Application For Funding (to be completed online) Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1. Basic Financial Institution (FI) information - Step 1 of 7Name of FI *Address *Address Line 1CityState / Province / RegionTelephone Number *Name of Principal contact person *FirstLastTelephone Number of principal contact person *Email address of principal contact person *BoU or UMRA Licence *Number of Branches *Location of each branch * Compliance with BoU or UMRA regulations *Please attach a declaration confirming that the institution is compliant with applicable regulation and there are no pending investigations or disciplinary action. (NB: File should not exceed 15mb)Board of Directors *Please attach List of Directors or equivalent. (NB: File should not exceed 15mb)Senior Management Team *Please attach List of Members of Senior Management Team. (NB: File should not exceed 15mb)Latest audited financial statements for the last two (2) years *Attach copies certified by external auditor. (NB: File should not exceed 15mb)NextCore Capital to Risk Weighted Assets (%) *Portfolio At Risk (thirty days past due including prior year write offs) *Liquid Assets to Total Deposits ratio (%) *PreviousNextSelect Yes if you have existing Loans/Borrowings *Select Yes if ApplicableNot ApplicableYesName of Lender/ Funder *Amount Borrowed *Outstanding Amount (UGX) *Interest Rate (%) *Maturity Date *Arrears if any Security Provided *Restriction on Additional Borrowing (Yes/No) *--- Select Choice ---YesNo Add Remove PreviousNextA computerised loan portfolio management system *--- Select Choice ---YesNoA system to monitor the loan portfolio real time *--- Select Choice ---YesNoPreviousNextEnvironmental and Social Management policy YesNoIf Yes, please attach the policy *File should not exceed 15mbPreviousNextAmount Applied for: *Quarterly On-lending Projections (Amount): *Quarterly Targets (Number of Loans/MSMEs): *Presence in Refuge and Hosting Districts (RHDs) or plan to extend operations to RHDs (number of branches or satellite offices if any) * On-lending branches or PreviousNext(i) Certificate of Incorporation *File should not exceed 15mb(ii) Memorandum and Articles of Association or Byelaws as applicable *File should not exceed 15mb(iii) Licence issued by BoU or UMRA *File should not exceed 15mb(iv) Declaration of Compliance with applicable regulation and there are no pending investigations or disciplinary action. *File should not exceed 15mb(v) Tax Clearance Certificate *File should not exceed 15mb(vi) NSSF Clearance Certificate *File should not exceed 15mb(vii) List of Directors or equivalent *File should not exceed 15mb(viii) List of Members of Senior Management Team *File should not exceed 15mb(ix) Audited financial statements if anyFile should not exceed 15mb(x) Credit Reference Bureau report for Tier IV Financial Institutions *File should not exceed 15mb(xi) Credit Management Policy *File should not exceed 15mb(xii) Environmental and Social Management Policy *File should not exceed 15mb(xiii) Anti-Money Laundering Policy *File should not exceed 15mbSubmit
