMME COMMON APPLICATION FORM

    3. INDUSTRY OR SECTOR (only applies for Business Growth/Resilience)


    Applicable sector for your main income

    4. LIST OF PRODUCTS AND SERVICES

    5. CLIENT/POTENTIAL CLIENTS
    a. Business Growth & Resilience Facility
    Who are your 3 most recent clients?

    Who are your 3 target clients?

    b. SMME Debt Relief Finance


    Who are your 3 most recent clients?

    How do you plan to resuscitate your


    business?

    Covid-19 SMME Financial Relief Applications 2


    COVID-19 SMME COMMON APPLICATION FORM

    6. FUNDING REQUIREMENTS
    Total amount of other (external) funding
    Important to note:
    1. You may only apply for one intervention
    2. Funding will be dependent on the level of financial distress calculated on the
    average of the last 3 months.
    Business Growth Facility Debt Relief Finance
    Categories: • No historical Municipal Debt Municipal
    • Micro R50 000 – R250 000 accounts capped at R 5000
    • Small R250 001 – R 2 5 00 000 • NB: salary payment scales will be in line
    • Medium R 2 500 001 – R 5 000 000 with UIF scale
    • Companies contributing to UIF must claim
    from UIF but the companies eligible for
    funding must register with UIF
    stock salaries
    bridging finance rent
    purchase order municipal accounts
    business equipment

    7. EXISTING CREDIT INFORMATION (NOT SPAZA SHOPS) IF APPLICABLE

    8. WHO DO YOU PROCURE INPUTS FROM (RAW MATERIALS)

    Covid-19 SMME Financial Relief Applications 3


    COVID-19 SMME COMMON APPLICATION FORM

    9. COMPLIANCE ENVIRONMENT
    Outline compliance in terms of the applicable standards, such as: (Yes/ No/ N/A)
    Health and safety Yes/ No/ N/A

    Municipal by-laws Yes/ No/ N/A

    SARS Yes/ No/ N/A

    Labour laws: UIF & Compensation Fund Yes/ No/ N/A

    Applicable industry laws Yes/ No/ N/A

    Membership of industry bodies Yes/ No/ N/A

    10. LIST OF ADDITIONAL DOCUMENTS (by email)


    ▪ Company Statutory Documents;
    o CIPC,
    o SARS,
    o CSD optional
    ▪ FICA documents (e.g. Municipal accounts, letter from traditional authority)
    ▪ ID Copies of Directors
    ▪ 3 months Bank Statements
    ▪ Latest Annual Financial Statements or Latest Management Accounts (Statement of
    Financial Performance and Statement of Financial Position) – where applicable
    ▪ Business Profile
    ▪ Project Execution Plan (applicable for Business Growth)
    ▪ Municipal trade permit (applicable to the spaza shops)
    ▪ 6 months Cash Flow Projections – where applicable
    ▪ Copy of Lease Agreement or Proof ownership (applicable for Debt Relief Finance)
    ▪ Relevant Industry Certification – where applicable
    ▪ Copy of Contract or Order
    ▪ Facility Statements of Other Funders - where applicable
    ▪ Estimations for applied funding

    Covid-19 SMME Financial Relief Applications 4


    COVID-19 SMME COMMON APPLICATION FORM

    DECLARATION AND CONSENT

    I/We, the undersigned declare that the information provided in this application form is to the
    best of my/our knowledge true and complete.
    I/We also understand that any wilful misrepresentation of the information in this application
    form will disqualify my/our application and may lead to legal action against me/us including
    the laying of criminal charges against me/us as sureties as well as against the entity I/we
    represent for furnishing false statement or information to the Department of Small Business
    Development (DSBD), Small Enterprise Finance Agency (SOC) Ltd (sefa) and Small
    Enterprise Development Agency (SOC) Ltd (seda) hereto referred as the DSBD Portfolio.
    I/We hereby grant the DSBD Portfolio consent to perform an entity/personal search and
    check on my/our records with any other party (e.g. credit bureau and/or a government agency)
    relating to this application.
    I/We further authorise the DSBD Portfolio to disclose my/our personal information to these
    parties to obtain the information they require and acknowledge that the DSBD Portfolio will
    never disclose more information than they are required to.
    DSBD Portfolio warrants that it will treat your personal information as confidential and take
    all necessary steps to protect your information as required by the Protection of Personal
    Information Act of 2013.
    DSBD Portfolio will only disclose your information if:
    • The law requires us to do so;
    • It is in the public interest to do so;
    • Our interests require disclosure; or
    • You have given us your consent.

    Surname
    Full Name(s)
    Designation
    Signature
    Place
    Date

    Covid-19 SMME Financial Relief Applications 5

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