Application For Funding Form

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Township Economic Partnership Fund (TEPF)

Kasi Mnotho Programme

Application Form

Privacy Statement

As a participant in the Kasi Mnotho Programme, you will be asked to share business information that we understand may be
sensitive and confidential to your operations. To ensure you that we safeguard all business-related information in the strictest
confidence, every year each member of FAMILY TREE HOLDINGS, through its local business association is required to sign a “Code
of Ethics and Conduct.” This Code establishes our commitment to our clients’ confidentiality and the proper conduct in all phases
of our relationship. This is especially applicable to the proper handling of information and communications that may develop in
our discussions. We look forward to working with you and assisting with your continued success. A consent to process personal
information in terms of the Protection of Personal Information Act, No. 4 Of 2013 (POPIA) is herein included.
Township Economic Partnership Fund (TEPF)
Kasi Mnotho Programme

SECTION A: PERSONAL/ BUSINESS INFORMATION

Business CIPC Registration Number:


Business Trading Name (As Per CIPC Document)

Full Names of Director/s


Director Details:

Identification Numbers

Age
Business Trading Address

Contact Details: Cellphone Numbers


E-mail address

Nationality

Gender Male Female

Living with Disabilities Yes No Specfy

SECTION B: FUNDING ASSESSMENT PRE-QUALIFICATION QUESTIONS

Does your business have a trading permit Yes No Specify

Do you belong to a Business Association? Yes No

Name of Business Association (if applicable)


Association Membership Number (if applicable)

Are you a member of a Stokvel group? Yes No Specify

How long have you been a member?


Township Economic Partnership Fund (TEPF)
Kasi Mnotho Programme

Value of Contribution per month in your Stokvel? ZAR

Loan Application Amount ZAR

What is the loan application for?

Have you attended the Entrepreneurial Skills Development


Training with Family Tree Holdings?

Do you have insurance for your business?

What is the Current Business Turnover?

SECTION C: BUSINESS BANKING DETAILS

Name of Bank

Bank Account Number

Branch Name

Branch Number

SECTION D: DOCUMENTS REQUIRED (STOKVEL)

Certified Copy of the applicants Identification Document (ID)

Certified Copy of Trading Permit

Proof of residence (Not older than 3 months)


3 months Bank Statement (Both of the Stokvel)

Fully completed Kasi Mnotho Loan application Form

Letter from the Stokvel (for stokvel members) confirming


that the member is in good standing

Proof that the stokvel is registered (For Stokvel members)


National Stokvel Association of South Africa (If R100k and
Above Is Collectable)
Township Economic Partnership Fund (TEPF)
Kasi Mnotho Programme

Proof that stokvel has been operational for at least 3 months


(for Stokvel members)

Income and Expenditure Statement


`

SECTION D: DOCUMENTS REQUIRED (NON-STOKVEL BUSINESSES)

Application form and Business plan

Three (3) year audited financials (Income Statement,


Balance Sheet, Cash Flow Statement)

Five (5) year financial projections (Income Statement,


Balance Sheet, and monthly Cash Flow Statement) with first
year prepared monthly

Recent management accounts (Income Statement and


Balance Sheet)

Personal Statements of Assets and Liabilities of all the


members or directors including those of spouses if person is
married in Community of Property.

Business bank statements for the past twelve (12) months

ID copies of all members or directors

Registration Documents and all the relevant legal documents


relevant to the entity.

Details of why the business is for sale in the event of


business sales

Sale Agreement in the event of an acquisition


Township Economic Partnership Fund (TEPF)
Kasi Mnotho Programme

FICA compliance - Proof of residence

Detailed CV of principle Applicant.

