The information given in this form, together with any accompanying documents, will help us carry out a credit appraisal.
 Please type all sections of the form or hand write in black ink and in BLOCK CAPITALS. All applicants should read the declarations and sign to confirm.
 If more than one person owns the business please ask them to complete a separate form and sign the form as they will be a joint applicant for the loan.

If you have any problems in completing the form please consult your designated Loan Development Officer. They will notify you on the timescale for the assessment of your application.

The information we require in support of your application is detailed below and overleaf. Additional information may be requested. Please enclose all required and any further information with your application. If any information is missing, the application process could be delayed.

Please send the completed and signed application form and information to Enterprise Loans East Midlands in the timescale advised by your designated officer.
Application Requirements
Along with an application form, applicants must provide as a minimum:
• A comprehensive up to date business plan covering all aspects of the business or proposed project/venture.
• Minimum of 2 years' cash flow forecasts and profit & loss forecasts and at least 6 months' business or personal bank statements.
•A minimum of 2 years' trading accounts (if you have been operating for that amount of time), or current management accounts.
• Evidence the business has registered for VAT if the business turnover has or within the next 12 months is expected to reach, the current threshold.
Exclusions
Assistance will not be given to businesses involved with religion, pornography, gambling, money lending, property purchases or property development. Applications for cars will not be considered except for commercial vehicles which are deemed to be an essential requirement of the business. Leasing is the preferred route for all vehicle purchase.
Please note:
1. Minimum loan application £20,001 maximum loan application £100,000. For loan requests less than £20,001 please contact a loan adviser.
2. Loans can be applied for with repayment normally over 1 to 5 years, but this period should match the purpose of the borrowing.
3. A client contribution will be required and must be evidenced in the applicant's bank account.
4. Interest Rates available on request.
An arrangement fee of 2% minimum £100.00 will be charged for all loans. Security fees will also be payable and advised in advance.
5. Applicants must have lived in the East Midlands for more than 18 months and have leave to remain in the UK.
6. Loans are normally not permitted to Limited Companies, but consideration will be given to lending to directors to enable a capital injection to be made into the business.
7. A credit search is carried out on every applicant and a satisfactory explanation required in case of adverse credit history, before consideration will be given to the application.
8. The loan is discretionary and should not be regarded as automatic in any circumstances. It provides opportunities to those that have a viable business plan and are unable to raise sufficient funds through other sources.
9. Representatives of ELEM, commercial banks and East Midlands organisations constitute the loan panel that meet to assess the applications.
10. Your home is at risk if you do not keep up the repayments on a loan secured by it.
11. The decision to sanction a loan rests with the Board of Directors whose decision will be final. In the event of an application being declined, there is no appeal process and the organisation is unable to enter into any communication, either written or verbal, regarding unsuccessful applications.
Enterprise Loans East Midlands
6 Sherwood Rise
Nottingham
NG7 6JF
Consumer Credit No: 623267
ELEM Loan Application Form Issue 10 Dec 15

PERSONAL DETAILS
Title:
Date of Birth:
Home address:
Postcode:
Home telephone number:
Work telephone number:
Email address:
Forenames:
Mobile number:
Surname:
Nat. Ins. No:
How long have you lived at your present address? Years Months
If less than 3 years at this address please state previous one/s including how long you lived there
(Continue on separate sheet if necessary)
Please provide a list of all assets owned by you (details and value for all). State if jointly owned and give name of joint owners (please continue on a separate sheet if necessary). For house/property please give full address, purchase price and date purchased. For car please mention registration number, make, model and year.
*Assets owned by you (details & values for all)
State if joint owned & gives names of joint owners
House / Property (state any other owners details)
(give full address, purchase price & date of purchase)
Car (inc reg number, make and model)
Other
Other
Total assets
Current Value
ELEM Loan Application Form Issue 10 Dec 15

State who borrowing / facility is with, date borrowed and purpose Include overdraft limits (whether utilised or not) mortgages, loans and credit cards etc.
Bank, Building Society, Hire Purchase, Credit Card and other Borrowing
Total Borrowing
Amount (£) Outstanding
Income and Expenditure
M
ONTHLY
I
NCOME
Salary/Business Drawing
Benefits
Others
Income Total
Monthly Expenditure
Mortgage
Rent
Rates and Utilities
General household Expenses
Expenditure Total
Monthly Surplus/Deficit
Annual surplus Deficit
A
PPLICANT
Spouse/Partner
£
£
£
£
Amount
Have you ever been subject to formal insolvency proceeding e.g. Bankruptcy, Trust deed, IVA or other credit arrangements in respect of arrears on repayments of funds owed. Yes/No
(If yes the please provide and explanation below)
Yes/No Do you owe any arrears of VAT/National Insurance/Income Tax
If Yes the please provide details
EQUAL OPPORTUNITIES
ELEM Loan Application Form Issue 10 Dec 15

