EIP Application form for Enterprise Investment Programme

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S E C T I O N A1I N V O L V E M E N T I N O T H E R B U S I N E S S E S16:-ENTERPRISE NAMEINCORPORATION NO INCORPORATION DATEPHYSICAL ADDRESS(of facility / factory)POSTAL CODE % SHARES IN THIS BUSINESSNATURE OF BUSINESS and PRODUCTSPlease make copies of section A1 if more businesses must be indicated17:-NAME OF PROJECTPHYSICAL ADDRESSS E C T I O N BP R O J E C T I N F O R M A T I O N(of facility / factory)POSTAL CODE PROVINCEDISTRICT/MUNICIPALITYESTABLISHMENT POINT18:-COMMENCEMENT DATE OF PROJECTCCYY/MM/DD19:-MOTIVATION FOR GRANTPlease provide motivation explaining how the grant will make the project viable20:-FUNDING OF PROJECTPlease provide a breakdown of how the project will be financedName of lender Capacity Terms(months) Amount(Rand)Total21:-SIC OF PRODUCT(provide the SIC code for project)(provide SIC code for applicant, if different to project)PRODUCT / SERVICE /ACTIVITY DESCRIPTIONPRODUCTION PROCESS /DESCRIPTION OF FACILITY TOBE DEVELOPEDDETAILS OF GRADING22.1:-PROJECTED EMPLOYMENT YEAR 1 YEAR 2 YEAR 3 TOTALFor this new projectTSP_ApplicationForm_Version 2 / 2008/11/12 Applicant’s signature___________________________________________
22.2:-BASE YEAR EMPLOYMENTMonthly average employment figures for the base year. (*Disabled employees should beincluded in the gender/race categories as well as disable categories)WHITE BLACK INDIAN COLOURED OTHER TOTALMale Female Male Female Male Female Male Female Male FemaleDISABLED MALE DISABLED FEMALE23:-REGULATORY REQUIREMENTSDoes the project comply with all regulatory requirements? If not, providedetails24:-FACTORY / TOURISMPREMISES (square meters)EXISTING AREAFOR BASE YEARADDITIONALAREA FOR YEAR1ADDITIONALAREA FOR YEAR2ADDITIONALAREA FOR YEAR3TOTAL NEWPROJECT AREA(1+2+3)Total Site / Land used for facilityFactory / Building used for facilityAdmin /Residential area for personal useS E C T I O N CF I N A N C I A L I N F O R M A T I O NINCOME STATEMENTHISTORYINCEPTIONPERIODFORECASTSYear (ccyy/mm)RevenueSalaries and wagesLease / rental of landand buildingsOtherDirect operating costsGross marginSalaries and wagesLease / rental of landand buildingsOtherIndirect operating costs(excluding depreciation)EBITDADepreciationEBITNet interest (paid) /receivedPBTShare of (loss) / profitof associatesTaxPATMinority interestsEarnings attributable toordinary shareholdersDividendsRetained (loss) /earningsTSP_ApplicationForm_Version 2 / 2008/11/12 Applicant’s signature___________________________________________
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Page 7 and 8: Cash flows fromoperations andinvest
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EIP Application form for Enterprise Investment Programme

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