FRANCHISE (BUSINESS) INFORMATION

Transcription

1 FNB Franchising APPLICATION FOR FRANCHISE FUNDING SECTION 1 FOR OFFICIAL USE ONLY FNB or WesBank branch FC receipt date FRANCHISE (BUSINESS) INFORMATION RM/BDO FC FAD4 Details of applicant of applicant Trading name of Franchise Cellular telephone number address Business type Sole proprietor Close Corporation Company Statutory registrations Physical address Partnership Registration No. Registration No. Income Tax Yes No RSC Yes No PAYE Yes No UIF Yes No VAT Yes No SDL Yes No Age of business Business Category Automotive Health & Beauty Fuel retailer Building & Home Real Estate Tourism Business to Business Restaurant (Specify) Education / Training Retail Fast food & take out Video and Entertainment Is the Franchisor a member of the Franchise Association of Southern Africa (FASA)? Yes No Purpose of financing Reason for application Start a new franchise concept Open a new franchise outlet Purchase an existing franchise outlet Expand / revamp an existing franchise outlet Total own contribution available Source of own contribution (proof to be attached) Description Initial franchise fee Land and Buildings Initial Stock Stock guarantee Vehicles Total Cost (Vat inclusive) Utilisation of own contribution Amount to be financed Page 1 of 11

2 Equipment (include list) Signage Shelving Shopfitting Structural changes Working capital Goodwill (if existing) Specify TOTAL BEE credentials (for Financial Sector Charter purposes) Shareholders (full names) ID number Share holding Marital status Citizenship Race 1 % 2 % 3 % 4 % 5 % Ownership % PDI participation in: Management % Employees % Ownership % PDI youth (ages 18-35) participation in: Management % Employees % Details of leased premises Landlord Monthly rental (excl VAT) Area (square metres) Details of advisors and service providers Accountant/bookkeeper Auditor/accounting officer Life assurance broker Insurance broker Business broker Cellular number Monthly costs (excl VAT) Expiry date of lease Page 2 of 11

3 Documents to be attached 1. For all Franchise businesses Franchisee RM/CPE Letter from Franchisor stating that it has assessed the applicant in terms of its usual requirements Business plan Personal balance sheet of all prospective shareholders (if not provided in application form) Detailed curriculum vitae on all prospective shareholders (see Section 3) Details/proof on the source of the financial contribution by each shareholder to the venture Detailed list of equipment to be financed Monthly cash flow forecast for at least 36 months Draft copy of the Franchise Agreement Draft copy of the Lease Agreement Disclosure Document from the franchisor Index page of the franchise training manual & operations manual Any other key documents related to management practice of the Franchise System Copy of bank statement for the last 6 months (if not a First National Bank customer) Copies of any customer contracts obtained, letters of intent or orders Copy of CK1or CK2 (for close corporations) and Certificate of Incorporation for companies Copies of IDs of all shareholders and sureties Documented proof of residential address Copy of marriage certificate or divorce decree Any other related information requested by FNB as applicable to the Financial Intelligence Centre Act No. 38 of For existing Franchise businesses (over and above point nr 1) Purchase and sale agreement Copy of the existing lease agreement Audited annual financial statements Latest management accounts comprising; income statement, balance sheet, trial balance, and debtors and creditors age analyses if financial statements are older than 6 months Application may be made at any branch of First National Bank. Page 3 of 11

4 FNB Franchising APPLICATION FOR FRANCHISE FUNDING SECTION 2 FRANCHISEE (PERSONAL) INFORMATION (An individual application to be completed by all prospective shareholders or members) Personal information of shareholder/member Full name ID number Residence status if not South African citizen Cellular number Residential address Citizenship Permanent / temporary: Post code Highest educational, technical, professional qualifications attained Post code Designation with existing employer Current monthly salary R Expected monthly salary R Marital status Married (ANC / CoP) / Divorced / Single / Islamic / of spouse ID number Occupation of spouse Personal banking details Bank Branch Overdraft limit Security offered for facilities Account number Branch code facilities Work history (detailed breakdown required in Section 3) Dates Employer/company Position & responsibilities to to to to to date interests (companies, close corporations and trusts) Entity Reg. No. Shareholding Loan account Position held Page 4 of 11

5 Details of trust(s) of which you are a trustee or in which your children and/or spouse are beneficiaries Trust name Trust number Personal statement of assets and liabilities Assets Fixed property (land & buildings registered in your name) Stand/Erf No. Township Date purchased Cost Market Value Bank Value Moveable assets vehicles, trailers, caravans and boats (insured value) Year Make Model Cost Current value Personal effects and equipment (only items worth R500 or more) Item Cost Insured value Current value Household furniture and appliances Investments (shares, investments, unit trusts, gold coins, timeshare etc.) Institution, asset or company invested in Current Value Bank Value Life assurance policies Company Policy no. Date issued Ceded to Life cover Disability cover Surrender value Cash assets (cash, money market accounts, fixed deposits) Bank Branch Account no. Account type Amount Bank Value assets (specify) Total assets Description of security offered Type of security Description Own value Bank Value Bond(s) over fixed property(ies) Cession of life assurance policy(ies) Cession of fixed deposit(s) Pledge of investment(s) Cession & pledge of listed share(s) Total security offered Page 5 of 11

