INVESTMENT cODE
tECHNICAL fORM

TRADING NAME:

Revision: / 19/07/13

File received by:

File instructed by:

INVESTMENT CODE

TECHNICAL FORM

I-IDENTIFICATION DE L’ENTREPRISE

  1. Trading Name:
  2. NINEA:………………… RC:…………………. CODE PPM:……………..
  3. Manager’s last & first name:………………………………………………….
  4. Headquarters (exact adress):

Tel:…………….. Fax:……………. Email: ………………………………

  1. Foreign address:

Town: …………………… Country:…………………………………………………..

Tel:…….…………....… Fax ………………………. Email ………………………..

  1. Activity to approve:………………………………………………………………..
  2. Juridical nature:

Corp L.L.CSUP EIG IE Other

  1. Production Site (exact address):……………………………………………
  1. Actual workforce (only extension projects concerned):

…permanents … ...casual labour

  1. Share capital:…………………………FCFA
  2. local percentage…………………………………..%
  3. foreign percentage……………………………….%

Foreign capital origins / Percentage
  1. Partnership

- Do you have a partner?yes no

- If yes, which kind?Technical Financial Commercial

- Are you looking for a partnership? yes no

- If yes, which type?Technical Financial Commercial

  1. Multinational

- You are filial of a multinational? yes No

- If yes, specify the name of the multinational and its activity sector

………………………………………………………………………………………………………………………………………………………………………………………………………………

-Multinational head office

Exact address…………………………………………….……………………………………

Tel: …………………....…Fax ………………………. Email ………………………..

  1. Financing search

- Have you acquired the financing?yes no

  • Is it stockholders? yes no
  • Is it loans? yes no

- If yes, which financing company is providing for it?

……………………………………………………………………………………………………

- If no, where did you apply for it? ………………………………………………………………………………………

  1. Project site

- Do you have a site for your project? yes no

- if yes:

  • What is the surface?

……………………….…………………………………………………….

  • What is the nature of the occupation? (land title n°, lease, rent allocation, attribution etc.)

………………………………………………………………………………

- if no:

  • What is the area of the targeted site?

………………………………………………………………………………

What kind of steps did you take to obtain a site?

……………………………..………………………………………………………

II –PROJECT PROFILE

  1. Activity Sector:
  2. Nature of the investment:

Creation / Extension / Modernization / Completion / Revaluation
Delocalisation / Diversification / Renovation
  1. Previous agreement (s)

Date & n° / Nature / Approved amount / Realised amount / Expected jobs / Created jobs

III –Projects costs and financing

  1. Project costs
  • First establishment fees(Preliminary expenses: solicitor etc.) ……….…..FCFA
  • Ground/Land: ………………………………………………… FCFA
  • Arrangements/Installations:………………….……………….. FCFA
  • Constructions(Buildings, Ships, Shed): ………………. FCFA
  • Fixed equipment: …………………………………….. FCFA
  • Works and services (initial expenses and other
  • Works and services): ………………………………. ….FCFA
  • Hardware:………………………………………………FCFA
  • Utility vehicles:……………………………………… FCFA
  • Tourism vehicles………………………………………………… FCFA
  • Working capital(sur 3 mois):………………………...... FCFA
  • Others:…………………………………………………………………FCFA

INVESTMENT TOTAL:………………………………….FCFA

  1. Schéma du total des investissements:

- Stockholder’s equity:……………………………………………………….FCFA

- Loan (s):………………………………………………………………..FCFA

IV - EXPLOITATION

  1. Technical elements

-Probable exploitation beginning(month/year): ……………………

Creation / Extension
Proposed products list: / ………………………………………
……………………………………..
…………………………………….. / ………………………………………
……………………………………..
……………………………………..
Services proposed list: / ………………………………………
……………………………………..
…………………………………….. / ………………………………………
……………………………………..
……………………………………..
Production capacity/ Accommodation facilities / service (by day, month or year): / ………………………………………
……………………………………..
……………………………………..
……………………………………… /
  • actual:
…………………………………….
………………………………………
  • to install:
………………………………………….
………………………………………….

-Raw materials

  • Principal inputs:
  • In which proportion does the principal input enter the final product composition?

- Technical aspects

  • Good Production

Main stages of the manufacturing process:……………………………………………………………………………………………………………………………………………………………………………………………………

  • Services provided

Nature: …………………………………………………………….

Intervention process stages (steps): …………………………………………….

……………………………………………………………………………………………...

  1. Specific Technical elements:

Infrastructures

(Commercial complexes, harbour, railway and airport infrastructures)

  • Project principal components:

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………

……………………………………………………………………………………………..

  • Targeted goals:

……………………………………………………………………………………………

…………………………………………………………………………………………….

……………………………………………………………………………………………

………………………………………………………………………………………………

Agriculture

- Available area...……………………………………………..…………………

- Wheat-sowed area...……………………………………………..…………………..

- Water sources.………...…………………………………..……………………

Cultures /

Areas

/ Output (T/Ha)

Breeding

  • Species: ……………………………………………………………………………………
  • Touristic transportation (equipment technical characteristics, considered circuits):……………………………………………..…………………………
  • Projects - subjects by rotation:……………………………………………..…………….
  • Production cycle:……………………………………………..…………………………

Tourism

  • Hotel trade (Components of the susceptible):

……………………………………………………………………………………………………

  • Touristic transportation (equipment technical characteristics, considered circuits; (specify the means of transportation used for every circuit, as well as the duration): …………………………………………………………………………………

………………………………………………………………………………………………..

