Online Application Form

For Seeking Funds From MIC

Company Name*

Sector*

Purpose of Financing*

Amount Required*
Mauritian RupeeUS Dollars

Contact Person*

Position Held in Company

Contact Person Email*

Company Address*

Company Phone*

Covid-19 Impacted
Maximum size of upload file: 5MB each

Item	Document required
1	Detailed restructuring plan setting out as a minimum the following:
(a)	Overview of the business and its revenue model
(b)	Management team and board composition
(c)	Analysis of the financial statements for the last 3 financial years with detailed explanatory notes on debt/loans taken during that period, purpose, current balance standing and any existing defaults/moratorium granted (If relevant)
(d)	Analysis of key financial and operating indicators for the last 3 financial years
(e)	Fair-valuation/impairment impact of COVID-19 on any investment on the balance sheet of the company/group
(f)	Detailed explanatory note on how COVID-19 has impacted the business and its resulting impact on the income statement and balance sheet of the company/group
(g)	Mitigating solutions implemented by management to date and their financial impact on the business
(h)	Income statement, balance sheet and cash-flow forecast in excel format for the next 5 financial years together with detailed underlying assumptions
(i)	Estimate of funding requirements and proposed repayment terms; and
(j)	Detailed proposal for application of proceeds on a quarterly basis
2	Copy of audited financial statements for the last 3 financial years
3	Latest management accounts, as approved by the board
4	Right of noteholder following conversion, if minority shareholder
5	Right of noteholder following conversion, if majority shareholder
6	Group structure showing shareholders having at least 5% until the Ultimate Beneficial Owner
7	Constitution of the company or each company in the group, as applicable
8	Copies of licences held
9	Copies of existing facility agreements and security agreements
10	Detailed list of fixed assets and most recent valuation reports
11	Copies of key business agreements including administration agreement, management agreement, franchise agreement and licence agreement
12	Copies of contracts with related parties
13	Copies of existing shareholders’ agreements, joint venture agreements or similar agreement
14	Description of rights attached to existing shares of the company
15	Number of employees (other than senior management) broken down by: (a) Working in Mauritius/Working outside Mauritius
16	Number of senior management employees broken down by: (a) Working in Mauritius/Working outside Mauritius (b) Average monthly cost of employment of each employee for calendar 2019; and 2020 (c) Monthly cost of employment of each employee for the months of 2021
17	Details of any proposal to reduce workforce or reduce remuneration/benefits
18	Details of any agreement with employees to reduce workforce or cost of employment and, if any, agreed period of reduction
19	Options (including employee share option schemes) granted in relation to the capital of the company
20	Board resolution for appointment of signatories
21	Mortgage search report on the company duly certified by a public notary.

Infrastructure Projects / Future Generation Projects

Item	Document required
1	Overview of the business and its revenue model
2	Management team and board composition
3	Analysis of the financial statements for the last 3 financial years with detailed explanatory notes on debt/loans taken during that period, purpose, current balance standing and any existing defaults/moratorium granted (If relevant)
4	Income statement, balance sheet and cash-flow forecast for the next 5 financial years together with detailed underlying assumptions in excel format (or more if relevant)
5	Proposed funding structure and estimate of type of facility being requested
6	Detailed proposal for application of proceeds on a monthly/quarterly basis
7	Detailed working financial model in ‘excel’ format of the forecast presented in the restructuring plan
8	Copy of audited financial statements for the last 3 financial years, where applicable
9	Latest management accounts, as approved by the board, where applicable
10	Proposed conversion event and proposed strike, where applicable
11	Right of noteholder following conversion, if minority shareholder, where applicable
12	Right of noteholder following conversion, if majority shareholder, where applicable
13	Group structure showing shareholders having at least 5% until the Ultimate Beneficial Owner
14	Constitution of the company or each company in the group, as applicable
15	Copies of licences held
16	Copies of existing facility agreements and security agreements
17	Detailed list of fixed assets and most recent valuation reports
18	Copies of key business agreements including administration agreement, management agreement, franchise agreement and licence agreement
19	Copies of contracts with related parties
20	Copies of existing shareholders’ agreements, joint venture agreements or similar agreement
21	Description of rights attached to existing shares of the company
22	Number of employees (other than senior management) broken down by: (a) Working in Mauritius/Working outside Mauritius
23	Number of senior management employees broken down by: (a) Working in Mauritius/Working outside Mauritius
24	List of professionals appointed in the project for example quantity surveyor, engineer, etc
25	Timeline of project (construction and operation)
26	Board resolution for appointment of signatories
27	Mortgage search report on the company duly certified by a public notary.

In addition to the application, Please kindly upload the necessary required up to date documents in PDF format only

*Latest audited financial statements.

*5 year forecast income statement, balance sheet and cash flow.

Your Reference number:

ATTENTION
Dear Applicant,
Please provide access to a secured data room for the MIC to this email applications@mic-ltd.mu using your Reference number to avail requested documents in the application check-list within 5 working-days from date submitted.
Incomplete submission of documents will not be processed.

Disclosure and Data protection clauses

I/We declare that to the best of my/our knowledge and belief the particulars given in this form are true and correct. I/we undertake to submit all required document(s) to the MIC as described in the application process within 5 working days from the date of application. I/We undertake to inform the MIC immediately in case any changes arise to the above particulars. I/We authorize the MIC to extract the Company’s MCIB report (Board resolution for appointment of signatories should be provided) I/We certify that I/We have been duly authorized to make this application on behalf of the Company as certified by the Resolution herewith attached. I/We hereby give my/our consent that my/our data will be used for appropriate and necessary collection and processing of my application. Also, I/We hereby acknowledge that necessary consent has been sought from the data subjects, in terms of the Data Protection Act 2017, in regards to the sharing of their personal data/especial categories of data to the MIC. The application will then be directed to the MIC and applicant will receive an automated email that application has well been submitted and is in process and the MIC shall revert.

Date of entry: