FRANCHISE APPLICATION FORM please boxes where indicated * Please note, any of the questions marked with an asterisk are optional

Transcription

1 FRANCHISE APPLICATION FORM please boxes where indicated * Please note, any of the questions marked with an asterisk are optional PERSONAL DETAILS: Title: Given name: Surname: Fax: Mobile: HOME ADDRESS: Street: Suburb: State: Postcode: How long have you lived at this address? PREVIOUS ADDRESS: Street: Suburb: State: Postcode: How long did you live at this address? Australian citizen: Permanent resident: Do you have any physical or health conditions which make being a franchisee difficult? PASSPORT & DRIVERS LICENCE INFORMATION: Full name (in passport): Passport no: Date of birth: (dd/mm/yyyy) Country of issue: Expiry date: Drivers Licence No: Expiry: State: SPOUSE S DETAILS: Name of Spouse: Marital Status: *No of dependants: *Age(s) of dependants: Page 1 of 7

2 EDUCATIONAL BACKGROUND: What is the highest qualification you have in English? What is the highest level of education you have reached? EMPLOYMENT AND BUSINESS INFORMATION: CURRENT EMPLOYMENT DETAILS: Company: Position held: From: Company contact: Title: Address: PREVIOUS EMPLOYMENT HISTORY: Company: Position held: From: To: Reason for leaving: Company contact: Title: Address: PREVIOUS EMPLOYMENT HISTORY: Company: Position held: From: To: Reason for leaving: Company contact: Title: Address: Do you have any retail experience? If Yes please give full detail on the role, how long you held this role, and the name of the business. Do you have any Fuel/ Service Station experience? If Yes please give full detail on the role, how long you held this role, and the name of the business. Page 2 of 7

3 Have you ever been bankrupt or subject of a creditor petition of debt recovery proceedings? Have you ever been charged or convicted of a criminal offence? Have you ever owned a business or been self-employed? If Yes what type of business or businesses Please specify the Name and A.C.N. of any company you have been a Director of in the past five years: Company name: A.C.N.: Dates: Company name: A.C.N.: Dates: Have any of the companies you have been a Director of or shareholder in been placed under receivership, administration or in liquidation or been charged with fraudulent conduct? Page 3 of 7

4 FINANCIAL OVERVIEW: ASSETS: Market Value of Home: Market Value of other Property: Market Value Motor vehicles: Cash in Bank/Savings: Equity in Business: Shares: Superannuation: Other assets: Details: LIABILITIES: Home Mortgage: Investment Loans: Vehicle Loans: Personal Loans: Loans Guaranteed: From Others: Your Business: Taxation: Total Credit Card Balance: Overdrafts: Other Liabilities: Total assets: $ Total liabilities: $ Do you have any assets or investments overseas? If Yes please give details. BANKING DETAIL: Who do you bank with? FUNDING: How do you intend to fund your franchise investment? (from what source?) How much liquid cash are you prepared to use to fund your franchise investment? How much are you prepared to borrow? What would you monthly repayments be? What is your budget range for purchasing a United Petroleum Franchise? Page 4 of 7

5 FRANCHISE WITH UNITED PETROLEUM How did you learn about our franchise opportunity? Why do you want to buy a United Petroleum franchise and in particular what features of this franchise have attracted you? As a Franchisee what do you expect from United Petroleum? Do you intend to own a franchise with another person? If Yes please state the name of the person. (please note that your business partner will be required to complete an application form) As a Franchisee, how many days do you intend to work in the business? How much do you expect to earn as a Franchisee? In Wages per annum? How many hours a day do you intend to work in the business? In Profit per annum? Please specify location (s) or State that you are interested in owning a franchise. Are you involved in any other current businesses? If Yes please specify the business and how many days a week do you spend there? Page 5 of 7

6 Do you understand that you must make your own financial and legal enquiries regarding this franchise opportunity? Are you prepared to comply with United Petroleum standards and guidelines? Do you fully understand that there is no guarantee of future earning? Are you aware that certain information that will be provided and/ or advised to you is confidential and shall not be divulged to any third person unless United Petroleum Franchise Pty Ltd gives its prior approval? The information disclosed in this Application Form will be gathered, disclosed and maintained according to the Commonwealth Privacy Act A copy of the Privacy Policy can be found at AGREEMENT: I have answered the questions and provided the information in this form to the best of my knowledge and belief, and that as far as I am aware the answers and information are true and correct in all respects, and that no relevant details have been omitted. I acknowledge and agree for United Petroleum Franchise Pty Ltd collecting the information contained in this Application Form to assess whether I should be considered as a potential franchisee. I accept that this information can be used by United Petroleum Franchise Pty Ltd. and associated entities. I will keep the confidential information absolutely secret and confidential and will not disclose, communicate or divulge to any other person, business or corporation any of the confidential information, with the exception of my lawyer and/ or financial adviser in relation to obtaining advice regarding a United Petroleum franchise. Signature: Date: Page 6 of 7

7 CONFIDENTIALITY AGREEMENT United Petroleum Franchise Pty. Ltd. (ACN ( United Petroleum ) In consideration of this Agreement by United Petroleum to provide to me/us Confidential Information, I hereby agree as follows: 1 I/We the undersigned will keep the Confidential Information absolutely secret and confidential and will not disclose, communicate or divulge to any other person, business or corporation any of the Confidential Information, with the exception of our lawyer and/ or financial adviser in relation to obtaining advice regarding a United Petroleum franchise. 2 I shall not at any time before or hereafter use either for my own benefit or the benefit of others, any such Confidential Information in any manner, shape or form whatsoever other than with the permission of United Petroleum in the operation of a United Petroleum franchise, agreement or licence. 3 The restriction contained herein shall continue to apply after the termination of any franchise, agreement or licence without limit of time but shall cease to apply to information which comes into the public domain except as a result of a breach of this Agreement. 4 Any breach of this undertaking shall cause irreparable harm to United Petroleum and therefore, in the event of a breach or threatened breach of the provisions of this Agreement, United Petroleum shall be entitled to an injunction restraining me from using, disclosing or appropriating, in whole or in part, the Confidential Information or from rendering any services to any person or corporation to whom such Confidential Information has been disclosed or is threatened to be disclosed. Nothing herein shall be construed as prohibiting United Petroleum from pressing any other remedies available for such breach or threatened breach, including recovery of damages. 5 I/We will return the Confidential Information (including all copies and embodiments thereof) to United Petroleum upon request. 6 I/We will indemnify United Petroleum for any breach of this Agreement. Confidential Information means documentation and information (in all forms including written, drawings, plans, models, digital, electronic or otherwise) provided to me/us by or on behalf of United Petroleum or acquired by me/us from or on behalf of United Petroleum and includes but is not limited to any documentation or information marked as confidential or which is of a confidential nature or which is not publicly available and which relates to United Petroleum, its franchising business or activities (or proposed business or activities) or its business, knowhow, methods of operation, processes, techniques, concepts, products, services, technical data, marketing information, financial information, customers or business plans (but does not include information which is generally available in the public domain except as a result of a breach of this Agreement). By my signature hereof, I hereby agree to abide by the provisions of this Agreement. My Signature My Name My Address My Telephone Number Date: / / Page 7 of 7