Application form to investees
(* indicates required/ mandatory fields)
1. Name and addresses of Business
* Name of Business________________
*Contact person __________________
*Region_________________________
*Wereda________________________
*Kebele_________________________
Telephone (office) _______________
*Mobile_________________________
E-mail__________________________
2. *Establishment Date __________________
3. *Types of business engagement (you can select more than one)
Milk Processing
Milk Collection & Trade
Live Animal Sale
Ox Fattening
Veterinary drug shop
Meat Sale
Sheep/goat fattening
Veterinary outreach Services
Feed Millers
Milk production
Slaughterhouse/ Abattoir
4. *Rationale of the business (motivation to start the business)
______________________________________________________________________________
______________________________________________________________________________
5. *Type of ownership
Sole proprietorship
Private Limited Company
Partnership
Other
If other please specify ______________
Telephone: +251(0) 114 401 473
Fax: +251(0) 114 403 649
Email: info@ethiolivestock-invest.com
Email: info@firstconsultet.com
6. Owner/Management Profile
*Name _________________________
*Educational Background:
PhD
High school graduate
MA
Below high school
BA
No Education
Diploma
*Experience (years & areas) __________________________________________________
7. *Land holding (in M2) ____________________________________________________________
8. *Installed production/supply capacity _______________________________________________
9. *Initial Paid in capital(Birr)_________________________________________________________
10. *Invested capital (Birr)____________________________________________________________
11. *Additional Capital Requirement (Birr)_______________________________________________
12. *Purpose of additional capital requirement (you can select more than one)
Working Capital
Other
Fixed asset acquisition
If other please specify _______________________
13. *Preferred type of financing
Equity
Debt and Equity
Debt
14. *Borrowing history
Not borrowed
Borrowed from banks
(Birr & name of bank) _________________________________
Borrowed from others
(Birr & name) _______________________________________
15. *Type of Market
Domestic Market
Export Market
Please specify the countries/ places __________________________
Telephone: +251(0) 114 401 473
Fax: +251(0) 114 403 649
Email: info@ethiolivestock-invest.com
Email: info@firstconsultet.com
16. *Key customers (buyers/suppliers)
Buyers:
Suppliers:
1. _______________________________
1. ______________________________
2. _______________________________
2. ______________________________
3. _______________________________
3. ______________________________
17. *Future Target markets
______________________________________________________________________________
18. Annual sales quantity & value for the past 3 years
2003 E.C. ____________________
2004 E.C. ____________________
2005 E.C. ____________________
19. Profit for the past 3 years
2003 E.C.____________________
2004 E.C. ____________________
2005 E.C. ____________________
20. Recognizable strengths of the business
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
21. Major Challenges faced by the business
Human Resource
Market
Management
Raw Material
Finance
If other please specify _________________________________________________________
22. Competitiveness position in the sector
Outstanding
Medium
Low
Telephone: +251(0) 114 401 473
Fax: +251(0) 114 403 649
Email: info@ethiolivestock-invest.com
Email: info@firstconsultet.com
23. Impact of the business
Number of employment created______________________________
Markets created for households and small businesses _______________________________
24. Other message you want to include, including why you want to participate in the forums?
(maximum of 300 words )
Thank you for your interest and Participation!
Telephone: +251(0) 114 401 473
Fax: +251(0) 114 403 649
Email: info@ethiolivestock-invest.com
Email: info@firstconsultet.com