Fillable COVID-19 Finance Relief Application BR1 Funding Template (dsbd.gov.za)

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COVID-19 Finance Relief Application BR1 Funding Template (dsbd.gov.za)

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The COVID-19 Finance Relief Application BR1 Funding Template (dsbd.gov.za) form is 5 pages long and contains:

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  • 7 check-boxes
  • 37 other fields

Country of origin: SOUTH-AFRICA
File type: PDF

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COVID-19 SMME COMMON APPLICATION FORM
Covid-19 SMME Financial Relief Applications
1
Business Growth /Resilience Facility
(complete and send to
bizgrowth@sefa.org.za)
Debt Relief Finance
(complete and send to
smmerelief@sefa.org.za)
First name(s)
Surname
ID Number
Telephone number (landline)
Cell phone number
Email address
SMME Database Reg No:
Organisation Type:
Company registered name:
Registration number:
Trading name:
Date registered:
Date started operating:
Financial Year-end:
CSD Registration Number:
Physical address:
Postal address:
Town:
District:
Province:
Please select facility
COVID-19 SMME COMMON APPLICATION FORM
Covid-19 SMME Financial Relief Applications
2
Who are your 3 most recent clients?
Who are your 3 target clients?
Who are your 3 most recent clients?
How do you plan to resuscitate your
business?
COVID-19 SMME COMMON APPLICATION FORM
Covid-19 SMME Financial Relief Applications
3
Total amount of other (external) funding
Business Growth Facility
Categories:
• Micro R50 000 – R250 000
• Small R250 001 – R 2 5 00 000
• Medium R 2 500 001 – R 5 000 000
Debt Relief Finance
• No historical Municipal Debt Municipal
accounts capped at R 5000
• NB: salary payment scales will be in line
with UIF scale
• Companies contributing to UIF must claim
from UIF but the companies eligible for
funding must register with UIF
stock
bridging finance
purchase order
business equipment
salaries
rent
municipal accounts
COVID-19 SMME COMMON APPLICATION FORM
Covid-19 SMME Financial Relief Applications
4
Health and safety
Yes/ No/ N/A
Municipal by-laws
Yes/ No/ N/A
SARS
Yes/ No/ N/A
Labour laws: UIF & Compensation Fund
Yes/ No/ N/A
Applicable industry laws
Yes/ No/ N/A
Membership of industry bodies
Yes/ No/ N/A
COVID-19 SMME COMMON APPLICATION FORM
Covid-19 SMME Financial Relief Applications
5
DECLARATION AND CONSENT
I/We, the undersigned declare that the information provided in this application form is to the
best of my/our knowledge true and complete.
I/We also understand that any wilful misrepresentation of the information in this application
form will disqualify my/our application and may lead to legal action against me/us including
the laying of criminal charges against me/us as sureties as well as against the entity I/we
represent for furnishing false statement or information to the Department of Small Business
Development (DSBD), Small Enterprise Finance Agency (SOC) Ltd (sefa) and Small
Enterprise Development Agency (SOC) Ltd (seda) hereto referred as the DSBD Portfolio.
I/We hereby grant the DSBD Portfolio consent to perform an entity/personal search and
check on my/our records with any other party (e.g. credit bureau and/or a government agency)
relating to this application.
I/We further authorise the DSBD Portfolio to disclose my/our personal information to these
parties to obtain the information they require and acknowledge that the DSBD Portfolio will
never disclose more information than they are required to.
DSBD Portfolio 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.
DSBD Portfolio 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.
Surname
Full Name(s)
Designation
Signature
Place
Date
Please select facility
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COVID-19 Finance Relief Application BR1 Funding Template (dsbd.gov.za)

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Completed 8 April 2020

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