The Namibia Procurement Fund Facility Application Form (Page 3 of 9) in pdf

The Namibia Procurement Fund Facility Application Form Page 3

Type of business:………………………………. Commencement date…………………………………….

Income TAX number………………………………….VAT no……………………………………………

Social Security number:…………………………………………………………………………………..…

Have you and /or your business including shareholders, been involved or declared in bankruptcy or

insolvency proceedings?

Yes

If Yes, please explain:

……………………………………………………………………………………………………………….

Ownership and shareholding (Please list below all persons with a shareholding in the business):

Name and

Gender (male

Identification /

Citizenship

Full or part

surname

or female)

Passport

time involved

number

held

Subsidiary /Associated /Affiliated Companies:

Name of business

Registration

Nature of business

Guarantees

number

Shares held

required

(if any)

Initial here………………………….

The Namibia Procurement Fund Facility Application Form Page 3