APPLICATION FORM
For
BUSINESS INCUBATION
&
FINANCIAL SUPPORT
[This document contains the guidelines for applying for business incubation at @iBizAfrica. All applicants
must fill in all the necessary details in order for their application to be considered]
BUSINESS INCUBATION APPLICATION FORM
SECTION A: COMPANY INFORMATION
(Please fill in all the fields where applicable)
1. Name of company
Company Location Details
Country
Physical Location
City
Company Contact Details
Phone Number
P.O. Box Address
Website URL
2. When was your company formed?
Mobile Number
E-mail
_day_ /_month_ /_year_
(Please indicate the month and year)
3. Which category would best describe your area of business? (Please tick where appropriate)
Arts & Entertainment
[ ]
Automotive
[ ]
Business & Professional Services
[ ]
Clothing & Accessories
[ ]
Community & Gov.
[ ]
Computers & Electronics
[ ]
Construction & Contractors
[ ]
Legal & Financial
[ ]
Media & Communications
[ ]
Education
[ ]
Personal Care & Services
[ ]
Real Estate
[ ]
Energy & Agriculture
[ ]
Shopping
[ ]
Home & Garden
[ ]
Food & Dining
[ ]
Health & Medicine
[ ]
Sports & Recreation
[ ]
Travel & Transportation
[ ]
Other [………………………………………………………………………………………………..]
4. Is your company registered? YES [ ] NO
[ ]
If YES, Please provide the Registration Number
5. Which category would best describe your company? (Please tick where appropriate)
1. Partnership (Please tick the appropriate category below)
i. General
2. Sole proprietorship
[ ]
[ ]
ii. Limited
3. Limited Liability
[ ]
iii. Limited Liability
[ ]
[ ]
4. Cooperative Society
[ ]
Other
[……………………………………………………………………………………………………………………………………………………..]
6. If your company is a partnership, briefly describe their primary role
7. How many key members form your company?
© 2012 @iBizAfrica & Idea Foundation Business Incubation Form (revised July 2012)
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BUSINESS INCUBATION APPLICATION FORM
8. In the table below, please fill in the details of each member
Designation
First name
Age
Surname
Person No.1
Gender
Other name(s)
Age
Surname
Alternative Number
E-mail
Person No.2
Gender
Other name(s)
Age
Surname
Alternative Number
E-mail
Person No.3
Gender
Other name(s)
Age
Surname
Alternative Number
E-mail
Person No.4
Gender
Other name(s)
Age
Surname
Alternative Number
E-mail
Person No.5
Gender
Other name(s)
Contact Details
Mobile Number
P.O. Box Address
Designation
First name
Contact Details
Mobile Number
P.O. Box Address
Designation
First name
Contact Details
Mobile Number
P.O. Box Address
Designation
First name
Contact Details
Mobile Number
P.O. Box Address
Designation
First name
Contact Details
Mobile Number
P.O. Box Address
Alternative Number
E-mail
© 2012 @iBizAfrica & Idea Foundation Business Incubation Form (revised July 2012)
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BUSINESS INCUBATION APPLICATION FORM
SECTION B: BUSINESS DETAILS
Business Description
9. Please provide a brief description of your business, including its products and services. (This
description should not exceed 500 words)
10. Which category best describes your company’s stage of development?
Concept
Prototype development
Production
[ ]
[ ]
[ ]
Research
Field Trials
Marketing
[ ]
[ ]
[ ]
11. What problem(s) is your business addressing? (This description should not exceed 300 words)
12. Who are your competitors or who might become your competitors? (This description should
not exceed 200 words)
13. What innovation does your business bring to the current market and what are you doing
differently? (This description should not exceed 300 words)
14. How is your business going to make money? (This description should not exceed 400 words)
© 2012 @iBizAfrica & Idea Foundation Business Incubation Form (revised July 2012)
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BUSINESS INCUBATION APPLICATION FORM
15. What are the major risks involved, and what might go wrong? (This description should not
exceed 400 words)
16. How do you plan to avoid or mitigate your risks? (This description should not exceed 300 words)
17. Please provide the skills set of the company’s personnel (including yours).
Names
Designation
Educational
Background
(Please start with the
latest achievements)
Prior working
experience and number
of years
1.
2.
3.
4.
5.
Financial Information
18. How much have you already invested into the business in terms of time, resources and cash?
(This description should not exceed 300 words)
19. Estimate investment to date and the source of funds.
Source of funds
Own Funds
Personal Sources
Loans
Contracts
Private Investors
Grants
Other
(……………………………………….......)
Approximate Amount (KSH)
© 2012 @iBizAfrica & Idea Foundation Business Incubation Form (revised July 2012)
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BUSINESS INCUBATION APPLICATION FORM
20. Please summarize your current financial status and breakdown of how funds will be used
(6,12,18 months) using the table below below:
Currently
6 Months
12 Months
18 Months
Assets
Liabilities
Equity
Sales
Gross Income
Expenses
Net Income
SECTION C: APPLICATION JUSTIFICATION
21. What immaterial difference does your business bring to its customers and society ( i.e. social
impact)? (This description should not exceed 300 words)
22. Kindly state your reasons for applying for incubation and how much financial support you
are seeking (start-up capital)? (This description should not exceed 200 words)
1)________________________________________________________________________________________________
2)________________________________________________________________________________________________
3)________________________________________________________________________________________________
23. Why should your application be considered?
1)________________________________________________________________________________________________
2)________________________________________________________________________________________________
3)________________________________________________________________________________________________
SECTION D: ATTACHMENTS
In addition to this application, please attach the following:

Resumes of the persons indicated in this application

Three personal references or clients using your service/ product
Full Names:
Signature:
Designation (in the stated
company/business)
Date of Application
SUBMISSION INSTRUCTIONS: Please save this document, delete all the comments, name it
Incubation_NameofYourCompany/NameofyourBusiness and submit it to
[email protected]
© 2012 @iBizAfrica & Idea Foundation Business Incubation Form (revised July 2012)
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