Name:    

Address: 

Sole Proprietor        Partner Ship        Corporation         State Agency

Telephone Number: Fax Number:  

e-mail:       

Type Of Business

Marine:      Agriculture:       Light Industrial:        Tourism:       Commercial:      Entertainment: 

Institutional:        Knowledge-Based:       Other (explain)   

Associated Companies( parent, Subsidiary, Associate): 

Major Shareholders / Principal / Partners

Name              Nationality

Address       % Ownership 

Name               Nationality

Address       % Ownership 

Name               Nationality

Address       % Ownership 

Name               Nationality

Address       % Ownership

DIRECTORS

Name   Address

Profession       Other Directorships 

Name   Address

Profession       Other Directorships 

Name   Address

Profession       Other Directorships 

Name   Address

Profession       Other Directorships 

Name   Address

Profession       Other Directorships 

Name   Address

Profession       Other Directorships 

Name   Address

Profession       Other Directorships 

MANAGEMENT (EXISTING & PROPOSED) - CURRICULUM VITAE OF KEY MANAGEMENT TO BE ATTACHED

Name   Position/Title

Name   Position/Title

Name   Position/Title

Name   Position/Title

 Name   Position/Title

Name   Position/Title

Name   Position/Title

Name   Position/Title

Name   Position/Title

Name   Position/Title

BANKERS AND ADDRESSES (BANKER'S REFERENCES REQUIRED)

Banker   Banker's Address

Banker   Banker's Address

Banker   Banker's Address

Banker   Banker's Address

Banker   Banker's Address

Banker   Banker's Address

Estimated Investment in Land Development                                 $ 

Estimated Investment In Building Development                        $     

Estimated Investment in Plant And Equipment                             $   

Number of Jobs to be created during Preparation / Construction

Estimated number of Permanent Jobs to be created                        

Will any special expertise be required to Complete or Establish theProject  - Y es No

If Yes, please identify  

Level of Infrastructure Support Required

Electricity      

Water                

Telephones      

Sewerage         

Road Development    

Other (Explain)          

INDICATE APPROVALS REQUIRED FROM REGULATORY BODIES

INDICATE FLOOR SPACE  AND OR LAND SPACE ACREAGE REQUIRED

ENVIRONMENTAL EFFECTS

State if Grease, Fuel, Toxic Materials are to be used and method of disposal.

SAFETY MEASURES PROPOSED FOR WORKERS, FIRE PREVENTION EQUIPMENT, ETC.

A Business Plan is to be submitted (attached) which includes the following:

1. Full description of the project.

2. Sales forecast for five (5) years.

3. Projected balance sheet, income statement and cash flow statement for five (5) years.

4. Start-Up Cost.

5. Market segmentation analysis.

6. Industry analysis.