Small Business Grant Form

Section 1

Applicant Information

Street Address *

City *

State/Province *

Business Phone *

Business Email *

Website

Primary Contact Name *

Title/Role

Contact Phone *

Contact Email *

CAC Registration Number *

Year Established *

Section 2

Business Overview

Brief Business Description *0 / 200

Industry/Sector *

Number of Employees (Full Time) *

Number of Employees (Part Time) *

Is your business currently operational? *YesNo

Annual Revenue (Last Fiscal Year) *

NGN

If no, please explain *

Does your business serve or represent any of the following? *Does your business serve or represent any of the following?Women-OwnedRural-BasedOther

If Other *

Section 3

Grant Request Details

Requested Grant Amount *

NGN

Purpose of Grant Funds *0 / 300

Expected Outcomes *0 / 200

Timeline of Project/Initiative *

Have you received other grants or funding for this project? *YesNo

Source *

Amount *

USD

Purpose *0 / 300

Section 4

Financial Information

Attach Profit & Loss Statement (Last 12 Months)

No file chosen

Attach Recent Balance Sheet

No file chosen

Attach Cash Flow Statement

No file chosen

Attach Budget Breakdown for Proposed Project

No file chosen

Current Outstanding Debt (if any)

NGN

Describe the financial health of your business *0 / 150

Section 5

Supporting Documents

Upload Business Plan (optional but strongly recommended)

No file chosen

Upload Proof of CAC Registration *

No file chosen

Upload Any other relevant documents

No file chosen

Upload Up to 2 Letters of Support

No file chosen

Section 6

Declaration & Signature

I certify that all information provided in this application is complete and accurate to the best of my knowledge. I understand that providing false or misleading information may result in disqualification. If awarded, I agree to comply with all grant conditions, including monitoring and reporting obligations. *YesNo

Full Name *

Title/Position *

Upload Signature *

No file chosen

Date *

The Olufunmilayo Adebisi Richardson-Allen (Née Benson) Business Grant

Section 1

Applicant Information

Section 2

Business Overview

Section 3

Grant Request Details

Section 4

Financial Information

Section 5

Supporting Documents

Section 6

Declaration & Signature