NUTIP membership intake form

Introduction

Dear prospective member of the Netherlands Uganda Trade and Investment Platform (NUTIP),

Before we can welcome you as an official member, two steps need to be taken:

First of all, we would like you to fill in this form. This form gives us the possibility to serve you better as a member and will give us viable information about your company that we can share with other members. As such it is your business card towards other organizations. As part of this exercise your ID or certificate of incorporation is required for purpose of alignment of our records with URSB.

Secondly, to complete the onboarding process, we kindly request the transfer of your annual membership fee as follows: UGX 3,000,000 for Platinum (Orange) membership, UGX 2,000,000 for Gold membership, and UGX 1,000,000 for Corporate membership.

We look forward to receiving you as a member.

Warmest regards,
Martijn Harlaar
Chairperson
NUTIP Board

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 MEMBERSI AGREE

NAME

Date

NUTIP Membership Intake Form

A. COMPANY INFORMATION / PRIMARY DATA

Details of the company/business.

DATA FOR OUR STATISTICS

CONSENT FORM