EXPRESSION OF INTEREST FORM FOR ACCESS TO

BANK OF INDUSTRY FUND

A. COMPANY INFORMATION
1. This part will provide Michael Stevens Consulting {MSC} with background information about
your business.
1. Name of Organization

2. Type of Organization – e.g. Ltd., Plc.,

Partnership, Charity, etc
3. Year of Incorporation and certificate of
incorporation number
4. Country in which your company is registered
5. What best describes the type of business you
are in?
6. Registered Address

7. Does your company belong to a group?

8. Name of Parent Company {if different from
above}
9. Information on Subsidiaries:
S/N NAME OF SUBSIDIARY TYPE OF BUSINESS % of SHAREHOLDING
by PARENT
COMPANY
a.
b.
c.
d.
e.
10. Name of your external auditors
11. When was the last audit conducted?
12. Name of Contact Person
13. Telephone number of Contact Person
14. Office Telephone numbers
15. Office Fax number

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16. Website Address
17. E-mail Address
18. Name of Senior Sponsoring Director
19. Name of Sponsoring Manager
20. Number of employees

2. What are your biggest income-generating lines? From which parts of your business do
you derive the most income? Complete the grid below, giving us details of your best
selling lines.
Period the Income refers {how many months}: Quarter/Months/Weeks
S/N Income Line Descriptor Income Cost Unit Price Units Sold
– Product {=N=} {=N=} {=N=}
1.
2.
3.
4.
5.
TOTALS
3. In the grid below, insert some further information that you will find in your Balance
Sheet {Statement of Financial Position} or schedule of annual accounts.
1. Earnings before interest and tax {EBIT}
2. Earnings after tax {EAT}
3. Value of fixed assets
4. Value of current assets
5. Value of current liabilities
6. Value of long-term liabilities

NOTE: Please attach copies of your last 3 years audited financial statements for our review.

4. The information below will inform us of the composition of your Board of Directors

NAME OF DIRECTOR NUMBER OF % OF

SHARES HELD SHAREHOLDING

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 5. Furnish us with the under listed concerning your management team

STAFF POSITION YEARS HOW LONG WITH

NAME…………………… OF EXP. YOUR COMPANY
…..

6. Does your company have an organizational chart? YES NO

7. If YES to {6} above, please attach a copy.

B. LOAN REQUEST INFORMATION

1. Amount of Loan Requested:

………………………………………………………………….

2. Purpose of loan:
…………………………………………………….................................

………………………………………………………………………………
…………………………….

………………………………………………………………………………
……………………………..

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 ………………………………………………………………………………
…………………………….

3. Planned Loan Repayment Tenor:

………………………………………………………….

4. Available Collateral for loan:

…………………………………………………………………

………………………………………………………………………………
………………………………

5. Value of Collateral:
……………………………………………………………………………..

C. NEED FOR OTHER CONSULTING SERVICES

The overall objective of Bank of Industry funding is to support small and medium
scale enterprises to grow into big industries and multinationals. In line with and to
meet this goal, clients are advised to seek the support of the BDSPs in developing
structures in their organizations.

1. Beside the issue of the loan, are there other areas you think your
organization would need our professional services? YES
NO
2. If YES to {1} above, please specify in the table below by ticking your area
of interest:
Access to Funding Restructuring & Staffing Human Capacity
Reorganization Building

Payroll Management Tax Advisory Project Management Information & Security

Management

Risk Management Strategy Development Business Process Review Research & Development

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 {BPR}

Business Plans, Change Management Corporate Performance Accounting Services

Feasibility Studies, Management
Surveys & Diagnostics

Accounting Software Developing Organizational Human Resource

Services Organizational Policies Development Advisory Services

3. Kindly provide brief details to {2} above:

S/No. DESCRIPTION OF BRIEF WRITE-UP ON PERCEIVED CONSULTING

NEED NEED

4. Others, please specify:

a. ………………………………………………………………………………
…………………………….

b. ………………………………………………………………………………
…………………………….

c. ………………………………………………………………………………
……………………………

Kindly complete and return same.

Many thanks and best regards.

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