Application Form
Islamic Republic ofIran
MinistryofEconomic AffairsandFinance Organization for Investment, Economic andTechnical AssistanceofIran (O.I.E.T.A.I.)
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A. TheApplicant(s):
1-Full nameof theApplicant(s):(individualorfirm)
I...... II...... III......
2- Legalstatusof the Applicant(s):
private state owned other (If other,givemore information):
......
3- Nationalityand legaldomicileof theapplicant(s) (full address): I...... Tel:...... Fax:...... E-mail:...... Website:......
II...... ………......
Tel:...... Fax:...... E-mail:...... Website:...... III...... ………...... Tel:...... Fax:...... E-mail:...... Website:......
4- Countries in which the Applicant(s) has implemented similar projects:
......
5- References (banks, industrial and business personalities):
......
B. TheProject:
6-TitleoftheProposedProject/ActivityinwhichtheApplicant(s)intendsto invest:
......
7- Project description and objectives:
......
......
......
8- Project Status:
New Existing
Note:IncaseofnewprojectssubmissionofcopyoftheEstablishmentLicenseissuedbythe relevantMinistry and/or Government agency is mandatory.
9- Project Location:
......
OIETAI,Tehran-IranP.O.Box:11365/4618,Tel:+982133967755/33967075,Fax:33967864,Website:
Application Form
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10- Total Project cost, including working capital:
(Express in Foreign Currency and specify the Currency unit)
Fixedcost: Workingcapital: Total:
11- Applicant's contribution to the project cost(The Foreign Capital):
(Express in Foreign Currency and specify the Currency unit)
a)
Equitycapital: Shareholder's loan/credit: Total:
b)Foreignshare(percentage)intheequitycapitalofDirectInvestment
Enterprise:
c) Terms and conditions of the shareholder’s loan(s)/credit(s): AmountRateRepaymentPeriod(inyears) No.ofInstallments
12- Terms and conditions of planned oranticipated foreign loan(s)/credit(s) (ifapplicable):
AmountRateRepaymentPeriod(inyears) No.ofInstallments Lender
13-Type of Foreign Capital to be contributed to the Project bythe Applicant(s):
(Express in Foreign Currency and specify the Currency unit)
a) Cash;
b) Machineryand equipments;
c) Tools and spares, CKD parts and raw,addable and auxiliarymaterials;
d) Patent rights, technical know-how, trade marks and names, and specialized services;
Note:
1- IncasetheForeignCapitalisplannedtobeimportedintheformmentionedinitemsbandc
above detailed list of the same be attached herewith if available.
2- IncasetheForeignCapitalisplannedtobeimportedintheform mentionedinitemdabove detailedinformationalongwithanydocumentation regarding the valuation or registration of the same in the home country of the foreign investor or a third country also must be attached.
14- Local Funding (if applicable):
(Express in Foreign Currency and specify the Currency unit)
a)
Localequitycapital: Localloan(s)/credit(s): Total:
b) Name of local shareholders/parties (individual or firm): I...... II...... III ......
OIETAI,Tehran-IranP.O.Box:11365/4618,Tel:+982133967755/33967075,Fax:33967864,Website:
Application Form
15- Project Implementation Timetable (KeyMilestones):
1.
2.
3.
4.
5.
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16- List of main permits, clearances and licenses required to be obtained from lranian official authorities:
Title/DescriptionOfficialagencyinchargeI...... II...... III ......
17- Contact person information: Name:
Title: Company: Address: Tel:
Fax:
E-mail:
18-Theapplicantisrequired toprovidethe followingdocuments alongwith the completed application form at the time of submission of the application to the OIETAI (please tick):
AcoveringletterbytheApplicant(s)addressedtotheOIETAI,statingApplicant’srequestfor approval under the FIPPA.
ShortresumeofApplicant(s),Corporatebrochuresandrecentannualreports(AuditedFinancial
Statements) and the same for the local direct investment enterprise if applicable.
In case of individual applicant(s),copy of valid passport is required.
Copy of the Joint Venture Agreement (if applicable).
Original copy of power of attorney for the person signing this form.
Anyotherdocumentdeemedtobehelpful. (express the title of document)
Having read the Foreign Investment Promotion and Protection Act (FIPPA) as well as its implementing regulations, I, ...... as authorized by thepowerofattorney enclosed/inmy capacity as………..…..(title/company), confirmthattheinformationsubmittedinthisformiscredibleandis,inno part, intended to be misleading.
OnbehalfoftheApplicant(s):
Name: Title: Company: Signature:
Date: ...... Stamp
Onbehalfofthelocalshareholder(s):
Name: Title: Company: Signature:
Date:...... Stamp
Note: Thisformshouldbesubmittedintypewritten.Incasethespace designated for eachquestion ofthe applicationformisnotsufficienttocovertheanswers,theApplicant(s)arekindly requested toattach additional pages as required.
OIETAI,Tehran-IranP.O.Box:11365/4618,Tel:+982133967755/33967075,Fax:33967864,Website: