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Use either the form below, or if you would prefer use the .pdf and mail your filled out form to us. If you choose the .pdf or word option, please click the icon below to download a copy of the form.

word

 

Please fill out ALL the fields in the form before you submit.

______________________________________________________________

 

Applicant & Project

Name of Project

 

Broker Details ( IF APPLICABLE )

Contact Name

Company Name

Address

Postcode

Email Address

Telephone Number


Applicant/Company Registered Address

Unit/Building Number

Unit/Building Name

Street Address

Postcode

Country

Contact Name

Position

Fax Number

 

Project Address

Unit/Building Number

Unit/Building Name

Street Address

Postcode

 

Loan/Investment Required & Security Available

Loan Required

Loan/Investment Duration

Deposit Amount Available from the Applicant

Type of Guarantee of Security Available

Description of Applicant's Current Free Available Assets

Estimated Market Value of Applicant’s Current Free Assets

Applicant Co’s Share Capital

Total Project Cost

 

Shareholder's Details

No Name %
1
2
3
4
5
6

 

Director's Details

No Name Role Profession
1
2
3
4
5
6
7
8

 

Applicant Company History

Applicants Company’s Registration Number

Is The Applicant Already Trading? 

No Name Role Profession
1
2
3
4
5
6
7
8

 

Year to 2010 Sales/Turnover Net Profit/Loss Tax Paid

 

Project /Loan/Investment Description

Project Type

Project Consists Of

Location

Amount Seeking

Developer

Time Frame

Entitlements

Total Project Cost

Appraised Value as is

Appraised Value as Completed

Total Cash Invested

Total Current Equity & Assets

Total Debt

Loan to Cost

Status

Exit Strategy

 

Project Costs

Item Description Amount
Land Purchase
Share Purchase
Plant & Equipment
Working Capital
Other Costs (Describe)
Agents
TOTAL PROJECT COSTS

 

Proposed Project Funding

Item Description Amount
Promoter's Personal Input
From Internal Resources
Other Bank Loans
Other Credit Facilites
Hire Purchase or Leasing
Other Sources
TOTAL PROJECT FUNDING

 

Employees

Number of Current Employees at the Project Location?

 

Planning

Is Planning Permission Required?

If Yes Who is the Planning Authority?

Date Applied For

Date Approved

 

Land/Premises

If leasehold, date of termination of the lease

What is the size of the existing site and buildings?

Site in Hectares

Building in Sq. Metres

What is the Proposed Project Site/Building Size?

Site in Hectares?

Building in Sq. Metres

 

Project Schedule

Proposed Project Start Date

Completion Date

Required Funding Schedule (amount required during)

Year 1 Year 2 Year 3 Year 4 Year 5

 

 

 

Financial Information

Applicants Company's Asset Value

Fixed Assets (market value)

Current Assets

Current Liabilities

TOTAL ASSETS

Long Term Liabilities

TOTAL LIABILITIES

The Company's Net Asset Value

 

 

 

 

 

 

 

Income Forecast From Start Date

Start Year 1 Year 2 Year 3 Year 4 Year 5
Income
Net Profit/Loss

 

 

 

14. Additional information that may be relevant to the application

 

Terms & Conditions

You must accept the declaration above to proceed with your application. I accept the Terms and Conditions above.

Please tick the box to accept the Terms and Conditions and proceed with your application.)

 
ALFA USA 1
ALFA USA 2

ALFA USA 3ALFA USA 4
ALFA ASIA 1
ALFA ASIA 2
ALFA BG
ACMS

 
 
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