Promoting and Facilitating Agri-Business Investments

SECTION 1: APPLICANT INFORMATION

Section 1A below is to be completed by individuals and unregistered entities.
1A. Name of Applicant:
Address:
Age:
Telephone Number/s
Email Address:
Date Operation Commenced:
TRN:
1B. Company’s Name / Name of Group
Trading Name
TRN:
Address of Registered Office:
Mailing Address of Company:
Date of Incorporation:
Date Operation Commenced:
If group, please indicate Date of Commencement:
Shareholders and Shareholdings:
Name:
Name:
Name:
Name:
% Holding:
% Holding:
% Holding:
% Holding:
TRN:
TRN:
TRN:
TRN:
Particulars of Chief Executive Officer/Manager/Managing Director:
Name:
Address:
Tel. Number:
Email address:
Company’s Attorney:
1C. Particulars of Group:
Number of Members:
Age Group of Members

  • – select a option –
  • 18-40
  • 41-65
  • over 65

Particulars of Group Leader:
Name of Group Leader:
Age of Group Leader:
TRN of Group Leader #
Telephone Number of Group Leader #

2. INFORMATION ON LAND/SPACE REQUIRED

a) Do you require land, office or warehouse space? Please tick:
b) Land/Space required (Square Ft. /Acres)
C) Nature of your business:
d) Desired Location:
Period required for lease:
f) Referred to Agro-Investment Corporation (AIC) by: (indicate by a tick in the left bracket)

3. PRODUCTION INFORMATION

Products to be Cultivated/ Manufactured:
State waste product from manufacturing process:
Monthly Quantity
Method of disposal to be used:
c) Anticipated employment:
d) State any special requirement(s):

4. FINANCIAL DATA

1. Net Book Worth and Profit/Loss Projection for next two (2) years and actual for last two (2) years. Attach Audited Financial Statement (where applicable) and Bank Statement
2. Projection
Total Assets:
Total Liabilities:
Asset less liabilities:
Sales:
Costs and Expenses:

3. Banker (s) / Financial Institution (s)

Individuals/ Groups & Companies
Name:
Address:
Contact Person:
Proposed Guarantor:
Name:
Address:
Contact Person:
Proposed Guarantor:

4. References( must be either a Justice of the Peace, Credit Union Manager, Bank Manager, Member of Parliament, Public Officer (SEG 1 and Above) , Medical Practioner and or Principal (Primary, Secondary or Tertiary Educational Institution).

References:

5. Technical Competence and Willingness to Operate

Indicate by a tick in the bracket which one best suits you:
Are you willing to participate as a group?
Are you willing to contribute to cost share expenses?
Are you willing to maintain up to date farm records?
Are you willing to adopt prescribed farming techniques and related best practices as recommended by the Ministry of Agriculture & Fisheries/ RADA Team?
How long have you been involved in farming?
State the type of training and institution training was received
Provide details on the Management for the facilities/ farm to include name and contact information ?
Name of Company / Applicant: Signature of Applicant: Position of Signatory:
Date:

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