Membership Application

Section 1 > Company Details

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Company Name in Full *

Registration No.

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Postal address: *

Telephone No. *

Fax No. *

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Physical address: *

Website address:

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Contact person (One name only): *

Email: *

Designation: *

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Number of full-time staff: *

VAT Number: *

Partners/Directors (Max. 6 names, provide a brief resume of each person)

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1. First Name: *

2. First Name: *

3 First Name: *

4 First Name: *

5 First Name: *

6 First Name: *

Surname: *

Email: *

Section 2 > Company Management Details

a. Type of Company *

b. Total capital under management / advised

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As at the end of 20 *

USD *

As at the of 20 *

USD *

c. Number of portofolio companies

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As at the end of 20 *

USD *

As at the end of 20 *

USD *

d. Total capital invested

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As at the end of 20 *

USD *

As at the end of 20 *

USD *

Section 3 > Investment preferences Across All Funds Managed

a. Investment amount

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Minimum amount USD *

Maximum amount USD *

b. Type of Financing Preferred (Max. 3 types)

Checkboxes

c. Type of Industries Preferred (Max 6)

Checkboxes *

Section 4 > FUNDS MANAGED

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Fund Name *

Name *

Capital of Fund in USD *

Numbers

Numbers *

Section 5 > Membership Fees

The membership fee for Full Membership is determined according to size of fund.

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Membership Type

Checkboxes

F4 Size of fund above USD 50million.
F3 Size of fund above USD 10million and not exceeding USD 50million
F2 Size of fund below USD 10million
F1 Associate Member

Membership Fee

USD 2,500 per annum excl VAT

USD 1,500 per annum excl VAT

Membership fee is payable annually. Members wishing to cancel membership must give at least 1 month notice prior to 1 January.

a. Please provide reasons for wanting to become memeber of East AFrica Venture Capital Association *

b. Where did you find out about East Africa Venture Capital Association *

We hereby confirm that we have acquainted ourselves with the East Africa Venture Capital Association Memorandum and Articles of Association and Code of Conduct and agree to:-

1. Abide by the East African Venture Capital Association Memorandum and Articles of Association and Code of Conduct;
2. Complete the questionnaire for the Annual East African Venture Capital Association Industry Survey.

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Name *

Signature *

Title *

Date *

The Articles of Association and Code of Conduct available on the website: www.eavca.org

Membership Application Form

Section 1 > Company Details

Partners/Directors (Max. 6 names, provide a brief resume of each person)

Section 2 > Company Management Details

b. Total capital under management / advised

c. Number of portofolio companies

d. Total capital invested

Section 3 > Investment preferences Across All Funds Managed

a. Investment amount

b. Type of Financing Preferred (Max. 3 types)

c. Type of Industries Preferred (Max 6)

Section 4 > FUNDS MANAGED

Section 5 > Membership Fees

The membership fee for Full Membership is determined according to size of fund.

Membership Type

Membership Fee

Membership fee is payable annually. Members wishing to cancel membership must give at least 1 month notice prior to 1 January.