MDV Biotech Application Form

8/8/2019 MDV Biotech Application Form

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Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)

Level 5, Bangunan Bank Industri1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.debtventures.com


Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my

SECTION A : APPLICATION

Thank you for your interest in Malaysia Debt Ventures Berhad (MDV). TheApplication Form is divided into seven (7) sections and these are:-

Sections Information

1 Applicant Particulars

2 Shareholding Structure

3 Organisation Structure

4 Products/Services

5 Summary of Key Financial Results

6 Type of Financing Facility & Funding Requirements

7 Declaration

INSTRUCTIONS FOR COMPLETION

1. Please refer to the application checklist to cross check that you have submittedall required supporting documents/information to the Application Form and BusinessPlan.

2. Please ensure that you have completed and submitted attested copies of thestatutory declaration furnished together with the Application Form and BusinessPlan.

3. Note that the application shall be valid for a period of twenty (20) working daysfrom the date of receipt by MDV of the fully completed Application Form, or for such

other extended period(s) as shall be prescribed by MDV at its absolute discretion(the Validity Period). In the event the information furnished with the ApplicationForm is incomplete, and the Validity Period has expired, a fresh application wouldneed to be submitted.

4. If you need further information on our products and offer, kindly visit our website atwww.mdv.com.my or contact our Business Consultants at 603-2617 2888.
http://www.debtventures.com/http://www.debtventures.com/


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SECTION 1: APPLICANT'S PARTICULARS

Company name

Categorisation as SME(Yes/No)

Company registrationnumber

Date of incorporation/Commencement ofbusiness

Principal activity(ies)

Industry focus(See Attachment 1)

Name of holdingcompany(if applicable)

Company address(Office andManufacturing/Operational facilities, ifapplicable)

Company contactnumber

Company fax number

Company website URL

Contact person andposition

Direct line / mobile

Contact email address

For MDV use only:Name Date

Consultant :

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Reference number :

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SECTION 2 : SHAREHOLDING STRUCTURE

EQUITY STRUCTURE (1) % Shareholding

Malaysian Owned

Bumiputra

Non-Bumiputra

Sub-total of Malaysian Owned

Foreign Owned (if any)

Total 100%

If foreign owned, please indicate country

Name of foreign equity partner(s)

EQUITY STRUCTURE (2)

Shareholders No. of shares %

TOTAL 100%

* Please attach a list should the above table is not sufficient.

SECTION 3: ORGANISATION STRUCTURE

LevelNumber of Staff

Malaysian Foreign Total

Director

Managerial

Technical / IT

R&D

Marketing/Sales

Clerical/Administrative

Non-clerical/General

Others (please specify)

Total

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BOARD OF DIRECTORS

Directors Nationality No. of

shares

%

** Please append a complete list should the above table is not sufficient.

SECTION 4 : PRODUCTS/SERVICES

* May be substituted with product/service brochure.** Please append a complete list should the above tables are not sufficient.

PRODUCTS/SERVICES DESCRIPTION *

Product Name/Service Type Product/Service Description

1

2

3

LIST OF CLIENTELE (Existing/Proposed)

Client Name Product/Service Description Value(RM)

% ofSales

1

2

3

LIST OF SUPPLIERS (Existing/Proposed)

Supplier Name Product/Service Description Value(RM)

% ofCost of

Goods Sold1

2

3

4


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SECTION 5 : SUMMARY OF KEY FINANCIAL RESULTS

FYEAudited

FYEAudited

FYEAudited

Turnover

Gross profit/(loss)

Profit/(loss) before taxation

Profit/(loss) after taxation

Total assets

Net tangible assets

(Total assets minus Intangible assetsminus Total liabilities)

Issued & Paid up capital

Total equity/shareholders funds

(Paid up capital add Unappropriatedprofits OR minus Accumulated losses

add reserves)

Bank borrowings

(outstanding amount)

NOTES (For further details on the above, where relevant)

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SECTION 6 : TYPE OF FINANCING FACILITY & FUNDING REQUIREMENTS

FINANCING REQUIRED

Infrastructure & Equipment Financing

ApplicationRM ________________

or Ringgit Malaysia

Please proceed to Section6A

Working Capital Financing

ApplicationRM ________________

or Ringgit Malaysia

Please proceed to Section6B

Contract/Project Financing

Application RM ________________

or Ringgit Malaysia

Please proceed to Section6C

MDV Equipment & Infrastructure Financing is to finance the acquisition andconstruction of land/building, equipment and fittings for laboratory, R&D and/ormanufacturing facilities, including financing of interest accrued during construction.

MDV Working Capital Financing is to fund and assist in the purchase business assets,

to meet business expenses, in particular to enable applicants to meet their operatingexpenses, purchase inventory, receivables financing.