Small Loans for Business operates an Equal Opportunities policy and to help us monitor the effectiveness of this policy, we ask that all applicants complete this section. Please note that any information given in this section will NOT affect the processing of your application.
Ethnic Origin (please tick the relevant box which best describes the ethnic group you belong to) If there is more than one applicant, each to complete and initial against the appropriate box.
White British
White & Asian
Caribbean
Black British
White Irish
Mixed (other)
African
Asian British
Black African Bangladeshi
Do you have a disability?
If yes, please discuss this with your adviser
White (other)
Indian
Black (other)
Other (please specify)
Yes/No
Black Caribbean
Pakistani
Chinese
Note - The business must be located or intending to locate in the East Midlands
Business Name
Address:
Postcode:
Mobile number:
Work telephone number:
Email address:
Length of time Trading/Intended Start Date:
Sole Trader: Yes/No Partnership: Yes/No Limited Co. Yes/No Social Enterprise Yes/No
If Limited Co, please give date of incorporation:
If VAT registered, please give date of registration: VAT Reg No.
Please indicate what type of premises your business is/will be housed in:
Rented Owned Home-Based Other
Partner/Director 1
Business Name
Address
City
Postcode
Partner/Director 2
Business Name
Address
City
Postcode
Co. Reg No.
Continue on a separate sheet if there are more than 2 Partners/Directors.
ELEM Loan Application Form Issue 10 Dec 15

Please list below details of all business assets including property
Details of Assets Type of Asset
Bank, Building Society, Hire Purchase,
Credit Card, Overdraft and other Borrowing
Total
Limit
Current Value
Outstanding
How much money in total do you estimate you will require for your new business?
How much is the Loan you are requesting? (minimum £20,001 maximum £100,000)
What term would you like to repay the loan over? The maximum term is usually 5 years
£
£
years
Other Sources of funding for this proposal including own investment
Other Investment
Own Savings
Friend & Family
Bank and other borrowing
Grants
Total Levered Funds
Funds Requested from ELEM
Debt Applicant 1
Debt Applicant 2
Debt Applicant 3
Total Debt including ELEM
£
£
£
£
£
£
£
£
£
£
Please give details of 2 referees we can contact, one should be your home or business landlord (or a trade supplier or someone else with an involvement in the business if you have no landlord), the other should be a personal referee.
Name
Address
Name
Address
City
Postcode
Telephone No
Email
City
Postcode
Telephone No
Email
Capacity in which known
ELEM Loan Application Form Issue 10 Dec 15

I hereby declare that the foregoing statements are correct to the best of my knowledge and belief, that I have not been adjudicated bankrupt, nor made any composition with my creditors or no judgment exists against me, and that I will accept the conditions upon which Enterprise Loans East Midlands is prepared to give any assistance and understand that any false information given could result in repayment of the monies paid to me in full immediately or prosecution.
I authorise Enterprise Loans East Midlands to make a search with a credit reference agency, and to keep a record of that search and share that information with other parties if necessary. I also authorise Enterprise
Loans East Midlands to make enquiries about the other interested parties in the business with a credit reference agency, and to request any references deemed necessary.
I confirm that I am not involved or in any way connected with any activity that is not suitable to be supported from public funds.
I further declare that the assistance which is the subject of this application will be used solely for the purpose stated above and proof will be supplied to confirm the amount spent.
I will continue to work with Enterprise Loans East Midlands for the development of the business. I confirm that information on my bank account may be released to Enterprise Loans East Midlands at any time in relation to the repayment of funds on this application.
I understand the loan is discretionary and should not be regarded as automatic in any circumstances.
I understand that if I do not make the loan repayments as and when they are due that Enterprise Loans East
Midlands may take legal action to recover the money due.
By signing this document I confirm that I have been unable to access traditional finance for my business.
If you have any evidence such as a bank decline letter / email please include this in your application.
DATA PROTECTION
All details will be held in accordance with the Data Protection Act 1998. All personal data collected by
Enterprise Loans East Midlands (ELEM) is used for administrative purposes, shared with ELEM’s funders and processed on Enterprise Loans East Midlands' and First Enterprise Business Agency’s client management system. This information is kept confidential at all times. From time to time this information may be used to send mail, fax, e-mail or telephone details of business services and news relevant to you and your business.
Signature Date
ELEM Loan Application Form Issue 10 Dec 15