sefa Product Application Form

Accessible Development Financesefa Product Application Form01 LICENSED CREDIT PROVIDER (NCRCP 160) PAGEOF 11 loan Application FORMSECTION A: COMPANY INFORMATION(To be completed by borrowing legal entity)COMPANY DETAILSCIPC Registered NameTrading NameType of BusinessIndustry (Sector)Registration NumberRegistration DateDDMM CCYYT elephone NumberFax NumberE-mail AddressVAT Registration NumberTax Reference NumberPhysical AddressProvinceCodePostal AddressProvinceCodeShould sefa contact you for telemarketing purposes?Ye sNoPeriod in Business (Years)Number of Current EmployeesNew jobs expected to be createdHow did you hear about sefa?(Tick applicable box)RoadshowRadioWord of MouthOutdoor Advertising ( Billboard, Pamphlet, etc.)Print Media ( Magazine, Newspaper advert, etc)Other (please specify)Indicate how you would prefer to receive copies for your legal documents. (Tick applicable box)Collecting in person at sefa s offices?PostFax( ) - E-mailCONTACT PERSON/COMPANY REPRESENTATIVET itle (Prof/Dr/Mr/Ms)SurnameFirst Name(s)Contact Number(s)Cell( ) - Te l( ) - Fax( ) - E-mailMEMBERS/SHAREHOLDER DETAILSFull Name(s) and SurnamePercentage ShareholdingCOMPANY BRIEF BACKGROUND INFORMATION (Should you require more space please attach a separate page)02 LICENSED CREDIT PROVIDER (NCRCP 160) PAGEOF 11 FINANC

O 10 GE 01 11 LOAN APPLICATION FORM SECTION A COMPANY INFORMATION (T ro COMPANY DETAILS CIPC Registered Name Trading Name Type of Business Industry (Sector)

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