Agro-InvestPROPERTY LEASE APPLICATION FORM

SECTION 1: APPLICANT INFORMATION

Section 1A

To be completed by individuals and unregistered entities.
Name of Applicant:
Address:
Age:
Telephone Number/s
Email Address:
Date Operation Commenced:
TRN:

Section 1B

To be completed by both registered and unregistered entities. A copy of company registration certificate is to be attached (where applicable).
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 #

SECTION 2. INFORMATION ON LAND/SPACE REQUIRED

Do you require land, office or warehouse space? Please tick:
Land/Space required (Square Ft. /Acres)
Date Required:
Nature of your business:
Desired Location:
Period required for lease:
Referred to Agro-Investment Corporation by:
Were You Assisted by an Investment Officer?
If yes, what is the name of the Investment Officer?
How will the application fee of J$2000.00 be paid?

3. PRODUCTION INFORMATION

Products to be Cultivated/ Manufactured:
State waste product from manufacturing process:
Monthly Quantity
Method of disposal to be used:
Anticipated employment:
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 (COMPANIES ONLY)
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:

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).

Individuals and Groups
References (No less than 2) :

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/agri-business?
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 ?
Comments
Name of Company / Applicant: Signature of Applicant: Position of Signatory:
Date:

Business Proposal Summary

Applicant Summary Profile

Name(s) of Applicant/Organization
Address of Applicant/Organization
Telephone Number:
Email Address
Investor/Farmer Profile
Advisors and Human Resources

References for the Business

TRN
Tax Compliance Certificate

Project Summary

Company Name
Legal Structure
Year of Incorporation
Name and Title of Contact Person(s)
Company Strategy
Available Markets
Farm’s Marketing Objectives
Market Segmentation
Market Positioning
Sales Strategy
Customers
Suppliers
Competition
Farm/Land Size
Farm Location
Intended Use
Project Goals and Specific Objectives
Expected Outcomes/Benefits
Project Justifications
Brief Project Description

Investment Information Sheet

Projected Capital
Projected Financing Plan
Loan Request
Funding Source
Collateral/Security
Name(s) of Investors and Sub-burrowers
Name of Main Shareholder
Historical Financial Analysis
Current Indebtedness
Submit

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