MDV Contract/Project Financing is to fund purchase of a project's major inputs forcontracts/projects that are dependent on medium to long-term contracts from sponsors.The facility may also provide for short to long term financing to companies awardedcontracts to construct and complete biotechnology infrastructure.

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SECTION 6A : EQUIPMENT & INFRASTRUCTURE FINANCING

Purpose RM000 %

Land

Building

Equipment

Lab/Scientific

Production/Manufacturing

Office

Other (Please specify)

IT Systems/Computers

Motor Vehicles

Furniture & Fittings

Other (Please specify below)

Total 100%

Tenure (period)of loan requested

Collateral offer

(Please select atleast one)

Assignment of contract proceeds

Debenture

Joint & several guarantee by directors

Corporate guarantee by holding/parent/related company

Assignment of intellectual property rights


1. Address and Description of Land and Building:

2. Names of Suppliers and Product(s) supplied:

3. Other detail and information:

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SECTION 6B : WORKING CAPITAL FINANCING

Facility RM000

Working Capital Financing required


Collateral offer

(Please select atleast one)

Assignment of contract proceeds

Debenture




Operational Track Record

FYEAudited

FYEAudited

FYEAudited

Total Current Assets

Total Accounts Receivables

Total Inventories


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SECTION 6C : CONTRACT/PROJECT FINANCING

Please append additional sections should there be more than one (1) project.

PROJECT (.)

Project name orTitle of contract

Project sponsor/Contract awarder

(if applicable)

Contact personfrom Projectsponsor/ Contractawarder

(if applicable)

Value

Timeframe ofProject

Supplier(s)engaged fordeliverables

PROJECT (.)

Type of facilityrequested

(Please choose atleast one and tickaccordingly)

Revolving Project Line

Guarantee to Banks

Loan amountrequested


Collateral offer(Please select atleast one)

Assignment of contract proceedsDebenture




* If there are more than one (1) project, please copy this section and complete aform for each individual project.

** Please append other relevant information and/or details should the abovetables are not sufficient.

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SECTION 7 : DECLARATION

I/We hereby declare that to the best of my/our knowledge and belief, the particularsand information furnished in the form are correct and true.

I/We, hereby declare that neither the Company nor any of the Companys director,shareholder and/or employee, has paid and/or made and/or offered to pay and/ormake, or will at any time hereafter pay and/or make and/or offer to pay and/or make,any fees and/or other form of incentive / inducement, whether in cash or in kind, toany employee, director and/or shareholder of Malaysia Debt Ventures Berhad and/or to

any third party intermediaries to expedite this application and/or to procure theapproval of this application by Malaysia Debt Ventures Berhad.

I/We hereby acknowledge that the Company is liable to pay only such fees as shall beexpressly notified in writing by Malaysia Debt Ventures Berhad.

Signature

Name and Position

Companys Stamp/Seal

Date

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Attachment 1

Industry Focus Definitions

Focus Area Description

Natural ProductCompany

A company involved in agricultural biotechnology and healthcarebiotechnology industries that utilises biotechnology processes toleverage upon Malaysias biodiversity and natural resources,undertakes process/product improvements to add value tocommodity products, or produces/modifies foods and higher valueingredients

Medical Devicesand Diagnostics A company that designs, develops and manufactures instruments,apparatus, implements, other similar or related article intended foruse in diagnosis of disease, or in the cure, mitigation, treatment, orprevention of disease

ContractManufacturingOrganisations

A company offering manufacturing services to pharmaceuticaland/or bio-pharmaceutical industries with capacities ranging fromvolumes for pre-clinical processes to full-scale commercialmanufacturing

ContractResearch

Organisations

A Company that undertakes product development and formulation,clinical trial management, central laboratory services for processingtrial samples, data management services for preparation of New

Drug Application (NDA) and/or relevant complementary services

IndustrialBiotechnology

Company

Industrial Biotech Companies that develops enzymes and/or biologicelements for the Bioprocessing for fine and specialty chemicals;Biocatalysts for diagnostics, value added food applications,pharmaceuticals, nutraceuticals and specialty chemicals; andBioremediation

Bioinformatics A Company that utilises the science of informatics as applied tobiological research and develops tools and processes to quantify andcollect data to study biological systems

RenewableEnergy A Company that develops Renewable Energy and/or the necessaryequipment or components, where energy is derived from sourcesthat do not deplete natural resources, or generated from naturalresources which are renewable (naturally replenished). Renewableenergy technologies includes but not limited to solar power, windpower, geothermal, photovoltaic, hydroelectricity/micro hydro,biomass, energy crops and biofuels.

Documents

MDV Biotech Application Form