Step 1 of 6 16% A. Applicant Company Information A1. Statutory and Company Information Company Name(Required) Trading Name(Required) Registration Number(Required) Years in Operation(Required) Address(Required) Postal Code(Required) Description of Company Key Product/Services Offered(Required) Industry and/or Sector(Required) Income Tax No. VAT No. A2. Company Contact Person Full Name(Required) ID Number(Required) Email(Required) Phone(Required)Position in Company A3. Company Ownership List Full Name% OwnershipCapacity in EntityID NumberPopulation GroupNationality Add Remove A4. Company Organogram Please upload a simple organogram detailing your company structure. Include ownership details and related parties. Company Organogram(Required)Accepted file types: jpg, png, pdf, doc, docx, xls, xlsx, Max. file size: 625 GB. A5. Job Statistics Number of Employees Number of Black Employees Number of Female Employees A6. Online Presence Website Facebook LinkedIn A7. Footprint Please indicate where you have a business footprint. Footprint Eastern Cape Western Cape Northern Cape KwaZulu-Natal Free State Limpopo North-West Gauteng Mpumalanga Other Footprint Other B. Loan Funding Requirement B1. Funding Purpose, Amount and Terms (as preferred by Applicant) Inyosi is mandated by our investors to provide funding to black-owned suppliers. Please classify your funding requirement by selecting one or more of the following? Funding Requirement Property Finance Asset Finance Working Capital Growth Capital Other (please specify) Untitled Loan Amount Required:(Required) Date(s) when funding is needed: Loan Term Preferred: Please explain in as much detail as possible what the funding will be used for: (Guidelines: Why does the business require loan funding? What will the loan funding be used for? How will the injection of funds assist the company?)(Required)Supporting documentation e.g., quotes or pictures of assets to be acquired (Optional)Accepted file types: jpg, png, pdf, doc, docx, xls, xlsx, Max. file size: 625 GB.Security Available (Value of security should exceed funding required, and can include assets to be funded):(Required)Detailed outline on what security is available to secure the loan funding (Supporting documents for security, e.g. asset valuations or pictures of assets.) (Optional)Accepted file types: jpg, png, pdf, doc, docx, xls, xlsx, Max. file size: 625 GB. C1. Existing Debt List Name of EntityType of FinancingInitial AmountOutstanding AmountTerm (months)Interest Rate (per annum)Security Arrangement Add Remove If you would like to upload existing loan agreements. (Optional) Drop files here or Select files Accepted file types: jpg, png, pdf, doc, docx, xls, xlsx, Max. file size: 625 GB. D. Statement of Marketing OptionsWould you grant permission for us to include your information in any marketing campaigns? Would you grant permission for us to include your information in any marketing campaigns? Yes No Would you like to be included in any mass distribution of e-mail or sms messages? Would you like to be included in any mass distribution of e-mail or sms messages? Yes No E. Declaration and Consent I, the undersigned, declare that the information provided in this application form is to the best of my knowledge true and complete. I also understand that any willful misrepresentation of the information in this application form will disqualify my application and may lead to legal action against me and/or the entity I represent including the laying of criminal charges against me as surety as well as against the entity I represent for furnishing false statement or information to Inyosi. I hereby grant Inyosi consent to perform an entity/personal search and check on my records with any other party (e.g., credit bureau and/or a government agency) relating to this application. I further authorise Inyosi to disclose some of my personal information to these parties to obtain the information they require and acknowledge that Inyosi will never disclose more information than they are required to. Inyosi warrants that it will treat your personal information as confidential and take all necessary steps to protect your information as required by the Protection of Personal Information Act of 2013 (POPI). We will only disclose your information if: – The law requires us to do so; – It is in the public interest to do so; – Our interests require disclosure; or – You have given us your consent. For further information on Inyosi’s Privacy Policy refer to our website: https://inyosi.co.za/privacy-policy/ I certify that I am duly authorized to sign this application, that I have read and understood the Ts & Cs, and that my signature will be binding on the Applicant. Name(Required) Place(Required) Date(Required) MM slash DD slash YYYY Consent(Required) Submission of the application is considered that all information provided is done so by an authorised party & deemed to be factually correct.(Required) PhoneThis field is for validation purposes and should be left unchanged.
