NUTIP MEMBERSHIP INTAKE FORM

A. COMPANY INFORMATION / PRIMARY DATA

Details of the company/business.

Company name *

Company logo *

No file chosen

Certificate of incorporation for company or valid ID for individuals *

No file chosen

Your ID or Certificate of incorporation is required for purpose of data update for our members with URSB

Registration number with registrar of companies or TIN for individuals *

Describe your core business in one line

Website *

Contact person details

First contact person name (Director/CEO) *

Position *

Phone *

Email address

Second contact person name (Finance/Admin) *

Position *

Phone *

Email address *

Street Address *

City

Country

Year of establishment *

DATA FOR OUR STATISTICS

Mention the sector you are in *

How many years have you been operating in Uganda?

Do you operate in other countries? *NOYES, If yes, list the countries below

Other countries you operate in.

Number of employees *

Annual turn over *Below 100,000 USDBetween 100,000 USD and 250,000 USDBetween 250,000 USD and 1 Million USDAbove 1 Million Dollar

Are you (mainly) operating in Kampala or (mainly) outside Kampala? *(mainly) in Kampala(mainly) outside Kampala

Are you in the production or service industry? *ProductionServiceBothNeither

Are you into exporting or importing? *ImportingExportingBothNone

Do you work with fresh and/or perishable products? *YesNo

Do you employ more than 3 (full time) Dutch staff in Uganda? *YesNo

Do you have Ugandan shareholders? *YesNo

What stage of development would you rank your company? *Start upScale upMatured

Would you describe your business as a social enterprise? *YesNo

Are you (also) operational in Netherlands? *YesNo

Kindly describe your company’s connection to Netherlands *

What are your main reasons for being a part of NUTIP? *

. Is your company a member of any other multi or bilateral organization(s) such as NUTIP? *NoIf Yes, Name the organization(s)

Name the organization of the multi or bilateral organization(s) *

What current activities from NUTIP are you specifically interested in?

NETWORKING EVENTSBUSINESS INSIGHTS AND INFORMATIONB2B SERVICES AND MATCH MAKINGLOBBY AND ADVOCACY

What activities would you like NUTIP to add to its offer?

Activity

CONSENT FORM

I HEREWITH GIVE CONSENT TO NUTIP TO USE THE GIVEN INFORMATION FOR INTERNAL ANALYSIS, TO SHARE RELEVANT DATA WITH OTHER MEMBERS AND TO USE IT FOR THE COMPOSITION OF GENERAL STATISTICS ON ITS MEMBERS

I AGREE

NAME

Date