Scorecard DD Questionnaire

Nithio Loan Application

Filling in the form below will help us better understand your company's profile and move forward in the lending process.

Financing Overview
Financing needed (in USD)
Intended Use of Proceeds of Financing

Solar Home System/Productive Use Asset Receivables Solar Home System/Productive Use Asset Inventory Other: (please describe)
Company Overview
Full Legal Company Name
List all Founder(s)
Year of Incorporation
Country of Incorporation

Street Address

Street Address Line 2

Country of Incorportation
Please share the address of the Company's headquarters.

Street Address

Street Address Line 2

City

Postal / Zip Code Country
Briefly describe principal activities/revenue streams of the Company:
e.g. Sales of SHS on cash basis, financing PUA etc.
Please briefly describe the Company's comparative advantage.
Please briefly describe the Company's growth and expansion plans.

Financial Information
Is your primary operating currency USD?

Yes No
If not, please describe any FX managing strategies used by your company.
Please provide the following information regarding your auditor(s).
What type of financing has the Company accessed previously?

Debt Grant Equity
Please list all previous debt financing partners and terms.
Please list all previous grant financing partners and terms.
Please list all equity financing partners and terms
Please upload your Year to Date ("YTD") Management Accounts.

Cancel of
Please upload your last 3 Years of Audited Financials (consolidated and audited) of Company or Group.

Cancel of

Management Team and Organization
Please provide the total years of industry experience for the top 3 members of the team.
(In most cases, this would be the: CEO/Director, CFO/Finance manager, COO/Risk manager or equivalent.)
Please provide the total years of experience in a senior leadership role for the top 3 members of the team.
(In most cases, this would be the: CEO/Director, CFO/Finance manager, COO/Risk manager or equivalent.)
Please provide the total years of management experience for the CFO/Finance Manager of the team.
Please list the members of your management team, their country of residence, and LinkedIn profile link (if available):
Please upload the resumes of the management team

Cancel of
Please list the members of your Company's Board, their primary affiliation, shareholder status, and LinkedIn profile link (if available):

Review and Submit

Please review all your answers carefully and make any corrections required before you finalize your submission.
Please confirm the following statements:

I acknowledge that this application will allow Nithio to assess my company’s suitability for financing and does not guarantee or imply a commitment to provide funding, nor a representation that such funding will be made available to me or my company. I hereby confirm that all information I have provided is accurate and correct to the best of my knowledge.
Should be Empty:

Nithio Loan Application