Client Company Name
Incorporation Number & Date
Incorporation Jurisdiction( State/Country)
Client Registered Office Address
Client Telephone Number
Client Website Address
Client Email Address
Description of Project/Name
Client Key Contact Name & Title
Who will be responsible for our Fund
Who are the Board of Directors & Promoters of the company
Client Banker's Name & Address
Client Author's Name & Address
Client Solicitor's Name & Address
Client's Number of Employees
How much funding required & in what currency
What security (if any) is being offered & what is the value of the security
Are you expecting 100% finance from the Investor
Is there any existing mortgage/changes on the security? if so provide details
Does the company have a clean credit record?
Do you have last 3 years audited financial statement?
Are there any politicians involved(directly or indirectly) in the company/project
Have you already submitted the proposal to any financial institution or investment firm
What is your financial strength?
Name/Title *
Company Name
Passport Number
Date of Issue
Date of Expiry
Country of Issuance
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Austrian Empire*
Azerbaijan
Baden*
Bahamas, The
Bahrain
Bangladesh
Barbados
Bavaria*
Belarus
Belgium
Belize
Benin (Dahomey)
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Brunswick and Lüneburg*
Bulgaria
Burkina Faso (Upper Volta)
Burma
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands, The
Central African Republic
Central American Federation*
Chad
Chile
China
Colombia
Comoros
Congo Free State, The*
Costa Rica
Cote d’Ivoire (Ivory Coast)
Croatia
Cuba
Cyprus
Czechia
Czechoslovakia*
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Duchy of Parma, The
East Germany (German Democratic Republic)*
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Federal Government of Germany (1848-49)*
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Grand Duchy of Tuscany, The*
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Hanover*
Hanseatic Republics*
Hawaii*
Hesse*
Holy See
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kingdom of Serbia/Yugoslavia*
Kiribati
Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Lew Chew (Loochoo)*
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mecklenburg-Schwerin*
Mecklenburg-Strelitz*
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Namibia
Nassau*
Nauru
Nepal
Netherlands, The
New Zealand
Nicaragua
Niger
Nigeria
North German Confederation*
North German Union*
North Macedonia
Norway
Oldenburg*
Oman
Orange Free State*
Pakistan
Palau
Panama
Papal States*
Papua New Guinea
Paraguay
Peru
Philippines
Piedmont-Sardinia*
Poland
Portugal
Qatar
Republic of Genoa*
Republic of Korea (South Korea)
Republic of the Congo
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Schaumburg-Lippe*
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands, The
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Texas*
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Two Sicilies
Uganda
Ukraine
Union of Soviet Socialist Republics*
United Arab Emirates, The
United Kingdom, The
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Württemberg
Yemen
Zambia
Zimbabwe
SUBMIT