| » Application Form |
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| 1- Full name of the Applicant(s): (person, firm, etc.) |
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| b. |
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| c. |
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| 2- Legal status of the Applicant(s): |
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| 3- Nationality and legal domicile of the applicant(s) (full address) : |
| a. |
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| a) Tel |
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| a) Fax |
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| a) E-mail |
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| a) WebSite |
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| b. |
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| b) Tel |
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| b) Fax |
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| b) E-mail |
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| b) WebSite |
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| c. |
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| c) Tel |
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| c) Fax |
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| c) E-mail |
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| WebSite |
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| 4- Countries in which the Applicant(s) has implemented similar projects: |
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| 5- References (banks, industrial and business personalities): |
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| B. The Project: |
| 6- Title of the Proposed Project/Activity in which the Applicant(s) intends to invest: |
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| 7- Project description and objectives: |
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| 8- Project Status: |
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| 9- Project Location: |
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| 10- Total Project cost, including working capital: |
| Fixed cost: |
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| Working capital: |
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| Total: |
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| 11- Applicant's contribution to the project cost (The Foreign Capital): |
| Equity capital: |
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| Shareholder's loan/credit: |
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| Total: |
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| b) Foreign share (percentage) in the equity capital of Direct Investment Enterprise: |
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| c) Terms and conditions of the sharehloder's loan(s)/credit(s): |
| Amount |
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| Rate |
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| Repayment Period (in years) |
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| No. of Installments |
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| 12- Terms and conditions of planned or anticipated foreign loan(s)/credit(s) |
| Amount |
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| Rate |
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| Repayment Period (in years) |
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| No. of Installments |
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| Lender |
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| 13-Type of Foreign Capital to be contributed to the Project by the Applicant(s): |
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| 14- Local Funding (if applicable): |
| Local equity capital: |
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| Local loan(s)/credit(s): |
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| Total: |
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| b) Name of local shareholders/parties( firms or persons): |
| a. |
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| b. |
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| c. |
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| 15- Project Implimentation Timetable (Key Milestones): |
| a. |
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| b. |
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| c. |
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| d. |
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| e. |
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| 16- List of main permits, clearances and licenses required to be obtained from lranian official authorities: |
| a. |
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| b. |
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| c. |
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| 17- Contact person information: |
| Name: |
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| Title: |
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| Company: |
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| Address: |
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| Tel: |
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| Fax: |
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| E-mail: |
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| Date & Time |
9/6/2010 8:47:47 PM |
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