Business Advisory Services (BAS) Moldova

Moldova BAS Office 10th floor, 63 Vlaicu Pircalab Street Sky Tower building Chisinau MD-2012 Moldova Tel: + 373 22 211 614 Fax: +373 22 235 224 Email: basmoldova@ebrd.com Web: www.ebrd.com/sbs/moldova

Project application
Enterprise information
Details:
Full enterprise name: Address: Tel: Email: Name of Director: Year of establishment: VAT/TAX ID (if applicable): Registration number: Post code: Fax: Website: Directors official position (if different): Annual turnover (EUR):

Employees:
Total number of employees: Number of female employees:

Industry:

Description of enterprise (history, products, services, client, volumes and main developments):

Structure of ownership (distribution of shares or units in %):

Local Foreign Female % % %

Product or services and their share of income:

% % % % Export %

History of enterprise establishment (last 5-10 years):

Year No. of employees Annual turnover (EUR) Significant milestones (privatisation, restructuring, implemented industry standard etc)

Investments (please provide information on credits used by company):

Year Name of credit institution Amount (EUR) Interest rate p.a. Status (active, repaid, required)

Project description
Description of business problem (definition of the main problem(s) to be solved by the project):

Type of business advice required:

Expected business development results:

Proposed consultant (if you have a consultant for the work, please provide company name, contact details, name of responsible person):

Expected start date:

Duration:

Employee responsible for project from your company:

Name: Address: Tel: Email:
Note: The provision of a grant is subject to the discretionary decision of EBRD and remains subject to the conclusion of an agreement between EBRD and the Enterprise, in form and substance satisfactory to the EBRD; All information in respect of BAS projects (including but not limited to the general description of the project and description of the consultant), enterprises and their activities obtained by EBRD during and/or as result of these projects may be made publicly available (through EBRD website for example).

Title: Post code:

Signed by: Date: Signature:

How did you learn about BAS? Website Consultant Previous client Visibility event

Residential office referral BAS team Other (please specify)

Has your enterprise used consultancy in the past, if yes, please specify:

Note: Any and all of the information listed below requested by the EBRD and provided by the client within the framework of a BAS project is strictly confidential.

BAS application checklist: BAS application form Copy of Registration Certificate Certificate of Ownership for majority shares (extract from Charter or Memorandum of Establishment) Copy of Annual Financial Statements for the previous TWO years (income statement, cash flow, balance sheet) stamped by company