Corporate – Loan Application Form

Bank Account Details

(Your Bank Account Name and Details Should Correspond with Company Name)

Loan Request Information

Authorized Signatory (1)

Authorized Signatory (2)

Attestation

I hereby certify that the information contained in this application is true, correct and provides a full and complete pictureof myfinancial position. FUSION CAPITAL PARTNERS LIMITED is authorized to verify all information disclosed and to performall creditinvestigation as maybe required from my employers, relatives and/or bankers in other to consider this application. I alsoconfirmthat details on my credit/loan status may be availed to an approved credit bureau subscribed to by FUSION CAPITAL PARTNERSLIMITED and all cost borne by me. I understand that my request may be declined based on a negative report fromcredit reportsafter I might have been debited for such search. I further authorize FUSION CAPITAL PARTNERS LIMITED to give credit informationtoadvise others about my credit experience with FUSION CAPITAL PARTNERS LIMITED. As an integral part of this application, l consentto credit life insurance cover being arranged to cover the facility. I understand and accept that the insurance policy maynotcoverallforms of disability or death. lt is also agreed that my financial statement shall remain the property of FUSIONCAPITAL PARTNERSLIMITED whether or not the credit is granted and that all documentation will be maintained to protect my confidentialityinaccordance with all applicable legal or regulatory requirements. Notwithstanding the insurance cover, I understandandagreethatIam personally liable to FUSION CAPITAL PARTNERS LIMITED for the credit facility, interest, insurance, premiums, charges, feesand/or penalties. I also confirm that I have read and understood and agreed to be bound by the terms and conditions of thefacilityI understand that FUSION CAPITAL PARTNERS LIMITED shall contact me via the stated e-mail address to acknowledgemyloanapplication as this shall not be a guarantee that the loan will be granted I understand and agree to pay the upfront interest at the rate specified in the loan offer letter only to the bank account of FUSIONCAPITAL PARTNERS LIMITED before the loan is disbursed, as FUSION CAPITAL PARTNERS LIMITED shall not be liable for anyinterestpaid into the account of any other party / individual.