Thriive Kenya

Thriive Kenya

ThriiveCapital Application Form

Introduction;

Thriive inspires a culture of philanthropy and offers a sustainable way out of poverty by helping viable small businesses with a unique loan to purchase new production equipment so they can grow their business and create new jobs.

Thriive Loan is paid forward with donations of job training and donation of in-kind goods to the most vulnerable in the communities equal to the value of the loan received.

Application form filling Instructions

i)Entrepreneurs from outside Nairobi and its environs need NOT apply.

ii)Start- ups enterprises are discouraged to apply.

iii)Enterprises with equipment needs of up to KES 1 million will be given a priority.

iv)Information provided MUST be verifiable on demand

Business Owner Personal Information

Full Name
Gender
Citizenship
Place of Residence
Date of Birth
Highest level of Education
Occupation/Profession
Full Time Employment
Telephone
Email

Business Information

1. Registered Business Name:

1. If company or partnership, who are the other owner(s) of the business?

Name / Gender / Telephone / Employment
1.
2.
3.

3. Physical address of the business:

4. Who are your main customers? (e.g. schools, walk ins, export, hospitals, NGOs etc.)

5. Tick your business registration

 Company  Sole Proprietorship  Partnership  CBO NGO

Other (specify)______

6. Sector(s) that the business is based

 Construction

 Medicine (pharmacology)

 Food production/Manufacturing

 Trade

 Agriculture (dairy, poultry, farming)

 Medicine (treatment)

 Consumer goods production

 Business-to-business merchandises production

 Service (such as hair salon/barbershop, child care, disabled care, jua kali – welding, vehicle service, weaving, posho mill, paint manufacturing, recycling, etc.)

 Other (specify)……………….……..

7. List the products or services you offer

8. How many years have you operated this business?

9. Do you have a business plan/Strategic plan for your business? If yes please provide a copy.

9. Please indicate amount of capital with which you started or bought your business (starting capital).

10 What is a current capital (assets owned by the business) of your business in Ksh?

11. What current percentage of the orders or service requested can you meet at a given time?

12. In the last 4 years (or less) what has been the COST and REVENUE flow of your business? Use the table below to answer this question.

Business Expenses / Cost/Profits / 2011 (KShs.) / 2012(KShs.) / 2013 (KShs.) / June 2014 (KShs.)
Total Cost of running your business e.g. utilities expenses, rent, marketing, salaries/wages
Total Revenue (sales income, receipts from services offered)
Profit

13. How many full time employees do you have in your business?Male ______Female______

14. How many of them are members of your family or relatives?

15. Are the premises for the business, if any:  Self-owned  Rented

 Other, specify……………………………..

16. Do you

 Own all the production lines and equipment

 Own a part of them and rent another part

 Rent all of them

 Other, specify………………………….

17. Please list the equipment you own and are currently using in your business (expand the list if need be):

Equipment / Bought from where? / Purchasing price (Ksh)
1.
2.
3.
4.
5.
6.

18. For what purposes do you intend to spend the loan (please indicate all purposes)?

Build new or expand the existing production facilities

Purchase new equipment

Purchase new production lines

 Other (specify)………………………………………………………………………

19. Amount of loan applied/required for the above purpose (in Ksh).

20. PLEASE INDICATE IN THE TABLE BELOW ALL EQUIPMENT YOU WILL BUY AND THEIR COST. ATTACH AT LEAST THREE VALID AND OFFICIAL QUOTATIONS FROM DIFFERENT SUPPLIERS OF EACH OF THE EQUIPMENT:

# / Equipment type / production facilities/ Other / Number of units / Cost (Ksh)
1
2
3
4
5
6
7
Total

21. What will be the impact of the THRIIVE loan on your business? Which improvements/changes/growth do you expect under each of the following categories?

i)Production/Service(quantity and /or quality):

ii)Employment:

iii)Quality of life of workers:

iv)Revenue

v)Others:

22. Please indicate the charitable products or services you will donate to repay the loan, which is your target recipient(s), and the estimated value (retail price) of the products or services.

Target Beneficiary(ies): ______

The example below is for a business that applied for salon equipment and repaid the loan by training underprivileged girls in Hair-dressing on a monthly basis.

Value of in-kind repayment:

In- Kind Payment / January 2014 / February 2014 / March 2014 / April 2014
Number of trainees girls / 4 / 4 / 4 / 4
Cost of training a girl/month (KShs.) / 2,000.00 / 2,000.00 / 2,000.00 / 2,000.00
Total monthly repayment (KShs.) / 8,000.00 / 8,000.00 / 8,000.00 / 8,000.00

PLEASE PRINT/DRAW AND ATTACH YOUR PROPOSED REPAYMENT PLAN USING THE ABOVE EXAMPLE. NOTE: REPAYMENT IS EITHER BY JOB TRAINING, SERVICE OR GOODS DONATION.

23. If offered the loan, after how many months would you anticipate to start making your charitable repayment? ------Months

24. When will you expect to complete the repayment of the loan? ……../20……..

25. Have you obtained any subsidies/help/grant for your business development from other sources?

 Yes  No

If yes, specify year of receiving, amount, and name of an organization provided the subsidy:

Year of getting subsidy/help/grant ……… Amount……………Institution…………….

26. Have you obtained any bank loan(s) for the business development purpose?

 Yes  No

If yes, specify year of getting the loan, year of completing the repayment and the amount of the loan

Purpose of a loan……………………………………………Year of obtaining…………………

Year of completing the repayment……………………….. Amount……………………………

PLEASE ATTACH YOUR BUSINESS REGISTRATION CERTIFICATE, COPIES OF IDS OF THE BUSINESS OWNER(S), AND ANY STATUTORY REQUIREMENTS (PIN, TCC ETC)

6) References (3) not family members:

Name of the referee / Contact details – physical location, telephone, email
I
II
III

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete, and that I am a private sector businessperson or civil society organization not affiliated with any governmental or political organization.
Name
Signature
Date

If you were assisted to fill the application form, let the person assisting declare below;

Reason for assisting.
Name
Signature
Date
Telephone

Draw and explain directions to your business premises/work station giving relevant land marks, street names and towns if someone is coming from Nairobi CBD.

Thank you for taking your time to fill this form and expressing interest in ThriiveCapital. We wish you success in your application.