UGANDA INVESTMENT AUTHORITY APPLICATION FOR AN INVESTMENT LICENCE? (FORM 1) "te pletion Farm foran investment Licence can be erased on our website (wan. ugméalnvesgoul. 110 ul 12 13 14 1s 16 1 DETAILS OF THE APPLICANT [Nam of Company/Businese——- 8) Physical adaess: Contact Person 8) Physical address ofthe contact person ‘Legal frm of business entity (Lid Liability company, Partnership, sole proprietorship, coopeeatve society ete, Project sitefLocation~ ‘Company Shareholders: Name of % shareholder shareholding Indicate th secondary licences required (ek) ‘Banking lcence—- Education licence fishing licence Drugs manufacturing Mining licence--~- Transport lcence-— [Land status forthe Projet: Does the company require land from UIA? Yes(),No( )yes, please indicate the estimated size of land... (hectares or area) and lection: ovate a 2.0 Projected Fixed Capital Investment Costs (USS) Tem Year Year2 Years Total Land, Building & Civ work Plant, Machinery & Equipment Transport (vehicle) Office equipment Furniture Installation cost Pre-operaiing Total Investment costs 2.1 Source of Funding (USS) State how the company wil reise funds required forthe project. Tem Fi Toeal ‘Share capital (equi TLoen capital ‘Other sources (Spec Toul (USS30 EMPLOYMENT DETAILS: Speci the numberof jobs tobe created witen the project is imlemented inte following categories Category of employees Foreign Local Total ‘Manageral/Supev “Tesinial ‘®) Slate he specific positions tbat wil be Sled by expatriate tai 5) State how fong it wil ake to replace the expatiate staff? 40 MARKET Domestic & Export) Indicate which market will ebsos the anticipated productoutput of your company. of Total Domestic market Export markt 5.0 Source of Inputs ‘State the percentage of inputs which willbe soured: ‘Local Import ‘Incase of imported inputs name the country where thay have been sourced. eg. Indi China etc % %6.0 Declaration I hereby centify that the foregoing particulars are correct to the best of my knowledge ‘Name: Copies ofthe following documents should be attached to the Application: ‘Legal status (Copy of Certificete of Incorporation and Articles & Memorandum of Association from URS8) + Abr Business Proposal onthe Project (not less than 5 pages) ‘+ Evidence of avalability of funds forthe Project, which could be @ Bank statement for the Company/shareholders + Land status forthe Project (Attach o copy ofthe land tle ora tenancy agreement to confirm location ofthe Project). + Passport Photocopy of Foreign directors {Filled in Application Farm for an Investment Licence (Form UIA), other Additional documents Bill of facing to confirm importation of machinery (exceptional Cases) 2, Copy of the secondary Licence issued by the relevant Government Minstry/Departinent or Agency 3. Environmental impact Assessment Report/Certifeate of Approval by VEMA ‘To be submitted to or as may be specified: Escetve Dreetor sans Investment Authority ‘TWED Plase 0 Box 7418 Fa 256-414 342903 En nfuwandinwes..ue ‘Website: rns ugandsinvest gn.