APPLICATION FORM. Facility amount applied for:... Company name: Registration number: VAT number: Physical Address: ... Postal Address: ...

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1 APPLICATION FORM 1. APPLICATION/APPLICANT Facility amount applied for:..... Company name: Registration number: VAT number: Physical Address: Postal Address: Telephone No: Fax No: Contact person: Cell No: address: Main Bankers: Branch:... Branch Code:... Account number:..... Phone Number:. Contact person:..... External Auditors: Name:..... Address: Tel No:. Fax No:.. Contact person:.....

2 Page 2 2. SHAREHOLDERS/MEMBERS/DIRECTORS DIRECTOR/ SHAREHOLDER/ MEMBER (1) DIRECTOR/ SHAREHOLDER/ MEMBERS (2) DIRECTOR/ SHAREHOLDER/ MEMBER (3) FULL NAME PHYSICAL ADDRESS IDENTITY NO/ REGISTRATION NO PERCENTAGE.%.%..% OWNERSHIP MARITAL STATUS: Married / Unmarried Married / Unmarried Married / Unmarried (Circle appropriate COP / ANC COP / ANC COP / ANC option) (Kindly utilise an annexure if provided space is not sufficient) 3. BUSINESS OVERVIEW Kindly utilise an annexure and elaborate on the following: - Date Registered - Main line of business - Other related companies (provide group structure diagram) - Financial/Business highlights - Staff complement - Premises rented/owned - Past turnover, current turnover, projected turnover (Breakdown between local and export turnover) Note: Provide any brochures pertaining to the Business

3 Page 3 4. DOCUMENTATION TO BE PROVIDED BY APPLICANT 4.1 Most recent audited financial statements (Kindly furnish reasons if not available). 4.2 Most recent management statements (Kindly furnish any change in business and funding activities since last report). 4.3 Last 3 months bank statements 4.4 Latest SARS e-filing Statement of Account OR 4.5 Recent Tax Clearance certificate 4.6 Most recent debtors information: Age analysis Payment terms and conditions Credit limits Details of credit insurance List 5 largest debtors General terms, discounts and rebates offered 4.7 Please complete a form for each debtor offered for Invoice Discounting 4.8 Please indicate if your debtor s ledger contains any of the following: Export debts Service contracts / progress payment invoices Consignments / warranties on goods / services supplied Consignment sales (sale or return) Retention deductions Interest on overdue accounts YES NO If your answer is Yes to any of the above please provide further details in a separate Annexure 4.9 Most recent creditors information - Age analysis - Payment terms and conditions - Credit Limits

4 Page External Auditors Certificate in the format attached as Annexure B 4.11 Facility letter from Bank detailing facility limits and securities held 4.12 FICA documents Copies of the documents (certified copies not required) listed below are regarded as complying with FICA: CLOSE CORPORATION: Proof of business address, reflecting trade name Proof of Income Tax registration number & VAT number For each member: Copy of ID Proof of residential address & contact details For any other person authorised to act on behalf of CC: (If applicable) Copy of ID Proof of residential address & contact details COMPANY: Proof of business address, reflecting trade name Proof of Income Tax registration number & VAT number For each director: Copy of ID Proof of residential address & contact details Schedule, including Name, ID, Address & Contact details of any person or legal entity holding 25% or more voting rights at a general meeting. For any other person authorised to act on behalf of the company: (If applicable) Copy of ID Proof of residential address & contact details

5 Page 5 5. CONSENT TO CREDIT SEARCH The undersigned Company/Close Corporation/Trust: (Reg Nr/Trust Nr: ), and its directors/members/trustees, hereby consent to Anglo African Finance (Pty) Ltd, or any of its employees, officers, managers and agents, conducting credit checks, including but not limited to TransUnion ITC and other related credit bureau searches, in respect of my/our application for finance.

6 Page 6 6. CONFIRMATION I/We confirm that the abovementioned information is true and correct Name.. Name Capacity Capacity Date Date

7 Page 7 ANNEXURE A PLEASE COMPLETE A FORM FOR EACH DEBTOR OFFERED FOR INVOICE DISCOUNTING: CUSTOMER/DEBTOR INFORMATION (ENTITY RESPONSIBLE FOR PAYMENT OF INVOICES) Company name Registration number VAT number Physical Address Postal Address Telephone number Fax number Trading terms Own credit limit Credit Insurance limit Current outstanding balance Contact person/s Cell phone number address

8 Page 8 ANNEXURE B TO BE TRANSPOSED ONTO A LETTERHEAD OF CLIENT S ACCOUNTANTS / AUDITORS Date Anglo African Finance (Pty) Ltd P O Box 433 Stellenbosch 7599 ATTENTION: MR F NEETHLING COMPANY NAME REGISTRATION NUMBER VAT NUMBER INCOME TAX NUMBER "I/We confirm that (3) Is currently trading under solvent conditions. (4) The following persons are directors/members of the company/close corporation: (5) The book debts of the company/close corporation have not been ceded to any other party. (If ceded, provide details of the cessionary holder.) (6) The financial year-end of the company/close corporation is: OPTIONAL CLAUSE IN CASE OF TECHNICAL INSOLVENCY In addition, we further confirmed that sufficient of the directors /s shareholders loan accounts have been sub-ordinated to restore solvency to as at 201. The original confirmation letter will be posted to yourselves. Kind Regards, THE AUDITORS

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