Application for Investment Land Page 1 Page 2 Page 3 Page 4 Twitter UGANDA INVESTMENT AUTHORITY APPLICATION FOR AN ALLOCATION OF INVESTMENT LAND (UIA FORM 2) *** Please Note: The form will not proceed to the next page until all mandatory questions are answered **** 1.0 DETAILS OF THE APPLICANT 1.1 Company or Business Name * Physical Address of Business * 1.2 Contact Person Name * Email * Mobile * Telephone * Physical Address * 1.3 Legal form of business entity * Ltd Liability Company Partnership Sole Proprietorship Cooperative Society Other Other Legal Form of Business entity 1.4 Proposed Business Activity * 1.5 Company Shareholders Select Number of Share Holders * OneTwoThreeFourFiveSixSeven Name of Share Holder 1 * Nationality * % shareholding * Address * 1.6 Indicate the anticipated period within which the project will be implemented * 1.7 Indicate the amount, location (in Acreage) and nature of land required for the project * 1.8 Indicate the infrastructure facilities required for implementation of the project 1.9 Indicate whether an Environmental Impact Assessment shall be required for the project 1.10 Indicate other investment projects (if any) implemented by the Company 2.0 Projected Fixed Capital Investment Costs (US$)in project requiring this land: ITEM YEAR 1 YEAR 2 YEAR 3 TOTAL (US$) Land land cost in Year 1 Land Cost in year 2 Land Cost in year 3 Total Land Costs Building & Civil Works Building cost in year 1 building Cost in year 2 Building Cost in year 3 Total building cost Plant, Machinery and Equipment Machinery Cost in year 1 Machinery cost in year 2 Machinery cost in year 3 Total Machinery cost Transport (vehicle) Transport cost in Year 1 Transport cost in Year 2 Transport cost in Year 3 Total Transport Costs Office Equipment Office costs in Year 1 Office costs in Year 2 Office costs in Year 3 Total Office Equipment costs Furniture Furniture costs in Year 1 Furniture costs in Year 2 Furniture Costs in Year 3 Total Furniture cost Installation Costs Installation costs in Year 1 Installation costs in Year 2 Installation Costs in Year 3 Total Installation costs Pre-operating Costs pre-op costs in Year 1 Pre-op costs in Year 2 Pre-op costs in Year 3 Total Pre-op Costs Total Investment Costs total Investment costs in Year 1 total investment costs in Year 2 Total investment costs in year 3 Grand Total Investment costs 2.1 Source of Funding (US$) a) Indicate how the lease premium and ground rent will be paid b) State how the company will raise funds required for the project. ITEM FOREIGN LOCAL TOTAL (US$) Share Capital (equity) foreign share capital Local Share Capital Total Share Capital Loan Capital Foreign Loan capital Local loan Capital Total loan Capital Other Sources (Specify) Other foreign sources Other local sources Total other Capital sources Total (US$) Foreign Funding total Total local funding Grand total 3.0 EMPLOYMENT DETAILS Specify the number of jobs to be created when the project is implemented in the following categories: FIRST YEAR SECOND YEAR FULLY OPERATIONAL CATEGORY OF EMPLOYEES Foreign Local Total foreign Local Total Foreign Local Total Managerial/Supervisory year 1 Foreign Managers year 1 Local Managers year 1 Total Managers year 2 Foreign Managers year 2 Local Managers year 2 Total Managers Foreign Managers Fully Operational Local Managers Fully Operational Total Fully Operational Managers Technical year 1 Foreign Technical year 1 Technical Local year 1 Tecnhical total Foreign Technical Year 2 local Technical Year 2 Total Technical Year 2 Foreign Technical Fully Operational Local Technical Fully Operational Total Fully Operational Technical Administration/Accounts year 1 Foreign Admin year 1 Local Admin year 1 Total Admin Foreign Admin Year 2 Local Admin Year 2 Total Admin Year 2 Foreign Admin Fully Operational Local Admin Fully Operational Total Fully Operational Admin Semi-skilled Year 1 Foreign Semi-Skilled year 1 Local Semi skilled year 1 Total semi skilled Foreign Semi skilled Year 2 Local Semi Skilled Year 2 Total Semi skilled Year 2 Foreign Semi Skilled Fully Operational Local Semi skilled Fully Operational Total Fully Operational Semi Skilled Unskilled year 1 Foreign Unskilled year 1 Local Unskilled year 1 Total Unskilled Foreign Unskilled Year 2 Local Unskilled Year 2 Total Unskilled Year 2 Foreign Unskilled Fully Operational Unskilled local Fully Operational Total Fully Operational un-skilled TOTAL Foreign first year total Local first Year total first year total staff Year 2 total Foreign Staff Local second year total Second year total staff Foreign total fully Operational staff total Local fully Operational staff Fully Operational total staff a) State the Specific positions that will be filled by expatriate staff i) Short term (1st & 2nd Year) ii) Long term (After 3rd year & Beyond) b) State how long it will take to replace the expatriate staff? 3.1 State any other benefits that the project will bring to the economy or community 4.0 MARKET (Domestic & Export) Indicate which market will absorb the anticipated product/output of your company % of total Annual Output Domestic Market Export Market 5.0 Source of Inputs State the percentage of inputs which will be sourced Locally (in %) Imported (in %) In case of imported inputs name the country where they have been sourced e.g. Germany, USA, China, India, etc 6.0 Declaration I hear by certify that the foregoing particulars are correct to the best of my knowledge Name * Copies of the following documents should be attached to the Application: *** Permitted file types include pdf,jpg,png,gif,jpeg ** ** Each File attachment should be less than 1 MB *** 1. Legal Status (Copy of Certificate of incorporation and Articles & Memorandum of Association from URSB) * 2.The Company's Investment Licence (issued by UIA) 2. A Detailed Business Plan of the project * 3.Evidence of availability of funds or ability to raise funds to implement the Project (which could be a Bank statement for the Company/Directors or a commitment letter from the Bank * 4. Evidence of Investor's track record in terms of experience in implementing similar or related investment projects in the past 5.Preliminary architectural layout of the proposed facilities (giving details of proposed land utilization) 5. Passport Photocopy of foreign Directors *** Please note: This form will only submit successfully if the correct file types have been selected***
