ISO 9001:2015 AUTHORISED LOGO

SMALL – SCALE FARMERS: TEMO LETLOTLO APPLICATION FORM

New Application [ ] Top Up [ ] Individual [ ] Company [ ]

Please Tick on Hectarage to be Ploughed

Level 1: 1 – 8 Hectares Level 2: 8.1 – 16 Hectares

CMS REF LOAN TRACK REFERENCE (FOR NDB USE)

PROPOSED LOAN REQUIREMENTS

Loan Amount applied for Proposed

Repayment Period Years Purpose of Loan

Project

Location (Village/Town)

District: _________________________________

Provide Directions to Project

Name of Agricultural Extension Officer: ____________

ANNUAL TURNOVER & EMPLOYMENT INFORMATION

Number of Employees: Permanent Casual/Part time

Previous Year’s Turnover/Income (If Applicable): BWP __________________

Other Income (provide evidence, i.e. Lease Agreement, if rentals): ____________________

1. BACKGROUND INFORMATION OF THE APPLICANT

Full Name of the

Applicant (Company
Partnerships etc)
Trade Name
Postal /Private Bag Address

Physical Address
Period at Physical Address: ______years Ownership at Physical Address: Owned [ ] Renting [ ]

Period at current physical address

Period at previous physical address
Contact Person
Telephone Work Home Fax Cell Email
Source Reference (how did you hear about NDB), i.e. TV, Print media, etc
Gender (If Applicable): Male [ ] Female [ ]
Age Range: 18 – 30 years [ ] 31 – 35 years [ ] 36 – 45 years [ ] 45 – 60 years [ ] Above 60 years [ ]

Marital Status (if Applicable) Married [ ] Single [ ] Widowed [ ]

2. PARTICULARS OF SPOUSE (If Applicable)
Name
Identification Number
Physical Address
Employed Yes [ ] No [ ] Self-employed [ ] Name of Employer:
Monthly Income
Shareholding in Other Companies Value:

Telephone Email: Cell

3. PARTICULARS OF NEXT OF KIN

Name
Postal Address
Physical Address
Telephone Email: Cell

4. PARTICULARS OF SUCCESSOR (Succession Plan)

Name
Postal Address
Physical Address
Telephone Email: Cell

5. APPLICANT’S EMPLOYMENT STATUS

Status
Employer Job Title Employment Start Date
(Permanent, Contract, Self employed or Pensioner)

6. EMPLOYMENT INCOME
Monthly Income
P ____________

7. SPOUSE’ EMPLOYMENT STATUS (If Applicable)

Status
Employer Job Title Employment Start Date
(Permanent, Contract, Self employed or Not)

8. OTHER INCOME
Other Sustainable Income Amount P
Source than Salary

9. COMMERCIAL BANKERS’ DETAILS

Name
Postal Address Branch Name
Account No
Telephone Fax

10. LOANS WITH OTHER INSTITUTIONS

Reference & Account Outstanding
Loan Duration Installment Interest Amount Approved Arrears
Numbers Balance

TEMO LETLOTLO LOAN APPLICATION FORM – VERSION 2

11. LOANS WITH NDB (if Applicable)
Reference & Outstanding
Date Acquired Loan Duration Interest Rate & Amount Approved Arrears
Account Balance
Installment
Numbers

12.LOAN PURPOSE
Purpose (breakdown of funds) Amount (BWP)

Total

13. PRODUCTION SCHEDULE: HISTORIC & PROJECTIONS…..(to attach cropping plan)

Crops HISTORIC PRODUCTIONS (Tonnes) PROJECTIONS (Tonnes)

Historic Year Historic Year _______ Historic Year_______ Year 1 Year 2 Year 3

TOTAL

14. MANAGEMENT CAPABILITY (IF APPLICANT IS A COMPANY)

Details of key management personnel and their capabilities

Name (Full Names) Nationality Position /Role Qualification Experience – Brief description No. of
Years in

TEMO LETLOTLO LOAN APPLICATION FORM – VERSION 2

 ISO 9001:2015 AUTHORISED

15. SUMMARIZED BUSINESS INFORMATION

15.1 Background of Business: Brief history of Borrower

15.2 Production Process: Overview of operational process/cycle, production capacity

15.3 List of Key Project Assumptions: Assumptions on Sales/Turnover estimates.

15.4 Market Information

15.5 Market Availability of Project Products/Services & existing customers

TEMO LETLOTLO LOAN APPLICATION FORM – VERSION 2

 16. PERSONAL BALANCE SHEET (Provide for each Shareholder)

Personal Balance Sheet of_________________________________ As at (date)

Spouse’s Name (if Applicable)

Married in Community of Property: Yes / No
Note: If any assets stated are outside Botswana, please stage the country where they are located.

