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MountEverestManagement Inc.
FINANCING APPLICATION FORM, International
I. CLIENT IDENTIFICATION
Business Legal Name: ……………………………………………………………………………………………………………………… Business Commercial Name: ................................................................................................................Business Registration #: …………………………….........................................................................................Business Registration date (M/D/Y): ……………………………………………………………………………………………….Industry: ...……………………………………………………………………………………………………………………………………….Representative Last name: ………………………………………………First name: ……………………………………………Representative Title: …………………………………………………………………………………………………. Sex: □ M □ FBusiness Address: …..........................................................................................…………………………………City: …………………………………………….. Province: ……………………………………… Country: ………………………….Phone#: ……………………………………………………………….. E-mail: …………………………………………………………….Phone WhatsApp#: ………………………………………………………………………………………………………………………….
II. TYPE OF FINANCING
Select the appropriate type of financing (ref. financing terms and conditions): CBF: Cash Backed Financing TDF: Term Deposit Backed Financing FBF: Financial Instrument Backed Financing
300 March Road, 4th Floor, Ottawa, Ontario K2K 2E2 CanadaTelephone. (613) 709-1892 Fax. (613) 317-1322
MountEverestManagement Inc.
III. PURPOSE & AMOUNT OF FINANCING
Purpose of financing (attach business plan or business case summary, 2-4 pages maximum): …………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………Requested loan amount USD (in number and in word): $...……………………………………………………………….……………………………………………………………………………………………………………………………………………………………Country/Province where the business/project is implemented: ……………………………………………………………………………………………………………………………………………………………..……………………………………………………Feasibility study available? ____ YES ___ NOIf yes (provide soft copy in PDF) to [email protected] Additional guaranties available? ___ YES ___ NO If yes, provide details………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………Value of additional guaranties available in USD (in number and word): $ ______________________…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………Collaterals or titles available? ___ YES ___ NO if yes, provide details………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Value of collaterals or titles in USD (in number and word): $ ________________________________………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….Please provide below any details you believe may help boost your application……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
300 March Road, 4th Floor, Ottawa, Ontario K2K 2E2 CanadaTelephone. (613) 709-1892 Fax. (613) 317-1322
MountEverestManagement Inc.
IV. BANKING INFORMATION
When applying for Term Deposit Backed Financing with POF in a third party’s name, the account holder must provide his/her Bank details and complete the KYC.
When applying for other than Term Deposit Backed Financing or with POF in own name, the applicant must provide his/her Bank details and complete the KYC.
Bank NameAgency/BranchBank address
Bank Phone numberBank SWIFT CodeBank officer nameBank account HolderAccount numberAccount Signatory name
International Corresponding Bank
I/we here consent to the use of my/our banking information only for the purpose of the current request for financing: ___ YES ___ NOI/we authorize MountEverest Management Inc. and/or its associates to block 30% of requested loan amount for 90 days minimum: ___ YES ___ NO (This is only for Term Deposit Backed Financing).Attached is the copy of my ___ Passport ___ Driver License ___ other (specify) ………………………………… Date of issue: ………………………………………………….. Date of expiration: …………………………………………………………………
Relationship to the applicant: ___ Self ___ Associate ___ Sponsor ___ Other(specify)…………………..
Signature of the bank account holder if different from the applicant: ________________________ I certify that the information I have provided is exact to the best of my knowledge.
Date: _ _ / _ _ / 2021 Signature of the applicant: _________________________
300 March Road, 4th Floor, Ottawa, Ontario K2K 2E2 CanadaTelephone. (613) 709-1892 Fax. (613) 317-1322