APPLICATION FORM FOR LOAN - Foundation for a Sustainable Society

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PROJECT PROPOSAL LOAN FORM

I. PROJECT INFORMATION

Project Title

Project Location

Name of Proponent

Contact Person

Contact Person*

First Name

Last Name

Contact Details

Requested Amount

Type of Financial Service

II. INTRODUCTION

(Present a brief background and description of the project.)

III. PROJECT SUMMARY

A. PROJECT OBJECTIVE

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B. PROJECT OUTPUT & INDICATORS

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C. KEY BUSINESS ASPECTS & TARGET

PRODUCT

CURRENT OPERATION

What product or services do you offer at present?

NEW BUSINESS TARGET

What new product or services will you offer?

CUSTOMER SEGMENTS

Who are your current customers/clients?

Who will be your new/additional target customers?

KEY ACTIVITIES

What are the most important activities in delivering your products and services?

What will be the key activities in delivering your new products and services?

KEY RESOURCES

What are the key requirements in delivering your product or services?

What will be the requirements in delivering your new product or services?

KEY PARTNERS

Who are your key partners?

– ex., major supplier, major buyer, R&D provider, or investor?

Who will be your new key partners?

COST STRUCTURE

What are your major cost items?

(variable and fixed cost, direct or overhead cost)

What will be your new major cost items?

REVENUE STREAMS

What are your major source of revenue?

(ex., sales, subscription, franchise fee, rentals)

What will be your new or additional source of revenue?

D. PROJECT BUDGET

IV. FINANCIAL PERFORMANCE & TARGET

A. COMPARATIVE FINANCIAL STATEMENTS & TARGETS (MAJOR HEADINGS)

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B. LOAN AGING/CREDIT STATUS

PREVIOUS YEARS

Current Loans

2014

2015

2016

Past due 1-30 days

2014

2015

2016

Past due 31 to 90 days

2014

2015

2016

Past due 91 to 180 days

2014

2015

2016

Past due 181 to 365 days

2014

2015

2016

Past due over 1 year

2014

2015

2016

Total loans

2014

2015

2016

Restructured-current

2014

2015

2016

Restructured-past due

2014

2015

2016

Accounts under litigation

2014

2015

2016

Written-off during period

2014

2015

2016

TARGET

Current loans

YEAR 1

YEAR 2

YEAR 3

Past due 1-30 days

YEAR 1

YEAR 2

YEAR 3

Past due 31 to 90 days

YEAR 1

YEAR 2

YEAR 3

Past due 91 to 180 days

YEAR 1

YEAR 2

YEAR 3

Past due 181 to 365 days

YEAR 1

YEAR 2

YEAR 3

Past due over 1 year

YEAR 1

YEAR 2

YEAR 3

Total loans

YEAR 1

YEAR 2

YEAR 3

Restructured-past due

YEAR 1

YEAR 2

YEAR 3

Accounts under litigation

YEAR 1

YEAR 2

YEAR 3

Written-off during period

YEAR 1

YEAR 2

YEAR 3

C. CREDIT DEALINGS

Creditor

Approved Amount

Interest Rate

Date Released

Maturity Date

O/S Balance

Status

V. ENVIRONMENTAL MANAGEMENT

A. ENVIRONMENTAL COMPLIANCE

(Identify environmental compliance requirement of the project & indicate if complied. Indicate also if the proponent adopted a higher standard.)

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B. ENVIRONMENTAL PRACTICES

(Describe the environmental practice adopted/integrated in the project operation/plan. Provide quantitative indicators on scope of environmental practices, if available.)

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C. ENVIRONMENTAL MANAGEMENT POLICY

(Describe scope of environmental management policy of the proponent, if available.)

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VI. THE PROPONENT

A. GOVERNANCE

(Compliances to oversight agencies, compliance to registration documents, labor compliance, strategic plan, manuals, gender and development)

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B. MANAGEMENT & STAFFING

(Personnel; accountability)

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C. PARTICIPATION (ownership, employment, livelihood)

(Male/female owners, employed, beneficiaries of livelihoods)

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VII. RISK MANAGEMENT

VIII. LOAN SECURITY

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PROJECT APPLICATION FORM

Business Information

Application for Financial Service

Documents for Submission

Upload Letter of Intent

Upload Project Proposal of Business Plan

1-a. For Cooperatives

Upload Certification of Registration, Articles of Cooperation & By-laws

Upload Cooperative Annual Performance Report (CAPR)

Upload Certificate of Compliance issued by CDA

1-b. For Organizations/Corporations registered with SEC

Upload Certificate of Registration, Articles of incorporation & By-laws

Upload General Information Sheet (GIS)

Upload DTI certification/registration form & bio-data (for single proprietorship)

Upload Registration/accreditation with pertinent regulatory agency

Upload Business permit

Upload AUDITED FINANCIAL STATEMENTS AND NOTES, 3 YEARS

Upload LATEST INTERIM FINANCIAL STATEMENTS

F. BANK AND TRADING ACTIVITIES

Upload List of top customers and suppliers, with contact persons & numbers

Upload List of creditors, with contact persons & numbers

Upload Bank statements

Upload Written authority for FSSI to conduct trade & credit checking

G. PROPOSED LOAN COLLATERAL

Upload Certified True Copy of TCT

Upload Copy of Tax Declaration for land &/or building, & receipts of payment of real estate taxes

Upload Copy of OR and CR of Vehicle

Upload Receipt &/or Registration of Equipment

Certification

Signature of authorized representative:

Your form has been submitted

PROJECT PROPOSAL LOAN FORM

D. PROJECT BUDGET

C. CREDIT DEALINGS

VII. RISK MANAGEMENT

VIII. LOAN SECURITY

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