Asset: Immovable Property

Type of Land (Commercial Estimated
Plot No. Location Size (m2) Remaining Lease Period
/ Industrial / Residential) Value (Pula)

Movable Assets

Estimated
Type of Assets Original Cost Year of Acquisition Net Book Value
Value (Pula)

Livestock ( Bulls, Cows, Oxen, Heifers, Tollies, Goats Sheep

Debts/Receivables

Fixed Deposits with Banks

Cash at Bank and in Hand

Other Assets

TOTAL ASSETS

Shares In Companies
Name of Company Number / % of Shares Estimated Value of Shares

Total Value of Shares in Companies

Liabilities:
Loans secured by Mortgage

Loans under Hire Purchase

Tax Liabilities

Personal Loans

Creditors

Other Liabilities
TOTAL LIABILITY

NET ASSETS/ LIABILITIES

TEMO LETLOTLO LOAN APPLICATION FORM – VERSION 2

 17. FINANCIAL PARTICULARS
Is there a criminal record on you / company [ ]

Is there a pending criminal case on you/company [ ]

Have you/company been Blacklisted: Yes [ ] No [ ] , if yes, Amount _________

Has the company or its major shareholders, ever been Liquidated: Yes [ ] No [ ]

Have you/company signed a Guarantee or Surety for any entity: Yes [ ] No [ ] , if yes, please attach particulars.

18. DECLARATION
I/We hereby declare that the information above is, to best of my/our knowledge and believe, true and correct. I/We further declare that the money
shall be used solely for the purpose indicated above and that there is no legal impediment for the intended use.

I/We also authorize the Bank to reschedule the monthly instalment in the event of an increase/decrease in the interest rate.

Signature: Date: / /
Applicant/Applicants authorized Representative

TEMO LETLOTLO LOAN APPLICATION FORM – VERSION 2

 ISO 9001:2015 AUTHORISED LOGO

19. REQUEST FOR CONFIDENTIAL REPORTS FROM COMMERCIAL BANKS

Applicant’s Name:

Business Name:

Address:

The Chief Executive Officer

National Development Bank
P.O. Box 225
Gaborone

Dear Sir/Madam

Re: CONFIDENTIAL REPORT

In connection with my/our loan application in the amount of Pula

I am hereby giving my consent to National Development Bank to contact my Bankers, namely

at Branch bearing account number and

at Branch bearing account number

as well as my Accountants/Auditors, namely

at for confidential information regarding my

dealings with them.

I hereby authorize my Bankers and Accountants/Auditors to provide any information about

my/our financial position and credit rating to National Development Bank, as it may require

upon presentation of this letter.

Yours Sincerely

___________________________________________________________________
Name of Applicant/Applicants authorized Representative.

Signature: _____________________________ Date: _____/ _______/_________

TEMO LETLOTLO LOAN APPLICATION FORM – VERSION 2

 ISO 9001:2015 AUTHORISED LOGO

20. CONSENT TO CONTACT COMMERCIAL PARTIES & OTHER FINANCIAL INSTITUTIONS

I………………………………………………….of ID/Passport Number………………………………. confirm and agree to giving National

Development Bank consent to contact any third parties and acquire any necessary information in relation to my accounts, loans

and/or financial status, whilst in the process of my/our loan application.

Yours Sincerely

___________________________________________________________________
Name of Applicant/Applicants authorized Representative.

Signature: _____________________________ Date: _____/ _______/_________

TEMO LETLOTLO LOAN APPLICATION FORM – VERSION 2

 21.ATTACHMENTS

YES NO
1 Confirmation of membership of Grain producers association.
2 One (1) certified copies of National Identity Cards (Omang), for all applicants, Shareholders & Directors.
3 A copy of residence permits & passports (non-citizens employees).

4 If Applicable, a copy of Marriage Certificate, proof of Marriage Regime & Letter of consent.

5 Current Pay slips for both applicant and Spouse

6 Provide printout of CIPA company documents (Certificate of incorporation, Share Certificates e.tc) trust, AMA, partnerships
and other legal entities.
7 Resolution by Shareholders/Board/Member to apply for a loan.

8 Provide Authorised Approved Cropping Plan

9 Provide Tax Clearance Certificate and TIN number, or Acknowledgment of Application (Letter provided pending certificate)

10 Provide latest 6 months (consecutive) Bank statements or Proof of Bank Account opening for the Borrower and Shareholders.

11 Provide relevant quotations and sales agreements.

12 Provide Soil Test results from accredited Laboratory

13 Provide Memorandum of Lease agreement / Title Deed / Land Board Certification.

14 Where applicant has loans with other financial institutions - provide 6 months loan statements.

15 Proof of Physical Address, i.e., Utility Bills.

TEMO LETLOTLO LOAN APPLICATION FORM – VERSION 2

 CONTACT ADDRESS:

GABORONE

Development House Queens Road, Main

Mall P O Box 225, Gaborone
Tel: 395 2801
Fax: 397 4446

FRANCISTOWN

Tswelelopele House
P O Box 282, Francistown
Tel: 241 6044
Fax: 241 6065

MAUN

NDB Office, Mall

P O Box 453, Maun
Tel: 686 0316
Fax: 686 0645

PALAPYE

NDB Office, Palapye Development Trust Mall P O Box 10387,

Palapye
Tel: 492 0552
Fax: 492 0551

TEMO LETLOTLO LOAN APPLICATION FORM – VERSION 2