Annex 4.f
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Wikileaks2024Annex 4.f
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Wikileaks2024Attachment B – Updated Walk-In Registration Form
Form # 1
Service Request
CLIENT BASIC INFORMATION & NEEDS
Date: / / Client # :________________________
Client Data
Name: ____________________________ Gender: Male Female
Place of Residence: _____________________________________________________________
ID #: ______________________________ Civil ID Passport
Telephone: Home: ____________________ Mobile: ______________________
Firm Activity: _________________________________________________________________
Firm address: _________________________________________________________________
Delegate’s data, if applicable
Name of delegate: ____________________________________________________________
Power of Attorney #: ___________________ Date of Power of Attorney _________________
Requested services
Inquiry about available services Financing small projects (banks, direct)
Tax card Financing micro projects
Commercial registry Land allocation
License issuance Service status check
Firm registration (civil number) Technical and marketing support
Industrial Dev. Authority Services Tax exemption letters
Complaints and delinquency Installment payment/direct loan installment payment
Training Courses Others_____________________________________
SFD needs to charge reasonable (subsidized) fees for services to continue offering them. Are their any
services indicated above you would not be willing to pay for?__________________________________
How did you learn about the SFD and the services it delivers?
Received other services from SFD already. If yes, what kind(s)_________________________________
or you heard about SFD from:
Newspapers & magazines Media campaign Mobile services unit
Nile Media Centers Friends and associates Representative offices
Civil societies Others (state) ______________________________________
Version #: 2A
Update Date: 4/3/2016
Service Request (Registration Form) page 2
Client profile baseline data – for all clients except those who have not yet started a business.
To better understand how to serve you and our other clients, we need to collect some basic
information from you. If you are an SFD client or become one, this information will help us learn
what services are most useful and see the impact we are having in the community. The information
below will not be shared with anyone outside SFD and will be kept confidential.
Please provide information requested in the table below as of today’s date
BASELINE DATA TABLE
Female
Total Full Time Employment
Male
Total Temporary Employment Female
Male
Total Youth Employment ages 15 – 24 (full time + temporary workers)
included in the above numbers
In Formal Sector? Yes No
Employees Average Monthly Gross Salaries (excluding owners)
Environmental Impact (negative, no impact,
Expected in first year
positive)
Annual Sales in LE Domestic
Export
