Online Application

Bellatrix SME Finance

Funding Request Form

We aim to respond to all requests within a 24 hour period Monday-Friday. However if this isn’t the case, simply pick up the phone and inquire the status of your request..

Green Finance Facility
The type of service/facility being applied for.
1. Business Details
Please enter the registered name of your business.
Select the type of entity applying for the loan.
Please enter your business's official registration number.
Please describe the nature of your business.
Physical address of the business.
Postal address of the business.
Please enter a valid email address where we can contact you.
Please enter a valid telephone / mobile number where we can contact you.
2. Economic Sector/Green Space (Applicable only to Term Loans & Guarantees)
The product for which the loan is being applied for.
The amount you would like to borrow
3. Breakdown of Required Facility Amount
PurposeAmount N$
Raw Material
Labour
Transport
Working Capital
Property Acquisition (land/buildings)
Equipment/ Machinery/ Vehicles
Other (specify)
Own Contribution (if any)
Total Amount Required:
4. Liabilities
Do you have any loans at other institutions?
Institution NameTotal Amount (Principal Loan)Monthly Installment (N$)Outstanding Debt Balance (N$)
5. Details of Directors, Shareholder/Member or Beneficial Owners Please note that each member will be required to sign the agreement digitally, upon approval.
Full NameID/Passport NumberResidential AddressDesignation (members, shareholders, directors or trustees)Member Interest/Shares (%)Mobile No.Email
Post Study/ Work Experience/ Academic Background
Name of the MemberInstitution Studied/Course StudiedMost recent EmployerTelephone number of the employer
6. Tender-Based Finance (Applicable only to Purchase Order Finance & Invoice Discounting)
Tender/Contract/Invoice Details
Tender/Purchase Order Description
Purchase Order Number/Invoice Number
Purchase Order Value (N$)/ Invoice Value (N$)
Name of Purchase Order Issuer (Off-taker/Buyer)
Contact Person at awarding entity
Tel/Cell number of Contact Person at awarding entity
Email of Contact Person at awarding entity
Select the type of entity or institution that issued the tender
References (Work Previously Completed)
Employer/Off-takerProject DescriptionProject DurationContact of ReferenceProject Value (N$)Location
7. Social Impact
Number of current temporal employees
Number of current permanent employees
Number of future temporal employees
Number of future permanent employees
8. Collateral and Insurance in Support of the Loan (If Any)
Collateral
Description of collateral/securityEstimated value
Total value of collateral
8. Representative Information
Please enter the representative's full name as it appears on their ID.
Please enter the representative's ID/Passport number.
File Uploads
Upload a certified copy of your ID or passport (not more than 3 months old).
Upload proof of residence such as municipal bills, rental agreement, etc.
Upload the MMSME Certificate.
Upload the registration documents of your entity (Close Corporation, Private Company, or Trust).
Upload a certified copy of your most recent NQF qualification.
Upload proof of registration of CC or sole proprietorship.
Upload a marriage certificate or divorce certificate if applicable.
Upload verifiable letters of reference.
Upload quotations for assets, vehicles, or stock to be financed.
Upload the business plan.
Upload the projected cash flow statement for the duration of the loan for new business (minimum 36 months).
Upload the Good Standing Certificate from SSC.
Upload the Good Standing Certificate from the Ministry of Finance.
Upload the Income Tax Registration Certificate.
Upload the 6 months bank statement for the business (applicable to existing business only).
Upload the 6 months personal bank statement for member/shareholder/sole proprietor/trustee/trust's beneficiary.
Upload the Balance Sheet (Assets & Liabilities) for each member/shareholder/sole proprietor/trustee/trust's beneficiary.
Upload a copy of the life insurance policy if applicable.
Upload a copy of the short-term insurance policy if applicable.