Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697797406425.pdf (Dominica)
For Office Use Only Training recommended: Date Approved/Declined: Reason: By: For Office Use Only Participant invited to <training ID> on <dd/mm/yyyy> by <staff name> via email / phone (circle) Dominica Youth Business Trust Loan Guarantee Fund Application Form PHOTOGRAPH OF APPLICANT Name ..............................................................

Date of Birth .......... / .......... / .....................
Address ........................................................... Marital Status ............................................... Telephone ....................................................... Social Security # ........................................... Email .............................................................. Children [ ]Males [ ]Females 1.

Name and Location of Enterprise: ……………..........………………………………………………………… ………………………………………………………………………………………………………………...... 2.
Type of Business: ……………………………………………………………………………………………… 3. Business Partners: ……………………………………………………….…………………….……………….

4. Business Status: Pre-start Trading 4a.

If Trading, business start-up date: .......... / ........ / .............. 5.

If business is Trading, number of employees (including owner): ...................................................................... 6.

Education level: No formal education Less than High School High School College University/higher 7.
Training/experience acquired to undertake your business venture: …………………………………….…….. ………………………………………………………………………………………………………………..... 8.

Duration of training: ………………………...…………………………..…………………………………….. 9.

Training Institution: ……...……………………...…………………………………………………………….. 10.

Current Employment details: .............................................................................................................................. 11.
Amount of loan being requested: ……….....................…………………………….…………….…………… 12.

Primary purpose of loan:……………………………….………………………............……………………… 13.

Financial Institution where loan is to be processed: ……...…..……………………………………...……….. 14.

Have you taken any loans in the past?

Yes ……….….. No …………….. 15.

Financial Institutions where loans were processed: ...………………………………………………………… 16.

What is your credit status?

Good …………….

Fair …………….. Poor …………….….

17.

How did you hear about us?


................................................................................................................................ 18.

Referee # 1: …………………………………………………… Telephone ………..………………………… # 2: …………………………………………………… Telephone ………………………………….. ………………………………… APPLICANT’S SIGNATURE ……………………………… DATE