THE UNIVERSITY OF THE WEST INDIES
ST. AUGUSTINE, TRINIDAD AND TOBAGO, WEST INDIES
TENANT / CONCESSIONAIRE APPLICATION FORM
Please PRINT information clearly.
UWI Campus
Mt Hope
First Time Applicant:
Renewal:
1.
Yes
No
Yes
No
BUSINESS INFORMATION:
Applicant Name: /__ /__ /__ /__ /___/___/___/___/___/___/___/___/___/___/___/___/___/___/
[Note: If the applicant is a sole proprietor, please state name of individual and please provide a copy of a valid Identification Card.
If the applicant is a business, please state name of individual trading as the business and please provide a copy of the business’
Certificate of Registration under the Registration of Business Names Act. If the applicant is a company, please state name under
which the company is registered and please provide a copy of the Certificate of Incorporation.]
Address: /__ /__ /__ /__ /___/___/___/___/___/___/___/___/___/___/___/___/___/___/
/__ /__ /__ /__ /___/___/___/___/___/___/___/___/___/___/___/___/___/___/
[In the case of a business, please state address of Proprietor or Principal Place of Business. In the case of company, please state
the address of the registered office of the Company]
Tel. No:
/___ /___ /___ /___ /___/___/___/___/___/___/___/
Mobile No:
/___ /___ /___ /___/ ___/___/___/___/___/___/___/
Other:
/___ /___ /___ /___/ ___/___/___/___/___/___/___/
Email Address: ____________________________
Website:
____________________________
Ownership: [Please tick appropriate description]Sole Proprietorship
Partnership
Corporation
Joint Venture
In the case of a business, partnership or joint venture, please state the Names of its Principals & Respective Titles as at the date of
this application:
1.____________________________________________________________________________
2.____________________________________________________________________________
3.____________________________________________________________________________
In the case of a Company, please state the Names of the Directors & their Respective addresses as at the date of this application.
1.____________________________________________________________________________
2.____________________________________________________________________________
3.____________________________________________________________________________
Type of business proposed to be carried on at UWI’s premises. (Please tick appropriate box).
Food and Beverage
Office Space
Vending Machines
Other
Please specify: _________________________________________________
Types of Goods/ services to be offered: (Please state briefly)
____________________________________________________________________________________________________________
Location Preference:
First Choice: _________________________________________________________________________________________________
Second Choice: _____________________________________________________________________________________________
Size of space(s) required: ______________________________________________________________________________________
Investment anticipated $’s including redesign (interior etc.): _________________________________________________________
Do you have a Business Plan? Yes
No
(If yes, please provide a copy along with this application)
Bankers Name: _____________________________________________________________________________________________
TRADE REFERENCES:
1.__________________________________________________________________________________________________________
2.__________________________________________________________________________________________________________
LITIGATION/CLAIMS HISTORY:
Have you at any time in the past five years been sued for arrears of rent on leased premises?
Yes:
No:
If your answer is yes, please state brief particulars of such litigation and provide an updated status of same
____________________________________________________________________________________________________________
Have you in the past five years been evicted and/or served with a Notice to Quit or a Notice of Forfeiture in relation to premises you
previously or currently rent?
Yes
No
If your answer is yes, please state brief particulars of such action and provide an updated status of same
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
2.
FINANCIAL INFORMATION:
In the case of a company, please provide copies of your audited financial statements for the past three years.
In the absence of such audited financial statements, please provide copies of your management accounts for the past three years.
In the case of a sole proprietor or business, please provide copies of your income and expenditure statement.
3.
OTHER INFORMATION:
i. Briefly explain the expected value that your business will contribute to the Campus.
___________________________________________________________________________________________________________
____________________________________________________________________________________________________________
ii.
Please state other special requirements (e.g. Utilities, opening hours etc.)
____________________________________________________________________________________________________________
Date: _____/_____/______/
Day
Month Year
Applicant’s Signature:
__________________________