Financing request — VANDELANOTTE Fiduciaire & Conseils

VANDELANOTTE

Fiduciaire et Conseils

Email: contact@vande-lanotte.com
Address: Hermeslaan 9, 1831 Machelen, Bruxelles, Belgique

CLIENT FILE | Companies, entrepreneurs and project promoters. Complete the applicable sections and tick the corresponding boxes. Indicate “Not applicable” where appropriate. For lengthy answers, attach a sheet indicating the section number. Fields may be completed on screen or by hand.

FINANCING APPLICATION

CLIENT FILE | Companies, entrepreneurs and project promoters

Application date

FINANCING APPLICATION

01 · APPLICANT DETAILS

Established companyCompany being formedSole proprietorIndividual

Legal name / full nameTrade nameLegal formCountry of registrationDate of incorporationRegistration numberTax identificationBusiness sectorAddressCity / postal codeCountryWebsiteCurrent employees

CONTACTS AND STRUCTURE

02 · REPRESENTATIVE AND CONTACT PERSON

Representative full nameRole / capacityNationalityCountry of residencePhone / WhatsAppOccupational emailShareholders and ultimate beneficial owners: names, countries, ownership and controlMain executives: names, roles and experience

PROJECT PRESENTATION

04 · PROJECT TO BE FINANCED

Project nameCountry / city of executionProject summary, products / services and objectivesTarget clients, market, competition and advantagesAchievements, sales, orders or contracts obtainedExpected start dateExecution period

FINANCING NEEDS AND PLAN

05 · AMOUNT AND TERMS REQUESTED

CurrencyTotal project costFinancing requestedAvailable own contributionOther financing sourcesAmount still to coverRequested term (months / years)Requested grace period (months)Desired availability dateUse of funds: property, equipment, inventory, acquisition, refinancing, other

FINANCIAL POSITION AND RISKS

07 · FINANCIAL INDICATORS

Data currencyLast closed financial yearRevenue / salesNet resultAvailable cashOutstanding financial debtRevenue forecast: year 1 / year 2 / year 3Proposed collateral: owner, estimated value and encumbrancesRisks and solutions: market, FX, execution, environment

DOCUMENTATION

09 · APPLICATION DOCUMENTS

Completed, dated and signed formValid identificationRecent proof of addressProject and team presentationDetailed budget and financing planFinancial forecastsFinancial statements and bank statements if existing activity

List of available attachments / files

ADDITIONAL DOCUMENTS AND SIGNATURE

14 · DECLARATION AND SIGNATURE

I certify that the information and documents submitted are, to the best of my knowledge, accurate and complete.

Signer name / capacityPlace and datePending documents: reason and expected delivery date

Financing application form

FINANCING APPLICATION

FINANCING APPLICATION

01 · APPLICANT DETAILS

CONTACTS AND STRUCTURE

02 · REPRESENTATIVE AND CONTACT PERSON

PROJECT PRESENTATION

04 · PROJECT TO BE FINANCED

FINANCING NEEDS AND PLAN

05 · AMOUNT AND TERMS REQUESTED

FINANCIAL POSITION AND RISKS

07 · FINANCIAL INDICATORS

DOCUMENTATION

09 · APPLICATION DOCUMENTS

ADDITIONAL DOCUMENTS AND SIGNATURE

14 · DECLARATION AND SIGNATURE