The Namibia Procurement Fund Facility Application Form Page 2
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1. YOUR PERSONAL DETAILS
Applicant’s representative full name:……………………………..………………………………….…….…
Identification number:…………………………………… Nationality:………………………….…….……
Date of birth:……../......./………………
Male
Female
Residential address:……………………………………………………………………………………….….
Postal address:……………….……………………………………………………………………………….
Home phone number:………………………….. Mobile phone number:……………………..……….……..
E-mail address:……………………………………………………………………………………..…………
How did you learn about the NamPro Fund:……………………………………………..……………..……
1. BUSINESS INFORMATION
Company name: …………………………………………………………….……………….....……………
Company registration number:…………………………………………………………………..………..…
Postal address: .………………………………………………………………………………………….……
Physical address: ….………………………………………………………………………………….………
Telephone number:…………………………….Fax number:………….………………………..…………...
E-Mail address:………………..……………………………………………………………………………....
Type of Corporation: Sole Proprietor
Closed Corporation
Company
Other
Other (specify):……………………………………………………………………...….……………….…..
Initial here………………………….
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Parent category: Business