ApplicationForm-DFL

TYPE OF BUSINESS

Type of Business *

Sole Trader Partnership Joint Ventures Cooperative

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PERSONAL DETAILS

Courtesy Title *	First name *	Surname*	Date of Birth*
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Gender*	Residential Address	Province*	Nationality*
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Postal Address	Name of Business*	Business Location*	TIN Number (Digit Only)*
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Home Phone	Mobile Number*	Business Contact*	Email Address*
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FNPF Number	Driving Licence	Nearest Branch*	Marital Status*
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Spouse Name	Spouse Contact	Number Of Dependent(s)*	Age Of Dependent(s)*
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Current Occupation*	Educational Attainment*	Income*
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BANK DETAILS

Bank Name*

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Bank Account/My-Cash/M-Paisa Name *

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Bank Account/My-Cash/M-Paisa Number *

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DISABILITY

Are you living with any form of disability?* (Disclaimer: Please note that FDB will only share statistical data with the Reserve Bank of Fiji. FDB does not discriminate against any form of disability)

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JOINT APPLICANT 1 PERSONAL DETAILS

Courtesy Title *	First name *	Surname*	Date of Birth*
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Gender*	Residential Address	Province*	Nationality*
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Postal Address	Name of Business*	Business Location*	TIN Number (Digit Only)*
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Home Phone	Mobile Number*	Business Contact*	Email Address*
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FNPF Number	Driving Licence	Nearest Branch*	Marital Status*
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Spouse Name	Spouse Contact	Number Of Dependent(s)*	Age Of Dependent(s)*
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Current Occupation*	Educational Attainment*	Income*
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JOINT APPLICANT 1 BANK DETAILS

Bank Name*

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Bank Account/My-Cash/M-Paisa Name *

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Bank Account/My-Cash/M-Paisa Number *

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JOINT APPLICANT 1 DISABILITY

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JOINT APPLICANT 2 PERSONAL DETAILS

Courtesy Title *	First name *	Surname*	Date of Birth*
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Gender*	Residential Address	Province*	Nationality*
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Postal Address	Name of Business*	Business Location*	TIN Number (Digit Only)*
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Home Phone	Mobile Number*	Business Contact*	Email Address*
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FNPF Number	Driving Licence	Nearest Branch*	Marital Status*
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Spouse Name	Spouse Contact	Number Of Dependent(s)*	Age Of Dependent(s)*
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Current Occupation*	Educational Attainment*	Income*
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JOINT APPLICANT 2 BANK DETAILS

Bank Name*

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Bank Account/My-Cash/M-Paisa Name *

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Bank Account/My-Cash/M-Paisa Number *

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JOINT APPLICANT 2 DISABILITY

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LOAN DETAILS

Loan Type*

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Loan Classification*

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Loan amount sought from Fiji Development Bank *

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Provide brief details (Short Paragraph) on the Purpose of loan *

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Brief background of Business*

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OTHER BORROWING

Financial Institution	Loan Balance ($)	Monthly Repayments

DECLARATIONS

Are you/or any of your company directors/shareholders an Un-Discharged Bankrupt, under Official Receiving Order or has assigned total personal or business estate for the benefit of creditors?

Is the company /or any related company under Receivership?

Have you /or any directors/shareholders of the company been involved in a company that was liquidated or under Receivership?

Has any application for any loan to any bank ever been declined?

UPLOADS

Photo ID (Fiji Voter Card, Driving License, FRCS/FNPF card, Tin letter etc., *
Birth Certificate *
Business Registration (If applicable)
Support Letter and registration from Fiji Cooperative Dairy Company Limited *
Evidence of Past production for past 2 years i.e., statement of milk production *
Support Letter and Brucellosis/tuberculosis latest record result from Ministry of Agriculture *
Right of Land Use: Title or current lease to be used by proposed projects. *
Latest receipt of confirmed Lease Rental payment *
Quotations and Detailed costs (if applicable)
Quotations and Detailed costs (if applicable)
Quotations and Detailed costs (if applicable)
Sales and Purchase Agreement (if applicable)
Valuation Report (if applicable)
Others (if applicable)
Others (if applicable)

DISCLOSURE

I/We certify that the information contained in this application and in all continuation tabs and attachments is true, accurate and complete in every particular.

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I/We authorize FDB staff to view my/our personal details for the purpose of loan appraisal.

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I/We authorise FDB to obtain credit and/or other related checks that may be required regarding my/our accounts and financial arrangements from my/our Bankers or other Financial Institutions or my/our Creditor or other search platforms.

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I/We authorize FDB to conduct credit checks on Credit Information Reporting Agency (CIRA).

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I/We authorize FDB to share my/our details with the Reserve Bank of Fiji for the purpose of reporting.

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I/We have read and understood the General Terms and Conditions of the Dairy Farming Loan specified under www.fdb.com.fj and agree to abide by the terms and conditions.

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By submitting this loan application and if successful, my/our subsequent acceptance of the loan offer together with the funds disbursed to me/us by FDB, is an absolute confirmation of my/our acceptance of the terms, charges and conditions outlined in Schedule 3 Acknowledgement of FDB’s Rights on Default, Schedule 4 Acknowledgement of Financial Advice, Schedule 5 Statement of Declaration and Authority by Borrower(s), Schedule 6 Acceptance Note, Schedule 7 Surety Acceptance Note and the Fees and Charges (if applicable).

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The Applicant’s attention is drawn to Section 41 of the Fiji Development Act 1966 which reads:

“If you willfully fail to disclose any material information within your knowledge, or willfully make any statement which you know
to be false or does not believe to be true, for the purposes of securing a loan from, or any investment in any form by, or assistance
in any form or any facility from the Bank, you shall be guilty of an offence and on conviction shall be liable to a fine not exceeding
one thousand dollars or to imprisonment for a term not exceeding two years, or to both such fine and imprisonment”.

FIJI DEVELOPMENT BANK

PLEASE READ THIS CAREFULLY BEFORE SUBMITTING THE FORM.
BY CLICKING SUBMIT YOU ARE AGREEING TO THE FOLLOWING:

UNDERTAKING

I/We, hereby undertake to fully repay the loan advanced to me/us by the Fiji Development Bank under Dairy Farming Loan together with all interest payable for the purpose of loan and its associated terms and conditions mention under www.fdb.com.fj

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I/We are aware that FDB shall retain the right to undertake legal recovery and enforcement proceedings against me/us if we fail to honour this undertaking

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I/We agree that all legal costs associated with pursuing a breach of the Undertaking will be borne by me/us on an indemnity basis.

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FIJI DEVELOPMENT BANK PLEASE READ THIS CAREFULLY BEFORE SUBMITTING THE FORM. BY CLICKING SUBMIT YOU ARE AGREEING TO THE FOLLOWING:

FIJI DEVELOPMENT BANK

PLEASE READ THIS CAREFULLY BEFORE SUBMITTING THE FORM.
BY CLICKING SUBMIT YOU ARE AGREEING TO THE FOLLOWING: