Address
7th Floor Wing A, Shri Atal Bihari Vajpayee Tower, Ebène Cybercity, Mauritius.
Phone
+230 467 6900
Fax
+230 467 6907
Email
procurement@landscopemauritius.com

THE COTE D’OR DATA TECHNOLOGY PARK – APPLICATION FORM

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PART 1 - DETAILS OF BUSINESS AND PROMOTERS

1.1 Applicant’s business name, address, and basic details Details of the Enterprise submitting this application.

a. Registered Name*

b. Enterprise Form*

c. If, as indicated in question (Enterprise Form), the applicant is quoted on a stock exchange, name the Stock Exchange

d. Registration Number

e. Contact Address*

f. Web page Address

g. Telephone Number*

h. Year Established

1.2 Contact person

Contact details of the person to whom communication regarding this application should be addressed.

a. Contact Name & Surname*

b. Designation*

c. Telephone Number*

d. Mobile Number*

e. Email Address

1.3 Enterprise Structure

Details of the ownership and control structure of the Enterprise submitting this application.
a. In Annex 1 – Director and Shareholders, provide details (shareholding structure, ID or Passport Number, Name, Date of birth or Incorporation, and Address) of every Director and Shareholder).

Annex 1 Document*

Note: In case of ultimate change of ownership or ultimate transfer of the company following this Expression of Interest which could impact on the control of the company, this Expression of Interest or any issue of letter of intent or the grant of an industrial lease will be cancelled ‘de plein droit’.

1.4 Current Business Activity

Provide a brief history of the business and describe the current activity in terms of the Enterprise’s current products, services, and markets.

PART 2 – PROJECT DETAILS

2.1 Project Description – Describe the proposed project.

2.2 Project Cluster – Specify the category of the proposed activities within the park

2.3 Applicant’s Experience and Track Record – Describe the applicant’s experience in the relevant industry and in similar projects.

2.4 Proposed Project Financing
Explain how the project will be financed. This may include funding from own financial resources, new bank loans, and/ or funding.

Source	Value(MUR)
Own financial resources
New bank loans
Other sources
Total Investment

2.5 Expected Project Results – Financial Performance

Describe and justify the expected project results and projections illustrated, elaborating on the contribution of the project to the financial performance. Clearly list any assumptions made.

2.6 Expected Project Results – Employment

Elaborate on the contribution of the project to the human resources of the enterprise.

a. Describe the skill base categories of the human resources required for the project.

2.7 Markets
This section analyses the market impact of the proposed project
a. The enterprise intends to be:

Domestic

Export Oriented

Mix of Domestic and Export

b. Describe how the proposed project will support growth in the above market/s and expansion into new markets.

c. Expand on the marketing strategy.

2.8 Indicative Implementation Plan including Phasing if required (Insert date as appropriate)

Land Extent	Phase 1	Phase 2	Phase 3
1. Detailed design
2. Application of EIA
3. Application for Building and Land Use Permit
4. Appointment of contractor
5. Construction starts
6. Construction finishes
7. Start of operations

2.9Land requirements

Indicate the land requirements for the proposed project.

2.10 Leasing or purchasing the land
Indicate your preference for either leasing (90-year lease) or purchasing the land required land for the development of the project.

2.11 Environmental, Regulatory, and Legal obligations
Explain any environmental, regulatory, and legal obligations, together with the environmental impact of the project and any mitigation measures.

a. Does the proposed project raise any environmental concerns? This section should highlight the requirement of any Environmental Impact Assessments or other Environmental Permits.

b. Describe the utilities consumption (power and water requirements) associated with the proposed project.

c. Describe any health & safety issues relating to the proposed project.

d. Describe any applicable industry standards in relation to the implementation of the proposed project (*if required).

PART 3 – APPLICATION FOR ALLOCATION OF LAND

3.1 Specify the size of the building planned for development i.e. footprint of buildings at ground level: m2

Item	Facilities	Gross Floor Area (GFA)(m2)
1	Industrial Services
1.1	Production/Operations
1.2	Warehousing/Storage
2	Administration
2.1	Office
2.2	Public Area
3	Commercial zone
4	Green Space
5	Parking
6	Other*
4-6	Subtotal
1-6	Total

PART 4 - ANNEXES

This section outlines the Annexes required for the complete submission of this application form.

Certificate of Incorporation*

COI and Date of Registration*

Enterprise brochure

Copy of the certificate of incorporation and register of shareholders
Enterprise brochure.

PART 5 – DECLARATION BY APPLICANT

It is hereby declared by the undersigned applicant(s) that:

a) all the particulars furnished in this application and in the documents and particulars attached hereto, are true and correct and that I/We have not suppressed any material fact,

b) any estimates given in this application have been made in good faith and with all due care, and

c) no director/shareholder of the company has ever been convicted in a Court of Law for a criminal offence, penalised, sanctioned or is currently or has ever been under investigation for professional negligence or malpractice by any regulatory authority in any country.

Name of Applicant (full legal name)*

Authorised Signatory

Designation

Date

Acceptance

I hereby warrant and represent that all information provided pertaining to my application is complete, accurate and true. I understand that if misleading, inaccurate or otherwise inappropriate information is provided, Landscope (Mauritius) Ltd reserves its full right to reject this application.