Participant Application Form

Sponsored in the framework of the 10th European Development Fund (EDF)

Regional Private Sector Development Programme (RPSDP)

DOMINICANA MODA 2013

Santo Domingo, DominicanRepublic, October 21-26, 2013

  1. GENERAL INFORMATION: (Please print)

Contact Person: / Position:
Company Name:
Address:
City: / Year Co. Established:
Country: Zip Code: / No. of Employees:
Tel: / E-mail:
Fax: / Web Site:
LEGAL STATUS – (Check One)
Co-operative / Ltd. Liab Co. / Partnership / Private Co. / Public Co. / Sole Owner / State Owned Corp.

2.TYPE OF COMPANY – (Please tick all that apply)

Manufacturer / Service Company / Exporter / __
Importer

3.INDUSTRY SECTOR (Please tick all that apply)

 Agribusiness
(fresh & processed) /  Apparel and Footwear /  Chemicals and Plastics /  Food and beverages
(Alcoholic & non-alcoholic) /  Furniture
(wood, metal, rattan, etc.)
 Handicraft
(Gift & decorative items) /  Cultural Industries
(Music, audio visual, fashion, etc.) /  ICT and Computer-Related Services /  Construction and Related Engineering Services /  Educational Services
 Financial Services /  Health and Wellness /  Tourism /  Professional Services
(Consulting, Legal, etc.) /  Recreational, Cultural and Sporting Services
 Research and Development Services /  Other please specify:______

4. YOUR COMPANY’S MAJOR NEEDS

Please prioritize your company’s major needs for which assistance is required. These needs may be related to the current proposal submission and may include,potential supplier of raw materials, supplier of finished goods, an opportunity to provide information on your products to a new market segment etc.
(i) ______(iii) ______
(ii)______(iv) ______

5. CORPORATE BUSINESS BACKGROUND

a. What is your company’s mission statement?
b. How is the current proposal aligned with your company’s goals and objectives?
c. Describe your company’s financial position (i.e. assets and liabilities)
d. What overseas markets has your company penetrated?
e. Has the number of markets penetrated increased in the last 3 years? Yes ☐ No ☐

FOR EXPORTERS

6.PRODUCT/SERVICE OFFERING

  1. Briefly describe each product/service that your company offers?
  1. Does your company plan to offer any new product(s) in the next 3 years?
Yes ☐ No ☐
  1. Does your company and your product (s) comply with the relevant international standards, such as ISO, CE (EU) etc?
Yes ☐ No ☐
  1. What strategies have you implemented to maintain consistency in the quality and supply of the products you export or intend to export?

  1. Are your inputs/raw materials sourced from within the region?
Yes ☐ No ☐
  1. Have you identified any other international and local trade fairs in which your company could participate? Yes ☐ No ☐
If yes, please list: ______
______
  1. Identify any potential partnerships and/or outlets for your company’s products/services in any export market you would like to target.
______
______
  1. Are you aware of any potential barriers to selling the product/service in the new target market? Yes ☐ No ☐
If yes, please specify: ______
(i) Are you interested in meeting with local/regional distributors? Yes ☐ No ☐
(j) Please state the product (s) you are interested in selling and the quantities you are currently able to supply ?
______
______

7.REVENUE SALES

(a) ANNUAL REVENUE: (Please state in US$) ______
(b).EXPORTS: (Please state percentage of annual revenue generated from exports?)
 Over 75% /  50-75% /  25 - 50% /  25 – 5% /  Less than 5%
(c) REVENUE FORECAST (FOR THE NEXT 3 YEARS): (Please state in US$) ______

FOR IMPORTERS/BUYERS

(a) Are you a Distributor ☐ Wholesaler ☐ Retailer ☐ Other ☐
(b) If Other, please specify ______
(c ) Please indicate annual sales by placing a tick in the applicable box.
Up to US$49,999 ☐ US$50,000-US$99,999☐ US$100,000 – US$249,999☐ US$250,000 – US$999,999☐ US$1,000,000 – US$4,999,999☐ Over US$5,000,000 ☐
(d) Are you interested in meeting with local/regional producers/suppliers? Yes ☐ No ☐
(e) Please state the product (s) you are interested in buying and the quantities?
______
______
(h) Please state the frequency with which you will require supplies
______
(i) Any other special requirement(s) ______

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