WEF - Fiji Development Bank

FDB Loan for Women Entrepreneurs

APPLICATION FORM

TYPE OF BUSINESS

Type of Business

Sole Trader Partnership Joint Ventures Cooperative Company

Required Field

DETAILS

Courtesy Title	First Name	Surname	Date of Birth
Required Field	Required Field	Required Field	Required Field Format

Gender	Residential Address	Province	Nationality
Required Field	Please leave blank if not applicable	Required Field	Required Field

Postal Address	Name of Business	Business Location	TIN
Required Field	Required Field	Required Field	1. New Applicant – provide TIN (only digits - without dashes) 2. Re-application – provide reference number (only digits) 3. Further Loan - provide account number Required Field

Home Phone	Mobile Number	Business Contact	Email
Please leave blank if not applicable	Required Field	Required Field	Required Field Please check if there is a space at the end of the email address

FNPF Number	Driving License Number	Nearest Branch	Marital Status
Please enter valid FNPF Number or leave blank	Please leave blank if not applicable	Required Field	Required Field

Spouse Name	Spouse Contact	Number of Dependents	Age of Dependents
Please leave blank if not applicable	Please leave blank if not applicable	Required Field	Please leave blank if not applicable

Current Occupation	Educational Attainment	Income
Required Field	Required Field	$0,- $5,000 $5,001- $10,000 $10,001- $20,000 $20,001- $30,000 $30,001- $50,000 $50,001+ Required Field

BANK DETAILS

Bank Account/MyCash/M-PAiSA Name	Bank Account/MyCash/M-PAiSA Number	Bank Name
Required Field		Required Field

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) Required Field

JOINT APPLICANT

JOINT APPLICANT 1 DETAILS

Courtesy Title	First Name	Surname	Date of Birth

Gender	Residential Address	Province	Nationality

Postal Address	Name of Business	Business Location	TIN
			Maximum 12 Characters

Home Phone	Mobile Number	Business Contact	Email
Please Enter Number	Please Enter Number	Please Enter Number

FNPF Number	Driving License Number	Marital Status
Please Enter Number	Please Enter Number

Spouse Name	Spouse Contact	Number of Dependents	Age of Dependents
	Please Enter Number

Current Occupation	Educational Attainment	Income
		$0,- $5,000 $5,001- $10,000 $10,001- $20,000 $20,001- $30,000 $30,001- $50,000 $50,001+ Required Field

APPLICANT 1 BANK DETAILS

Bank Account Name	Bank Account Number	Bank Name

APPLLICANT 1 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)

JOINT APPLICANT 2 DETAILS

Courtesy Title	First Name	Surname	Date of Birth
			Format-mm/dd/yyyy

Gender	Residential Address	Province	Nationality

Postal Address	Name of Business	Business Location	TIN
			Maximum 12 Characters

Home Phone	Mobile Number	Business Contact	Email
Please Enter Number	Please Enter Number	Please Enter Number

FNPF Number	Driving License Number	Marital Status
Please Enter Number	Please Enter Number

Spouse Name	Spouse Contact	Number of Dependents	Age of Dependents
	Please Enter Number

Current Occupation	Educational Attainment	Income
		$0,- $5,000 $5,001- $10,000 $10,001- $20,000 $20,001- $30,000 $30,001- $50,000 $50,001+

APPLICANT 2 BANK DETAILS

Bank Account Name	Bank Account Number	Bank Name

APPLLICANT 2 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)

LOAN DETAILS

Loan Type	Loan Classification
New Customer Further Loan (FDB Existing Customer)	Business

Loan amount sought from Fiji Development Bank	Provide brief details (Short Paragraph) on the Purpose of loan
(Disclaimer: The loan amount requested will not necessarily be the amount that is approved which is subject to the Bank’s assessment which can influence your insurance cover) Required Field, minimum amount is $1,000 and maximum amount is $10,000

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Brief background of Business
Required Field

OTHER BORROWING

Financial Institution	Loan Balance ($)	Monthly Repayments
Required Field	Numbers only	Numbers only
Required Field	Numbers only	Numbers only
Required Field	Numbers only	Numbers only
Required Field	Numbers only	Numbers only
Required Field	Numbers only	Numbers only

Tower Parametric Insurance Cover:

Note: $1000 is applicable for $75 premium for Eastern & Central Division and $95 for Northern & Western Division and so forth for the $2000 and $3000 premium.

Please select your preferred sum insured and premium amount based on the region where your business is located:
Required Field

UPLOADS

Photo ID (Voter Identification Card/Passport/Driving License/Joint FRCS/FNPF Card ) *

Birth Certificate *

TINLetter *

Valid Business registration certificate for 3 years /Certificate of business license/Health license or Canteen license /Market master letter/Letters from - SPBD, Ministry of Women, Provincial Councils and Women Entrepreneurs Council (WEBC). *

Current utility bills – this would be utility bills for the business for proof of address. *

Bank statement/MPaisa or MyCash Business Transaction statement: New loans - 3 months or more. Further loan for existing customers - 12 months or more. *

Others Upload 1

Others Upload 2

Others Upload 3

Others Upload 4

Others Upload 5

(A loan decision will not be made unless these documents are uploaded here.)

DISCLOSURE

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:

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.
Required Field

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

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.
Required Field

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

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

I/We have read and understood the General Terms and Conditions (Revised-effective from 13/7/23) of the FDB Loans for Women Entrepreneurs specified under www.fdb.com.fj and agree to abide by the terms and conditions.
Required Field

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).
Required Field

UNDERTAKING

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

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 Required Field

Agree to the mandatory terms and conditions of the Bank towards the Parametric Insurance Cover.
Required Field

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.
Required Field

The Fiji Development Bank (FDB) does not collect personal information for commercial marketing or distribution to any
private organizations, except for reporting with the Reserve Bank of Fiji.