Application Form
Application Form
mire
International
Finance
Corporation
World Bank Group
Applicant Details
Address/Location: S5 — ^ 0 1 3 ^ ^ ( QrVM
Does you or your organization have a recurring income stream? YES NO \/\
Are you or is the organization a member of African Investment & Development Fund? YES ^ NO
Full Names:
Phone [sf. _
Have you or your organization applied for a loan within the last 12 months? YES £ NO\f\
If yes please specify the intended use of the loan (the "Project"):
Please specify the main town/suburbs in which the Project will occur: _
|T<lMl U N^tU^gT
Will the Project have an overall benefit for the community? YES £ NO \S\
If the project will benefit a section of the community please describe that section (for example, the elderly,
If we unable to fully fund your application would you accept partial funding? YES NO [P
If you or your organization have a recurring income stream do attach a copy of your bank statement.
Declaration
I declare that the information given herein is true to the best of my knowledge and belief and acknowledge
that the decision of the Approval Board is final.
Signed:
Full Name:
Date:
NOTE:THIS FORM MUST BE DOWNLOADED,FILLED IN INK PEN AND SIGNED BEFORE IT IS SUBMITTED