  • Gambling activities (existence of a basis or a susceptible hotel): …………….

………………………………………………………………………………………………….

  • Catering

Number of tables:……………………………………………………………………

Available area:……………………………………………………………………

V –EMPLOYMENT FORECAST

QUALIFICATIONS

/

EFFECTIFS

/ PAYROLL CHARGES (millions de F CFA/year)
Local / Other / Total / Local / Other / Total
Executive staff
Superior technicians and junior staff
Technicians and mastership agents
Employees, qualified workmans and apprentices
TOTAL PERMANENT WORKERS
SEASONAL WORKERS

Specify the country of origin for the foreign personal: …………………………….

VI - TURNOVER

  • 1st year: ……………………………………………………………………. FCFA
  • 2nd year:………………………………………………………………………FCFA

VII - PRODUCTION TO EXPORT(only concerns good production)

- Targeted markets: ………………………………………………………

- Percentage of the exported production: …………………………

  • 1st year:
  • 2nd year

I declare all information in conformity with the truth. Any false declaration might lead to the agreement’s withawal.

In Dakar, on

Signature

Name and function

Name or Trading name: ………….. …………………………

Amount of the investment to approve: ……………………………FCFA

Immobilization’s value: ……………………………………….. FCFA

Address: …………..…………………………….. …………………….

Tel:…………….……… Fax: ……………………email: ……………

EQUIPMENT AND MATERIAL LIST

Tariff position / Title (Description) / Quantity / CIF value / Tax rates (%) / Tax (FCFA)

PROJECT FORM

COMPANY NAME
LEGAL STATUS (LIMITED COMPANY, SURL, PP, GIE, Subsidiary of multinational etc.)
SHARE CAPITAL(in FCFA)
REPARTITION (local and foreign %, foreign capital origins)
TYPE OF APPROVAL (Investment Code or Free Export Company)
DATE OF FILING
PROMOTER’S PROFILE
NAME OF (of the) LEADER(MANAGER) S)
FUNCTION (OFFICE) (Manager / Managing director / Administrator (Director) etc.)
FOREIGN ADDRESS
NATIONALITY(if foreign promoter)
PREVIOUS ACTIVITIES (nature activity and name of the structure carrying the previous activities)
CURRENT ACTIVITIES (nature activity and name of the structure carrying the current activities)
PROJECT
NATURE OF THE INVESTMENT (creation / extension etc.)
AMOUNT OF THE INVESTMENT
MAIN INVESTMENTS
- Ground
- Arrangements(Developments)
- Constructions
- Fixed Exploitation materials (nature)
- Works and services(departments)
- Computer hardware
- Vehicles and utilitarian machines (nature)
- Vehicles of tourism
- Needs for financing of exploitation(operation)
BUSINESS PARTNERS (partners and country of origin)
TECHNICAL PARTNERS (partners and country of origin)
FINANCIAL PARTNERS (partners and country of origin)
SOURCE OF FUNDING / Stockholders' equity : ...... %
Loan (s): ...... %
Préciser l’origine des emprunts…………………………….
AVAILABILITY OF GROUND OF PLATE (if yes: surface, nature of the occupation authorization and place. If not: initiative undertaken for the obtaining of a ground of plate)
BUSINESS SECTOR
DATE STARTING UP OF the PROJECT
PERIOD OF the BEGINNING OF OPERATIONS
PRODUCTS / SERVICES PROPOSED
AIMED MARKET
PROJECTED TURNOVER (of which in the export) / 1st year:
2nd year:
JOBS / Number of permanent jobs(uses) planned for the project: … … …
Number of jobs(uses) created in the starting up of the project(National and foreign):……………
If the number of necessary employees used cannot be reached at the starting up, which is the reason?
Insufficient financial means
Required skills difficult to find
Extension with no job creation
Other: Spécify…………………………………………………………………………………………………………………………
CLASSIFICATION OF JOBS(USES)
Senior executives:
Senior technicians and middle managers:
Technicians and supervisors:
Used, skilled workers and apprentices:
Seasonal workers:
Motivations and opportunities for the project
ADDRESS AND PHONE NUMBER(COORDINATES)
Head Office address: / Tel office:
Tel mobile:
Fax:
Email:
Website :

APIX SA REGIONAL REPRESENTATIONS

-APIX SAINT LOUIS

  • Soda DIOP BA

Regional Representative APIX Saint Louis

CNCAS, Quai Henri Jay, Sud

Saint-Louis

Tel: 33961 14 14 / 33961 14 05

Fax: 33961 23 73

-APIX ZIGUINCHOR

  • Eugène DIEME

APIX Ziguinchor

CNCAS, Rue du Commerce BP 289

Tel: 33991 66 13

Fax: 33991 19 56

-APIX TOUBA

  • Bintou DIAGNE

Regional RepresentativeAPIX Touba

CNCAS, Touba Khaïra, route 28, rue de la Grande Mosquée

Tel: 33 978 34 88

Fax: 33 978 34 89

-APIX KAOLACK

  • Mamadou SOW

Regional RepresentativeAPIX Kaolack

CNCAS, 4 Place de l’Indépendance

Tel: 33942 24 25

Fax: 33942 24 26

-APIX TAMBA

  • Cheikh Tidiane TOURE

Regional RepresentativeAPIX Tamba

CNCAS, Avenue Demba DIOP

Tel: 33981 16 16

Fax: 33981 16 19

INVESTMENT CODE – TECHNICAL FORM / 1