Your address will show here
+12 34 56 78
email@example.com
HOME
HOME
ABOUT US
ABOUT US
WHO WE ARE
OUR STRUCTURE
OUR FOCUS AREAS
SUCCESS STORIES
ESD
ESD
RETAIL
RETAIL
LOANS
LOANS
ECD
MPATHY
SMME
CONTACT US
CONTACT US
HOME
HOME
ABOUT US
ABOUT US
WHO WE ARE
OUR STRUCTURE
OUR FOCUS AREAS
SUCCESS STORIES
ESD
ESD
RETAIL
RETAIL
LOANS
LOANS
ECD
MPATHY
SMME
CONTACT US
CONTACT US
PRIVATE EQUITY APPLICATION FORM
TOWNSHIPFLEVA PRIVATE EQUITY APPLICATION FORM
Step
1
of
5
20%
Context & Contact Details
Is the business older than 3 years?
Yes
No
Annual Turnover
> R500K
> R750K
> R1mil
> R1.5mil
Are there any past or current legal actions/criminal charges against you or your company?
Yes
No
Is the company under Business Rescue or intend on entering Business Rescue proceedings in the next 6 months? Yes/No
Yes
No
Contact Person Names
Mobile Number
Office Number
Email Address
Enter Email
Confirm Email
Do you give consent and certify for Township Fleva to store, process and verify the information provided for the purpose of processing your loan application?
Yes
No
Application Details
I’m applying as
Private Company
Sole Proprietorship
Close Corporation
Partnership
Trust
Registered Name
Trading Name (if different from registered)
Registration Number
Year established
Industry Sector
Agriculture
Construction
Manufacturing
Food & Beverage
Technology
Retail
Transport
Distribution
Trade
Entertainment & Media
Hospitality
E-commerce
Fashion
Hair & Beauty
Healthcare
Financial Services
Telecommunications
Energy
Forestry
Marketing
CURRENT REGISTRATIONS
VAT
Yes
No
UIF
Yes
No
PAYE
Yes
No
INCOME TAX
Yes
No
AUDITOR/ACCOUNTANT
Name of Auditing/Accounting firm
Contact Number
Email Address
Enter Email
Confirm Email
Business Information
BANK DETAILS
Bank
FNB
Standard BANK
Nedbank
ABSA
RMB
Investec
Account Type
Current
Savings
Transmission
Cheque
Account Holder Name
Account Number
Branch
Branch Code
BUSINESS LOCATION
Primary Business Address
City
State / Province / Region
ZIP / Postal Code
Contact Person Names
Contact Number
LANDLORD DETAILS (if renting premises)
Landlord’s Address
City
State / Province / Region
ZIP / Postal Code
Landlord’s Full Name
Landlord’s Contact Number
Landlord’s Email Adress
Enter Email
Confirm Email
Shareholder Details
DIRECTORS/MEMBERS/SHAREHOLDERS/OWNERS
Director
Yes
No
Member
Yes
No
Owner/Shareholder (but not a Director/Member)
Yes
No
Mobile Number
Email Address
Enter Email
Confirm Email
Has a Director, Member or Shareholder ever been declared as insolvent?
Yes
No
FINANCIAL NEED
Purpose of Finance
Specialized Asset Finance
Growth Finance
Working Capital
Business Acquisition
Property Development
Investment Amount
0 - 49K
50K - 99K
149K - 199K
200K - 399K
> 400K
Equity Percentage %
DIRECTORS INTEREST
Name
BBBEE/ Non-BBBE
Male/Female
Contribution
Shareholding % (pre TF funding)
Shareholding % (post TF funding)
Add
Remove
Supporting Documents
TELL US MORE ABOUT YOUR BUSINESS
Declaration:
I confirm that the information I am proving below is accurate and that I will be able to provide supporting documents when requested.
Please upload the following documents to complete your loan application:
Business Plan
(Required)
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 50 MB.
Co-operative registration documents by CIPC
(Required)
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 50 MB.
Tax Clearance Certificate
(Required)
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 50 MB.
BBBEE Certificate
(Required)
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 50 MB.
Certified Copy of the Identity Document(s)
(Required)
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 50 MB.
Proof of Residence
(Required)
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 50 MB.
Business Bank statements – for the past (12) months
(Required)
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 50 MB.
Three (3) year audited financials (Income Statement, Balance Sheet, Cash Flow Statement)
(Required)
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 50 MB.
Registration Documents and all the relevant legal documents relevant to the entity
(Required)
Drop files here or
Select files
Accepted file types: pdf, Max. file size: 50 MB.
CHECKLIST
Documents/Information required (Tick if provided)
Completed application form (this form) and Business Plan
CK documents / PTY / Co-operative registration documents by CIPC
Tax Clearance Certificate
BBBEE Certificate
Certified Copy of the Identity Document(s) – Directors/Members
Proof of Residence (Municipal Account or Letter from Ward Councilor)
Company Profile
Business Bank statements – for the past (12) months
Three (3) year audited financials (Income Statement, Balance Sheet, Cash Flow Statement)
Registration Documents and all the relevant legal documents relevant to the entity
Please provide your business’ website, fb, Linkedin or any similar url (not mandatory)
Website:
FB:
LinkedIn:
Other:
CAPTCHA