6 Liabilities Mortgage bonds over fixed property Property Bondholder Monthly payment Registered bond amount Balance Asset finance (motor vehicles, trailers, caravans and boats) Asset financed Financier Monthly payment Original loan Balance Household furniture and appliances (instalment sales and leases) Asset financed Financier Monthly payment Original loan Balance Personal loans and overdrafts (details of lender, security given and account number) Loan type Lender Security Balance Loans taken against life assurance policies Monthly Date taken Policy number payment Term of loan Original loan Balance liabilities (income tax, arrears payable, personal and private loans) Creditor Detail Monthly payment Original debt Balance Total liabilities Net worth (assets less liabilities) Contingent liabilities and credit history Person or business for whom you have stood surety or guarantor Details: Have you ever been summonsed or had a judgement taken against you? Yes / No Details: Have you ever been sequestrated? Yes / No Details: If so, have you been rehabilitated? Yes / No Date of rehabilitation Page 6 of 11

7 Personal income and expenditure Monthly Income Self Spouse Monthly Expenses Gross salary Housing allowance Car allowance Commission Bond repayment/rent HP/Loan/Credit Card Insurance (Life and short term) Domestic (Water & electricity etc) Education Transport Open accounts Net Income Total Expenses Page 7 of 11

8 Declaration and Acknowledgement 1. I identity number warrant : a) that the information provided in this application form is true and correct to the best of my knowledge and belief; and b) I have not misrepresented any facts or statements; c) that the statement of personal assets and liabilities is complete, true and correct and all liabilities have been fully disclosed. 2. I acknowledge : a) that FNB in processing this application may require to access information about myself recorded with any third party including but not limited to credit bureaus and any financial institutions and I hereby consent to FNB accessing and / or obtaining this information; and b) that, save for the obligation set out in this declaration, this application does not constitute any binding agreement on FNB to provide the financ ing requested in this application. Should however FNB grant the financing requested, FNB will place reliance on the information provided herein and should it at any stage come to the fore that any information was incorrect, then FNB reserves the right, if it is prior to the financing being provided, to withdraw such financing and if it is subsequent to the financing being provided, then to cancel such financing and to demand immediate repayment of any amounts utilised thereunder. (*Section 2(b) to be deleted if the franchisee is a Company and/or Close Corporation already formed.) 3. I authorise FNB to disclose : a) any information relating to the conduct of my bank accounts held with FNB and/or my relationship with FNB to any other division within FirstRand Bank Limited and/or any other member of the FirstRand Group of Companies and/or any credit bureau or similar agency; and b) to the franchisor that my application for financing has been: i) approved and the terms and conditions applicable to such financing; or ii) declined, and where it has been declined because of a lack of, business viability, then I furthermore authorise FNB to disclose the specific reasons therefore. (*Section 3 (b) to be deleted if the franchisee is a Company and/or Close Corporation already formed.) Signature of applicant Signature of Witness 1 Date Signature of Witness 2 Page 8 of 11

9 Declaration by Company or Close Corporation (*This section to be completed if the franchisee is a Company or Close Corporation already formed.) I the undersigned in my capacity as.. of ( the Company or the CC ) [*delete which ever is not applicable.] hereby warrant my authority in terms of a resolution passed by the Board of Directors on the and with my signature hereto, do hereby bind the Company / CC [*delete which is not applicable] and confirm that: a) the information provided in the business information section is true and correct and that the facts have not been misrepresented; b) the Company / CC [*delete which is not applicable] consents to FNB accessing any information pertaining to the Company / CC [*delete which is not applicable] recorded with any third party including but not limited to information with any financial institution; c) save for the obligations set out in this declaration, this application does not constitute any binding agreement on FNB to provide the financing requested by the Company/CC [*delete which is not applicable] provided however that should FNB grant the financing requested, FNB will place full reliance on all information completed in terms of this application whether or not on behalf of the Company/CC [*delete which is not applicable] or otherwise, and should FNB grant the financing requested, FNB will place reliance on the information provided herein and should it at any stage it came to the fore that any information was incorrect then FNB reserves the right, if it is prior to the financing being provided, to withdraw such financing and if it is subsequent to the financing being provided, then to cancel such financing and to demand immediate repayment of the amounts utilised there under. d) the Company/CC [*delete which is not applicable] authorizes FNB to disclose any information relating to the conduct of the Company s /CC s [*delete which is not applicable]bank accounts held with the Bank and/or its relationship with FNB to any other division within FirstRand Bank Limited and/or any other member of the FirstRand Group of Companies and to the franchisor should the Company s/cc s [*delete which is not applicable] application be successful or should it be declined and if it is declined for reasons relating to a lack of business viability then the Company / CC [*delete which is not applicable] furthermore consents to FNB disclosing the specific reasons therefore. : For and on behalf of : Date : Page 9 of 11

10 FNB Franchising APPLICATION FOR FRANCHISE FUNDING SECTION 3 FRANCHISEE (PERSONAL) CURRICULUM VITAE Personal Details Full State of Health First Language Languages Drivers Licence Personal Attributes Goals and Objectives Personal qualities Secondary Education Last school attended Year matriculated Highest standard passed Subjects Leadership roles Outstanding achievements Post-matric Qualification Institution/University attended Courses/Degree competed Year achieved Current Employer Duties Period to date Previous Employer Duties Period Reason for leaving Page 10 of 11

11 Previous Employer Duties Period Reason for leaving Previous Employer Duties Period Reason for leaving References Employer Telephone Number References Employer Telephone Number References Employer Telephone Number Please motivate below why you consider yourself as being likely to succeed in this business venture Page 11 of 11

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