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ENTREPRENEUR PARTNERSHIP & FUNDING SUPPORT PROGRAMME - CAMEROON II

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Entrepreneur Intake, Expression of Interest and Initial Consent Form

Lead Organisation: EasyPlan Limited
Implementation Partners: Yibicare African Entrepreneurship Foundation and Planify Business School
Programme: Entrepreneur Partnership and Funding Support Programme
Purpose of this form
This form collects information to assess applicants, understand their business ideas or existing businesses, identify support needs, facilitate genuine business partnerships where appropriate, and provide business development and funding application support.
Instructions to applicants
☐ Complete all applicable questions accurately and provide genuine, verifiable information.
☐ Read the acknowledgements and consent statements before agreeing.
☐ Do not provide email passwords, banking PINs or one-time verification codes.
☐ Submitting this form does not guarantee programme admission, business partner matching or funding.

SECTION A: APPLICANT AND PERSONAL INFORMATION

A1. Last name:

A1. First name:

A2. Email address:

A3. Phone number (WhatsApp):

A4. Date of birth (DD/MM/YYYY):

A5. Country of origin:

A6. Region/State of residence:

A7. Local Government Area (LGA) (Nigeria residence Only):

A8. Town or city of residence:

A9. Residential address:

A10. Highest level of education (select one):

A
B
C
D
E
F
G
H

A11. Major or primary area of study:

A12. Preferred means of communication (select all that apply):

A13. Social media profiles (optional)

SECTION B: IDENTITY AND APPLICANT VERIFICATION

B1. Type of valid identification available (select one):

A
B
C
D

B2. Identification number:

B3. Upload a valid identification document (JPEG, PNG or PDF):

B4. Upload a recent passport photograph (JPEG or PNG):

SECTION C: NEXT OF KIN DETAILS

C1. First name:

C1.5. Surname:

C2. Phone number:

C3. Email address:

C4. Relationship to applicant:

SECTION D: BUSINESS INFORMATION

D1. Proposed or existing business name:

D2. Is your business registered?

A
B
C

D3. Business registration type, if applicable:

A
B
C

D4. Business registration number, if applicable:

D5. Full business address, if available:

D6. Business location - Region/State:

D6. Business location - LGA(for Nigerians Only):

D6. Business location - Town/City:

D7. Business location classification (select one):

A
B
C
D

D8. Business sector or focus area (select all that apply):

D9. Upload business registration certificate, if registered and required (JPEG, PNG or PDF):

D10. What stage is your business at?

A
B
C
D

D11. Briefly describe your business idea or existing business:

D12. What products or services will your business provide?

SECTION E: BUSINESS SUPPORT NEEDS

E1. What types of support do you currently need? (Select all that apply.)

E2. What is your most urgent business support need?

SECTION F: PARTNERSHIP INTEREST

F1. Are you willing to consider establishing a genuine joint business with another entrepreneur?

A
B

F2. Which business sectors/Type would you consider working with?

F3. What skills or experience would you like your prospective partner to contribute?

F4. Are you willing to share responsibilities, maintain proper financial records and participate in joint decision-making?

A
B

F5. Are you willing to discuss and sign a separate written partnership agreement before establishing a joint business or jointly applying for funding?

A
B

F6. Any other information relevant to assessing your suitability for a business partnership?

SECTION G: FUNDING APPLICATION SUPPORT AND AUTHORISATION

G1. Previous funding applications
Have you previously applied for a grant, loan, business competition or other funding opportunity?

A
B

If yes, name the funding opportunity or programme:

What was the outcome?

A
B
C
D
E
G2. Funding support
The programme may assist applicants with identifying suitable funding opportunities, preparing business plans and financial projections, reviewing application documents and submitting applications where permitted by the funder. I agree to provide accurate information, submit required documents promptly and review application drafts. False information, incomplete documents or delays on my part may prevent an application from being submitted.
G3. No guarantee of funding
I understand that funding is not guaranteed and that the relevant funder makes the final decision. The organisations are not responsible for an unsuccessful application solely because funding was not awarded.
G4. Ownership and control of funds
I understand that Yibicare African Entrepreneurship Foundation, EasyPlan Limited and Planify Business School do not acquire ownership of, or access to, my bank account or awarded funds by assisting with my application. Funding is to be paid to the beneficiary designated by the funder. I remain responsible for complying with award conditions.
G5. Fees and expenses
This form does not create an automatic obligation to pay an application fee, commission, success fee or reimbursement. Any proposed charge or expense must be disclosed, agreed separately in writing and comply with the funder’s rules. No organisation is authorised by this form to deduct money from my award or bank account.

G7. Application authorisation
I authorise the organisations to assist with preparing and reviewing my funding applications. Submission on my behalf where required and permitted by the funder. I retain responsibility for confirming the accuracy and state of my application.

SECTION H: PARTNERSHIP AND ORGANISATIONAL PROTECTION ACKNOWLEDGEMENTS

H1. Voluntary participation: Submitting this form does not guarantee programme admission, partner matching, business registration, training or funding.
H2. Genuine business partnerships: I will not knowingly participate in a fictitious partnership, misrepresent business ownership or provide false information to satisfy a funder’s eligibility requirements.
H3. Separate partnership agreement: Any joint business must have a separate agreement documenting ownership, contributions, roles, decision-making, profit and loss sharing, dispute resolution and exit arrangements before establishment or a joint application where required.
H4. No automatic ownership or agency: Participation does not automatically create an employment, agency, joint venture or ownership relationship between me and a participating organisation. Any separate relationship must be established in an appropriate written agreement.
H5. No unauthorised representation: I will not represent that an organisation has endorsed, guaranteed, approved or committed funding to my business unless it has expressly authorised that representation in writing.
H6. Accuracy and verification: I confirm that my information is accurate to the best of my knowledge. Relevant information may be verified for legitimate programme purposes, subject to the Privacy Notice, applicable law and any necessary additional consent.
H7. Programme materials: Templates, training materials and other resources may be subject to intellectual property rights. This does not transfer ownership of my original business idea or confidential business information to the organisations.

Confirmations:

SECTION I: PRIVACY, CONSENT AND COMMUNICATION CHANNELS

I1. Privacy Notice: I acknowledge that I have received or been given access to the programme’s Privacy Notice explaining how my information will be collected, used, protected, retained and shared.

I2. Information sharing: I understand that relevant information may be shared with implementation partners and, where necessary and appropriately authorised, funding organisations or verification providers for legitimate programme purposes.

I3. Business partner matching: I consent to sharing relevant information with potential business partners for matching purposes.

I4. Programme updates.
WhatsApp Channel: I would like to receive programme announcements and updates through the official WhatsApp Channel.

A
B

YouTube Channel: I would like to access business education, training videos and funding-readiness information through the official YouTube channel.

A
B

I5. Publicity consent: I hereby give my consent to the use of my photograph, video and others for publicity.

SECTION J: APPLICANT DECLARATION

J1. Declaration

Applicant's full legal name/Signature: