DEVELOPMENT BANK OF MAURITIUS LTD



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DEVELOPMENT BANK OF MAURITIUS LTD

APPLICATION FORM

LOAN SCHEME FOR DISTRESSED ENTERPRISES

Company Details

|Name of Company | |

|Name of Main Promoter/ Applicant | |Position: |

| | |ID: |

| | | |

| | | |

|Company No | |Date of Incorporation: |

|Business Address | |BRN No: |

| | | |

|Registered Address | | |

|Contact Details |Email: |Tel: |

BUSINESS DETAILS

|Type of Business | |

|Sector | |

|Products Services offered | |

|Business Location | |

|Bank Details | |

|Amount of Loan Required | |

|Purpose of Loan | |

|Market |Local…………% |Foreign……………..% |

| |Local |Foreign |

| |2018 ………. |2019 ……. |2018 ……… ...………… |2019 ………. |

|Turnover | | | | |

|Net Profit/Loss | | | | |

|Operating Permit/License | |

| | | | |

|No of Full Time Employees |Total |Local |Expats |

SHAREHOLDING (Details to be attached)

|Name |Number of Shares |% Shareholding |Ultimate Shareholder |

| | | | |

OFFICE BEARERS (Details to be attached)

|Name |Position Held |Occupation |Telephone |Address |

| | | | | |

BACKGROUND OF COMPANY (BRIEF) :

BACKGROUND OF MAIN PROMOTER/SHAREHOLDER (BRIEF):

Existing Facilities available from other sources (Details to be attached)

|Financial Institution |Nature of facility |Terms and conditions |Balance outstanding as at |

| | | | |

Any other Details:

APPLICANT/S DECLARATION

• I/We declare that to the best of my/our knowledge and belief the particulars given in this form are true and correct.

• I/We am/are fully aware of the provisions applicable under the Data Protection Act. The purpose of data collection is to process the loan. I/We consent that DBM uses, updates and processes the data and keeps the details submitted in a database. I/We understand that it is mandatory to provide the data, else the DBM will not process the loan.

• I/We undertake to inform the DBM immediately in writing any changes in the personal data provided above.

• I/We hereby authorize the DBM to make necessary enquiry from the Mauritius Credit Information Bureau (MCIB) regarding any loan facilities previously granted to the company, promoters & shareholders by any financial institution in Mauritius

• I/We also authorize the DBM to share relevant data among the participants namely SIC, ISP, MIC, MRA, MOFEPD, Ministry of Labour, MCIB and Registrar of Companies for the purpose of appraising the request for financial assistance.

• I/We also authorize the DBM to provide the MCIB with relevant details of the loan availed of under the present credit facility.

• I/We also signify our agreement to the fact that any default on the payment the present loan facility will result in the company being debarred from availing any further facility under any schemes called by whatsoever name, from the Government and/or any Government institution.

• I/we certify that I/we have been duly authorized to make this application on behalf of the Company as certified by the Resolution herewith attached .

Authorised Representatives

Signature ………………………… .…………………………

Name ………………………… …………………………..

Date …………………………

APPENDIX 1 – COLLECTION AND PROCESSING OF DATA CONSENT FORM

I, __________________ acknowledge that I have duly been explained my rights as per the Data Protection Act 2017 and/or subsequent amendments.

I hereby give my express consent for appropriate and necessary collection and processing of my personal data by the service provider for the purposes linked to the processing of my application.

I declare that I have been specifically made aware of:

a) the fact that the data is being collected;

b) the purpose or purposes for which the data is being collected;

c) the intended recipients of the data;

d) the name and address of the data controller;

e) the consequences if all or any part of the requested data is not provided;

f) whether or not the data collected shall be processed and whether or not my consent shall be required for such processing; and

g) my right of access to, the possibility of correction of and destruction of, the personal data to be provided.

Signature:

Name:

Date:

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