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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 FacilityPreference 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. Loan application form

2. Feasibility study (where applicable)

3. Business plan including financial projections: see attached business plan guide

4. Financial statements: 3 years audited balance sheet, income statement, cash flow (for existing business)

5. Certificates of Good Standing(Receiver of Revenue & Social Security Commission)

6. Business Registrations Documents (Founding Statement or Memorandum of Articles of Association)

7. Certified ID documents of the shareholders/ members/partners

8. Certified Marriage certificates of shareholders/ members /partners (where applicable)

9. Business bank statements for the past 12 month (where applicable)

10. Promoters (Proprietor/members/shareholders) personal cheque account bank statements for the past 12 months

11. Statement of Assets & Liabilities of shareholder/ member/ partner (including statement of monthly income &expenditure)

12. Profile/CVs of promoters and key personnel

13. Other Documentation (Please list)

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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 riskInterest rates and feesInterest rates for direct financing are determined by the Development Bank of Namibia reflecting cost of funds, riskexposure (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 theappraisal process.

The Development Bank of Namibia will review the application in accordance with stipulated criteria and will informapplicants of one of the following outcomes:

o application approvedo 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 thatoutcome is final.

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Private Enterprise Finance Application Form 2


SECTION A. RECEIPT OF SUBMISSION OF LOAN APPLICATION

Applicant name(Business Registered name)

Business RegistrationNumber

Registered PhysicalBusiness 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

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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

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SECTION C. LOAN APPLICATION DETAILS

1. Region in which main operations are located

Caprivi Erongo Hardap Karas Kavango Khomas Kunene Ohangwena Omaheke Omusati Oshana Oshikoto Otjozondjupa

2. Economic sector

Agriculture & ForestryFishing & FishProcessing

Mining & Quarrying Manufacturing

Other (specify)Electricity

Construction Retail HospitalityWater

Tourism Transport Communication Health Education

3. Business structure

Proprietary limited PartnershipClose corporation Other (specify)

4. Business status

New business (start-up) Management buy-in(existing business)

Expansion of 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.Percentageshareholding

*Please use attachment if necessary

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6. Funding RequiredProduct Offering Amount Term of

FacilityRepaymentFrequency(Monthly

/Quarterly, etc)

Grace periodRequired ( in

months)

Term Loan

Instalment Sales Facility

Trade Finance (Import & Export )

Other (Please Specify)

TOTAL

7. Proposed financing sourcesAmount (N$) Percentage

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.

8. Project uses of fundsAmount (N$) Percentage

Property acquisition (land and buildings)

Machinery and equipment

Working capital

Inventory/ trading stock

Performance Guarantee

Other (specify)

TOTAL

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

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10. Empowerment impact on Previously Disadvantaged Individuals

(PDIs)Percentage of total

Year OneAfter YearOne

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)

11. Employment creation

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

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)

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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 BusinessLoan Report.

A copy of this authorisation (being a photographic or fax copy of the signature(s) of the undersigned) may bedeemed 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.

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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 andI / 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 itimply 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 tomake any commitment of loan funds.

I / we further understand that notification as to approval or disapproval of my loan request will be made by theDevelopment 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 otheragency 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

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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 thisapplication is accurate, complete and current to the best of my / our knowledge. I / we further acknowledgethat intentional material misrepresentation of facts may result in significant adverse action including, but notlimited 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 thecompanys history, including personal and company credit checks, contact financial institutions, and performother due diligence efforts deemed necessary and proper in the reasonable and prudent evaluation of this loan

application.

Signature Date

Name (print) Position

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Business Plan Guide: Private Sector Facility 2

Financial segment (continued)5.2 Forecasts: budgeted / projected (Please provide electronic version of forecasts as well)

5.2.1 key assumptions5.2.2 sales projections5.2.3 income projections: profit/loss5.2.4 break-even analysis5.2.5 pro-forma balance sheet5.2.6 cash flow projections5.2.7 financial ratios: debt-to-equity, cash flow to capex, capex per jobs created, etc.

5.3 Sensitivity analysis of scenarios5.3.1 tax regime5.3.2 foreign exchange regime5.3.3 return distribution: concession fees, royalties, dividends, repatriation of profit, etc.

6. Implementation plan6.1 disbursement schedule6.2 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 management7.1 risk identification

7.1.1 business and industry risk (including regulatory framework)7.1.2 financial risk7.1.3 management risk

7.2 risk management plan7.2.1 risk reduction and elimination mechanisms7.2.3 risk transfer and/or retention

7.3 critical success factors

8. Environmental Impact Assessment (where applicable)8.1 environmental impact assessment study results8.2 environmental management plan

9. Economic and/or developmental impact9.1stimulation of targeted economic sectors and/or geographic area9.2projected job creation: primary9.3empowerment impact: ownership structure, capacity building, skills transfer, dollar value