The Namibia Procurement Fund Facility Application Form (Page 7 of 9) in pdf

Equipment Leases (attach separate list if necessary)

Operational Lease:

Financial Lease:

Type: ………………………………………….…

Quantity: …………………………………….….

Make: ……………………………………………

Model number: …………………………….…...

New:

Used:

Year of manufacture: …………………………...

If used, state:

Machine hours:………………..

Location:……………………………….…..……

Equipment cost: ………………………………....

Dealer name………………………………..……

Dealer E-mail……………………………….........

Dealer address (postal and physical address, telephone and fax no)

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

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

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

Lease term (Please tick one): 6 Months

12 Months

24 Months

36 Months

Have you applied to other institutions for this facilities ? Yes

If yes, with whom?..........................................................................................................................................

What have you applied for (guarantee, working articles, asset finance, overdraft)? What is the value of the

facilities applied?..............................................................................................................................................

Have any facility finance applications ever been turn down? Yes

If yes, by whom and

why?.................................................................................................................................................................

Have any facility or guarantee issued on your behalf ever been called up? Yes

If so, please provide details………………………………………………………………………………..…

What collateral will you pledge: Properties: ………… Vehicle: ………… Office equipment: …………..

Machinery / Plant: ………… Inventory: ………… Other: ……………………………………………....…

Total value of Security provided: N$.................................................

Initial here………………………….