ACCOUNT APPLICATION FORM

GENERAL INFORMATION
Insert names as they appear in the Certificate of
1 Registered Name Incorporation or Registration or Passport/NRC

Tax Payers ID No (if app.)

VAT No. (if app.) Turnover Tax No. (if app.)

Complete applicable Please attach VAT
information in boxes Exemption Certificate
2 Tax Registrations provided or tick where (if applicable)
Is Applicant VAT Exempt instructed
(Tick appropriate below)

YES NO

Insert principal and

3 Principal/Secondary secondary business
Businesses

Insert Physical and

4 Physical & Postal Address Postal Address of
Head Office

Telephone Fax
Insert main Head
Office telephones and
5 Telephone/Fax fax numbers in boxes
provided

NAME ID NUMBER TELEPHONE NO EMAIL ADDRESS

Directors
6
And

Shareholders

Name Position
Note: Unless changed
by you in writing,
7 Primary Contact - Complete applicable AGROFUEL shall
information in boxes consider any Order
Purchasing Mobile Number Email Address (Work) provided or tick where received from this
instructed person as having
been validly issued

Name Position
Note: Unless changed
by you in writing,
8 Primary Contact – Complete applicable AGROFUEL shall
information in boxes consider any
Finance & Payments Mobile Number Email Address (Work) provided or tick where correspondence
instructed received from this
person as having
been validly issued

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 FINANCIAL, COLLATERAL REFERENCE INFORMATION – ONLY FOR CREDIT CUSTOMERS
BANK DETAILS Auditor Firm Name .

Name of Principal Auditor

Name of Account Manager Principal Auditor – Tel No.

Banking, Auditor and

1 Asset Details Details Account Manager – Tel No. Principal Auditor – Email
/ Email

Credit amount / quantity required for:

Please request the amounts Allowable credit limit shall be
Fuel: Min ___________Max__________ in ZMW for days and periods required. We lower of requested credit term
2 Product and credit currently offer up to 30 days and valuation of collateral
Terms Requested credit period on truck spares
Spares: Min ___________ Max__________ in Liters for and up to 7 days on diesel.
___ days

3 Details of Bank Guarantee

Bank Name &

Address –
Guarantee amount Period
Contact Person
and Phone number
(From the Bank)

Creditor No. 1 - Name Creditor No. 2 - Name

Note: Completion of this
Section indicates your
Credit Limit – ZMW VAT Credit Limit – ZMW VAT authority for AGROFUEL to
Inc. Inc. contact the Trade References
Trade References and enquire as to your
4 Complete applicable dealings with them
Max, Credit Limit - Period Max. Credit Limit - Period information in boxes provided

Creditor Fin. Manager - Creditor Fin. Manager -

Name Name

Creditor Fin. Manager – Tel Creditor Fin. Manager – Tel

No No

 I hereby warrant that I am duly authorized to make this request on behalf of the applicant herein
 I hereby warrant that the information herein submitted is true and correct as at the date hereof

Signed at __________________________ on this ________ day of ______________________________ 20 ____________

Name: ______________________________________________ Position: ____________________________________________________

Signature: __________________________________________ Contact No: _________________________________________________

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Required Documents: - (Cash Customers)

 TPIN Copy,

 Certificate of Incorporation.

 PACRA Copy.

Required Documents: - (Credit Customers)

 Bank Guarantee as per the provided template

 Completed Credit Purchase agreement.

 Bank reference letter.

 Two trade reference letters.

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