Company Name (Registered name) T/A. Address Suburb City Code. Principal in charge Phone Cell

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1 Security Number: Payuplus Business Unsecured Business Loan Application Company Information Company Name (Registered name) T/A Address Suburb City Code Principal in charge Phone Cell Secondary contact person Phone Cell (Inhouse controller or bookkeeper) CC to Type of Business Date established Type of entity (check one) Proprietorship Partnership Corporation Pty Ltd Company Ownership Name Title % of Ownership Name Title % of Ownership Name Title % of Ownership Name Title % of Ownership If Corporation please indicate who is president and who is Secretary References Bank name Acct No Branch Acct held at Date acct opened Accounting firm Account Officer Contact no accounting officer Company attorneys Attorney name Attorney phone no Trade reference Contact person Phone no Trade reference Contact person Phone no

2 Nature of your business No of employees Permanent staff Temp or casual staff Use of funds Business Acquisition R Working capital R Machinery / Equipment purchases R Soft Costs R Building improvement repaids R Other (Specify) R Inverntory Purchases R TOTAL PROJECT AMOUNT R Debt Refinance R Owners Injection R Total Loan Request R Business Debt Schedule Indebtedness: Please furnish the following information on all installment debt, contracts, notes and mortgages payable. Do not include accounts payable or accrued liabilities. * Date Creditor Original Original Present Interest Maturity Monthly Security Current or Name /Address Amount Date Balance Rate Date Payment Held Delinquent * * Total * Should be the same as current financial statement Total monthly payment

3 * * Must agree with balance shown on current financial statement Personal Resume Form (To be completed by each principal involved in the loan - Please make copies for each individual) Name FIRST MIDDLE MAIDEN LAST Date of birth Idnetity number Passport no Are you a natural of South Africa... Yes No If applicable please provide alien registration permit copy and number. Home address City Province Code From To Home no Business contact no Currently employed (if employed outside business) Position From to Salary Spouse's name FIRST MIDDLE MAIDEN LAST Date of birth Identity No Marriage date Employer Position From to Salary Personal information Be sure to answer the next three questions carefully and correctly as they are important. The fact that you have an arrest or conviction record will not necessarily disqualify you; an incorrect or dishonest answer will in all probability cause your application to be disqualified. Have you ever been arrested? YES NO Have you ever (ever), been charged with and / or arrested for any criminal offense other than minor vehicle violation? Include offenses which have been dismissed, discharged, or not prosecuted. ( All arrests and charges must be disclosed and explainedon an attached sheet) Have you ever been convicted, placed on pretrial diversion, or placed on any form of probation, parole, including adjudication, withheld pending probation, for any criminal offense other than minor vehicle violation? YES NO Are you or your business involved in any pending or prior lawsuits? YES NO Have you or any officers been involved in bankruptcy or insolvency proceedings YES NO

4 Personal Resume Form (continued) Work Experience - (List chronilogically beginning with present employment ) Name of company % of business owned Full address City Province Code From To Title Duties Name of company % of business owned Full address City Province Code From To Title Duties Education (University, College or Technical Training) Name and Location Dates attended Major Degree, Diploma or Certificate Comments Personal monthly expenses Residence payment Insurances Rent or Mortgage.. R Life.. R Rates and Insurance. R Health.. R Maintenance & Services. R Vehicle payment. R Food & Groceries.. R Vehicle Insurance.. R Utilities (Water & Lights). R Educational costs R Telephone & Cell.. R Transport & Petrol. R Incidentals.. R Medical Aid. R Clothing.. R Total R Total R Add the two colums together to form Total Monthly Personal Expenses.. Credit check authorization I declare that the information provided is true and correct. I hereby authorise the release of all and any credit report and other information required in the processing of my loan application and as required in the servicing and / or during the term of my loan. I / We hereby certify that the enclosed information, including any attachments or exhibits provided here within or at a later date is valid and correct to the best of my / our knowledge. Name Signature Date

5 Personal Resume Form (continued) PERSONAL FINANCIAL STATEMENT Complete this form for : (1) each proprietor, or (2) each limited partner who owns 20% or more interest and each general partner, or (3) each stock or share holder owning 20% or more voting and each corporate officer and director, or (4) any other person or entity who can influence the cash flow directly of this business. Name Id number Residential addrss Business name of applicant /borrower : contact no Assets Cash on hand and or in banks..r Savings accounts R Retirement funds.. R Accounts and notes receivable.. R Life Insurance - cash surrender value only.r Stocks & Shares..R Real Estate..R Vehicles Present Value.R Personal Property, furnishings and Jewels, Paintings, stamps, collections & collectables.. R Other personal property..r Other Assets.R Liabilities Accounts payable.r Loans payable to banks and or other.r Installment accounts R Loan on life insurance.r Mortgages..R Unpaid Taxes R Long term agreements of funding. R Other liabilities. R Total liabilities.. R Total Assets R Total Net Worth R

6 General Information - this will aid us to develop your business plan. Overview of the current positon of your business, where it wants to go and how it plans to achive its goals. It is a summary, past, present and future. Your Business plan is your ambassador - showing potential investors how the various elements of your business are intergrated into the whole. The added benefit of developing a Business Plan is to sit down and thin, brianstorm and discuss business matters or stratergy with all the key players in your business. Describe your Business in One line summary: Business Description and Overview This section should include Franchise information. Current and future. Assist us to understand your industry. Age and stage of the life cycle of your business. This will help us understand your prospects of growth or not growth, stagnation and demise of the industry. This will assist us in a succession or continuity plan illustrating the owners are prepared for upswing or downswing of the current economic market and business environment. This plan should also expand on future ownership of the business and any owners retirement plans of the near future. Provide also Insurance policy information related to your business which will enable us to assess whether your business is frotected and sustainable.

7 Business Operations Briefly explain the Business concept and what your business is about, the need you business will satisfy or the gap it fills in the market. Briefly explain the stock or inventory on hand, its value and quanity. Competitors in your Business environment Explain who your key competitors are, include details such as name, proximity from you and any uniqueness your business can/does offer to minimalise the threat. Application For Funding What is needed: What and how it is to be used: How do you forsee your affordability of repayment obligation to be met.

8 SWOT (please do not complete this section at all) (Office use only) Checklist SWOT Report (Office only) Min Loan Range R Mid Loan Range ########## Max Loan Range ########## Clients Requirement Interest 25% Per 6 months 25% Repayment Understood Business Age Business Turnover Business Age Premises Management accounts Credit Profiles Bank statements Funders Most essential criteria Per week via debit order 1 Year or Motivated R per year or more 1 year or more If leased one year or more. If owned 1 year or more (Include lease and/or Bond agreemet) Must be included Each member /owner/trustee/shareholder 6 months May carry out any other checks to ensure lona serviceability Repayment affordability