CITI MICRO ENTREPRENEURSHIP AWARDS APPLICATION FORM

Completed Form must be submitted to:

Name:    Winnie Edward Terry, Executive Director

TAMFI

Address: _Plot 54A, Uporoto Street, off Bagamoyo Road

P.O. Box 950, Dar es Salaam

Phone: +255 764 668 331

E-mail: info@tamfi.com/ wterry@tamfi.com 

PART 1:   Nominating Microfinance Institution Information

Organization (MFI)

Contact    Chief Executive Officer

Contact    Loan Officer

Phone Number

Email address

PART 2:      Entrant Information (Client of MFI)

Full Name

Gender

Birth Date

Marital Status

No. of Household Dependents

Full Street Address

Phone Number

Email address

PART 3:      Business Information of MFI Client

Location of Business

Type of Business

No. of Business Branches

Monthly Sales (gross)

Total # of Employees

PART 4:      Details of the Business

What has been the key to this microentrepreneur’s success?  (Nini siri ya mafanikio ya biashara yako?)

1-   ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

2-  ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

3- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

4- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------------------

5- ------------------------------------------------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What future plans does the microentrepreneur have for the business?

(Una mpango gani wa baadae kwenye biashara yako?)

1-  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

2-  --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

3- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

4- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

5- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What have been some of the microentrepreneur’s greatest challenges and how have they been overcome?

(Unakumbana na changamoto gani  kwenye biashara yako? Na je? unatumia mbinu gani kuzitatua)

  1. -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

  1. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

  1. -------------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

  1. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

  1. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

How has this business and/or microentrepreneur had a positive impact on his or her family and community? (Nini mchango wa biashara yako  kwenye maisha yako, familia yako na jamii kwa ujumla?)

  1. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

  1. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

  1. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

  1. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

  1. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------