CONSENT FORM

I ______________________________________________(Name) with ID number __________________________,


the duly authorised representative of ______________________________________(“Company”) with registration
number ____________________________________ agree that Family Tree Holdings (Pty) Ltd may make inquiries to
confirm any information provided by the Company and that Family Tree Holdings (Pty) Ltdmay verify the information
and obtain additional information from Experian, a registered credit bureau, when assessing the information provided
herein. I authorise Family Tree Holdings (Pty) Ltdto conduct a credit report on the company and to continuously access
the Company credit report for as long as the Company is a client of Company XYZ, and warrant that all the directors
and/or members have consented to the Company instructing Family Tree Holdings (Pty) Ltdto conduct the credit
enquiry on the Company and that the Director and/or Members acknowledges that the enquiry will include an inquiry
into the Director and/or Member’s credit profiles for as long as the Company is a client of Company XYZ. I further
warrant that the Directors and/or members authorise Family Tree Holdings (Pty) Ltd to obtain the credit information on
the Directors and/or Members and that the Company has the consents as stated herein, in writing. In the event of
Family Tree Holdings (Pty) Ltd being required to do an account verification check to verify that banking details provided,
are correct, or to enquire with the Company’s banker to obtain its opinion with regards to lending amounts and lending
terms applicable to the Company, I hereby authorise such an enquiry for as long as the Company is a client of Family
Tree Holdings (Pty) Ltd. We furthermore consent to Family Tree Holdings (Pty) Ltd submitting our information, including
payment profile and default information and any other relevant information, to Experian and to allow Experian to release
the information for lawful purposes to third parties.

I furthermore warrant that all information supplied to Family Tree Holdings (Pty) Ltd is to the best of my knowledge true
and correct, that I am not aware of any other information that would affect the credit application of the Company in any
way and that I am authorised to sign this document.

The Company:

Name of the Company:

Name of the Authorised Representative:


Township Economic Partnership Fund (TEPF)
Kasi Mnotho Programme

Title:

Signature:

Date:

Directors / Members Details:

Name:

ID Number:

Name:

ID Number:

Name:

ID Number:

The information provided in this document does not, and is not intended to, constitute legal advice; instead, this template
clause should only be regarded as a guideline and be used for general informational purposes and we recommend that you
seek a legal opinion on the matter from your legal advisors.
Township Economic Partnership Fund (TEPF)
Kasi Mnotho Programme

By signing this form, you consent to your personal information to be processed by Family Tree Holdings
(Pty) Ltd and consent is effective immediately and will remain effective until such consent is withdrawn.

1. I …………………………… a natural person “herein referred to as the Data Subject” with ID

No…………………………… hereby give my consent to the Family Tree Holdings “herein referred to

as the Responsible Party” to collect, process and distribute my personal information where Family

Tree Holdings is legally required to do so.

2. I understand my right to privacy and the right to have my personal information processed in accordance
with the conditions for the lawful processing of personal information.

3. I understand the purposes for which my personal information is required and for which it will be used

and consent to third parties accessing my personal information and to the Family Tree Holdings

sharing my personal information strictly for application processing for Kasi Mnotho Funding Programme
purposes.

4. I understand that, should I refuse to provide Family Tree Holdings with the required consent and/or
information, Family Tree Holdings will be unable to assist me.

5. I declare that all my personal information supplied to the Family Tree Holdings is accurate, up to

date, not misleading and that it is complete in all respects and will be held and/ or stored

securely for the purpose for which it was collected and that I will immediately advise the

Family Tree Holdings of any changes to my Personal Information should any of these details

change.
Township Economic Partnership Fund (TEPF)
Kasi Mnotho Programme

6. I also understand that I have the right to request that my personal information be corrected or deleted,
if it is inaccurate, irrelevant, excessive, out of date, incomplete, misleading, or obtained unlawfully or

that the personal information or record be destroyed or deleted if the responsible party is no longer

authorized to retain it.

Signed at .......................................... this ...................... day of ...........................20………...

…...........................................................................

Signature of data subject/ designated person

……………………………………………………………………… ………………………………… …………………..

Full Name (Names and Surname)

OFFICE USE ONLY

Designation Name Date Signature Statement of


Review

Admnistration
Officer

Pre- Assessment

Approval

Finance

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