SAIRF Application Form

Basic Business Information

Business Name: Business Email: Phone Number: Geographic Location: —Please choose an option—BeninBurkina FasoCameroonCote d’IvoireEthiopiaGhanaKenyaMalawiNigeriaTanzaniaTogoUgandaZambiaOthers (please specify) Products/Services: Years in Operation: —Please choose an option—>5 years2-5 years<2 years Business Address: Industry Sector: —Please choose an option—ExistingNon-existing Registration Number: Business Structure: —Please choose an option—Limited Liability Company (LLC)Sole ProprietorshipPartnershipOther

Financial Information

Annual Revenue: —Please choose an option—>$500,000$300,000 – $500,000<$300,000 EBITDA Margin: —Please choose an option—>25%10% – 25%<10% Debt to Equity Ratio: —Please choose an option—<0.30.3 – 0.8>0.8 Current Ratio: —Please choose an option—>1.5x1x – 1.5x<1x Interest Coverage Ratio: —Please choose an option—>2.5x1.5x – 2.5x<1.5x

Team and Governance

Number of Employees: —Please choose an option—≥20<20 Key Management: Management Experience: —Please choose an option—>10 years5 – 10 years<5 years Independent Directors: —Please choose an option—>30%<30% or no board Audited Accounts: —Please choose an option—Tier 2 & above<Tier 2No audited FS

Impact Metrics

SHF Reach: —Please choose an option—>30050 – 300<50 Gender Inclusion: —Please choose an option—>50%20-50%<20%

Scalability and Growth

YoY Growth: —Please choose an option—>30%10% – 30%<10%

Supporting Documents

Supporting Documents – (Please ensure all documents, including the Business Plan, Management Accounts, Financial Models, and any other relevant files, are compiled into a single ZIP file before uploading. The maximum file size allowed is 10MB.):