| SECTION 1: PERSONAL INFORMATION |
|
| FIRST NAME | MIDDLE NAME | LAST NAME |
| DATE OF BIRTH | NATIONAL INSURANCE NUMBER | ELECTRONIC MAIL ADDRESS |
| HOME ADDRESS | | |
| HOME PHONE NUMBER | WORK PHONE NUMBER | CELL PHONE NUMBER |
| NATIONALITY | CITIZENSHIP |
| SECTION 2: BUSINESS INFORMA TION |
|
| BUSINESS NAME | ADDRESS | LAST NAME |
| TELEPHONE NUMBER | FASCIMILE NUMBER | ELECTRONIC MAIL ADDRESS |
| BUSINESS WEBSITE URL | | |
| SOCIAL MEDIA ACCOUNTS | | |
| (Please select all applicable) | | |
| 1 FACEBOOK | 1 INSTAGRAM |
| 1 TWITTER | 1 LINKEDIN |
| 1 NONE | 1 OTHER |
| A. TYPE OF OPERATION (Please select the appropriate box as applicable) |
| 1 CORPORATION | 1 LIMITED LIABILITY PARTNERSHIP |
| 1 SOLE PROPRIETOR | 1 PARTNERSHIP |
| 1 LIMITED LIABILITY COMPANY | 1 OTHER |
| B. REGISTRATION DETAILS (Please tick as applicable, **Supporting Documentation is required**. Please see Attached Checklist) |
| 1 CERTIFICATE OF INCORPORATION | 1 CERTIFICATE OF REGISTRATION |
| C. NATURE OF BUSINESS (Please tick where applicable and provide brief details below): |
| 1 NEW | 1 EXISTING |
| 1 RESTAURANT | LOCATION |
| 1 BAR | LOCATION |
| 1 RECREATIONAL FACILITY | LOCATION |
| Type of Facility |
| 1 CAMP SITE | 1 WATERFALL | 1 MUSEUM |
| 1 GARDEN | 1 SPA | 1 OTHER |
| 1 ACCOMMODATION | LOCATION |
| Accommodation Type | |
| 1 HOTEL | 1 BED & BREAKFAST |
| 1 VILLA | 1 APARTMENT |
| 1 COTTAGE | 1 OTHER |
| 1 GUEST HOUSE | |
| SECTION 3: PROJECT DET AILS |
|
| 1 CONSTRUCTION | 1 RENOVATION/ REFURBISHMENT |
| 1 EXPANSION | 1 OTHER |
| A. SERVICES NEEDED (Please indicate the type of services required) |
| 1 FINANCIAL SUPPORT |
| 1 BUSINESS SUPPORT |
| 1 OPERATIONAL SUPPORT |
| 1 MARKETING SUPPORT |
| 1 OTHER |
|
| SECTION 4: CERTIFICATION (Please tick or state where applicable) |
|
| A. Fire Certification | 1 YES | 1 No | Comments |
| | | |
| B. Liquor Licence | 1 YES | 1 No | Comments |
| | | |
| C. Public Health Measures Certificate | 1 YES | 1 No | Comments |
| | | |
| D. Other | | | Comments |
|
SECTION 5: PROFESSIONAL REFERENCES
(Signed and stamped or letterhead copies required) |
| References (Please provide two references) |
| FULL | COMPANY |
| TELEPHONE NUMBER | ELECTRONIC MAIL ADDRESS | RELATIONSHIP |
|
| FULL | COMPANY |
| TELEPHONE NUMBER | ELECTRONIC MAIL ADDRESS | RELATIONSHIP |
| CTA Confidential Partnership Agreement Form Code |