CREDIT LIMIT REQUEST FORM

Registered Name(Insert names as they appear in the Certificate of Incorporation or Registration or Passport/NRC) *:

Legal Character

Private Limited Company

Private Unlimited Comp.

Comp. Ltd by Guarantee

Public Comp.

Partnership

Limited Partnership

Sole Proprietor

Individual

Other

If Other Please Explain

Identification Number

Nationality OR Country of Registration/Incorporation

Passport NRC, Registration or Incorporation Number

Select a file:

TPIN Registrations

Tax Payers ID No (if app.):

Country Reg. (if app.):

Is Applicant VAT Exempt (Tick appropriate below)

YES

Select a file:

Principal/Secondary Businesses :

Physical & Postal Address :

Street

Street 2

City

State :

ZIP

Country *:

Physical Address same as Billing Address

Billing address :

Street

Street 2

City

State :

ZIP

Country *:

Telephone/Fax

Telephone:

Fax:

Directors

Director Name	ID Number	ID Attachment	Telephone No	Email Address

Primary Contact - Events/Procurements

Name

Position

Mobile Number

Email Address

Primary Contact – Finance & Payments

Name

Position

Mobile Number

Email Address

Credit Limit

Credit Limit

Period

DECLARATION BY THE CUSTOMER

We declare that the above information is true and complete and that we fully understand the above terms and conditions and intend to abide by them.

I/We as representatives of the Customer do hereby acknowledge that we are jointly and severally liable for the amounts outstanding in this agreement from time to time.

I/We fully understand that my/our liability is co-extensive with the customer in my/our capacity as co-principal debtor.

I/We further renounce the benefits of excussioniset divisions.

In the event of Approval, the credit facility is extended under the following terms and conditions:

The amount on this facility shall become due within 15 days of the invoice date. The company shall be entitled to charge interest on all payments not made by the due date at the rate of 2% above the prime lending rate charged by the company bankers from time to time, compounded monthly.

The customer shall have 24 hours from date of service to raise any complaints relating to the service. Thereafter, the Company will not entertain any claim whatsoever.

In the event that the Company incurs any costs in recovering overdue amounts in this agreement, the applicant agrees to pay all such costs, e.g., tracing costs, collection commissions, and litigation costs at the legal practitioner’s scale.

It is agreed that these terms apply to all previous transactions with outstanding amounts as of the date of signing this agreement.

The parties choose the above domicilium citandi et executandi (“domicillium”) for all correspondence purposes unless otherwise advised in writing.

The Debtor consents to the jurisdiction of the High/Magistrates Courts of Zambia for any action by the Company arising from this agreement, even if the matter exceeds the ordinary civil jurisdiction of those Courts.

No variation, alteration, or waiver by the Company shall be effective unless in writing and signed by both parties.

The Company reserves the right to withdraw credit facilities at its discretion without needing to state the reason for such withdrawal.

I hereby warrant that I am duly authorized to make this application on behalf of the applicant herein.

Signed at on this day of 20

Name:

Position:

Signature:

Contact No: