Loan Application FormBUSINESS DETAILS:Registerd Business Name:Business Registration NoVAT Registration NoContact personEmailPhone/MobileNature of BusinessEstablished DatePhysical AddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)RomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweBANK DETAILSAccount HolderAccount NumberBranchBranch CodeLANDLORD DETAILS:Contact PersonPhone/MobileEmailPreviousNextINSURANCEBrokerContact PersonPolicy NumberPhone/MobileEmailAUDITORSNameContact PersonEmailPhone/MobileFinancials Available Yes NoPreviousNextSHAREHOLDERS, DIRECTORS, MEMBERS, CONTROLLING COMPANY DETAILS1. Full names of Director / Member / ShareholderIdentity NumberResidential AddressesBond O/sValueShareholding Interest %2. Full names of Director / Member / ShareholderIdentity NumberResidential AddressesBond O/sValueShareholding Interest %3. Full names of Director / Member / ShareholderIdentity NumberResidential AddressesBond O/sValueShareholding Interest %TRADE REFERENCES1. Trade ReferencesContact PersonContact DetailsPhone/MobileYears of Service2. Trade ReferencesContact PersonContact DetailsPhone/MobileYears of Service3. Trade ReferencesContact PersonContact DetailsPhone/MobileYears of ServiceAnnual Turnover Under 2 Million Over 2 MillionTRANSACTION PARTICULARSMain SuppliersContact PersonPhone/MobileEquipment to be FinancedDropdown- Select Choice -36 Months48 Months60 MonthsDescription of Equipment:(1) Copy of Bank Confirmation Letter and Company LetterheadChoose File (2) Copy of Company documents (CK1 and/or Certificate of Inc)Choose File (3) Copy of Directors/Members/Individuals’ Identity DocumentsChoose File (4) Brief profile on your CompanyChoose File (5) Latest Annual Financial info and 3 months Bank statementsChoose File (6) VAT Registration, HPCSA REGISTRATIONChoose File (7) FICA DocumentsChoose File Agreement I/We declare that to the best of my/our knowledge and belief, the particulars set out in this application, are true and correct, and that no additional information has been withheld. I/We warrant that the Annual Turnover and/or Net Asset Value is true and correct and acknowledge that Technofin and /or its cessionary has relied on such warranty in determining the legal framework of the facility. I/We Consent toPROTECTION OF PERSONAL INFORMATIONACT 4 OF 2013 ("POPIA")Technofin and or its cessionary is obliged to obtain the consent of the person or entity set out above (“the Applicant")to process all personal information of Applicant as defined within POPIA (“the Personal Information”) Therefore, theApplicant expressly consents and agrees to the following and that Technofin and or its cessionary may:Make enquiries to confirm and verify any Personal Information provided by the Customer of whatever nature with any third party including without limiting; credit bureaus , trade references and any third party, to confirm and verify any Personal Information received from the Applicant. Collect and process the Personal Information for purposes of providing the services provided in terms of a rental agreement entered into directly with the Applicant or which may be by the Applicant with a supplier and which agreement was subsequently ceded toTechnofin and or its cessionary and to administer and maintain the business relationship with the Applicant; As signatory to this application, I/we indemnify you or your cessionary/ies by any director, shareholder, member and/or associate of the applicant by virtue of this consent, entered in to process and disclose the Personal Information for the following purposesof prevention,detection and reporting fraud and combatting criminal activities to any person providing services to or requiring services from or representative, agent or supplier of Technofin determining the creditworthiness of the Applicant and retain and utilise the Personal Information for credit record and scoring purposes;FINANCIAL INTELLEGENCE CENTRE ACTS ( FICA) All accountable institutions are requiered to identify their clients. I/ We therefore concent to Technofin carrying out identity and fraud prevention checks,detection and reporting of fraud and criminal activities including money laundering activities and sharing information as required by the Financial IntelligenceCentre Act No1 of 2017;CERTIFICATE I/We certify to the best of my/our knowledge and belief the information I/we have given you is correct in compliance with any legal obligations. I/Wecertify that there are not writs, summonses, judgements, petitions, winding up order or pending applications for liquidation or threatened against theapplicant or its directors/shareholders;ANNUAL TURN OVERI/We warrant that the Annual Turnover and/ or Net Asset Value is true and correct an acknowledge that Technofin or it'scessionaries have relied on such Warranty in determining the legal frame work of the facility.NameDesignationDate / Time Previous Submit Form