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MicroGREEN Capacity Development and Value Chain Enhancement Programme - Enterprise Data Form
Invest in Africa (IIA) has received a grant from the African Development Bank (AfDB) to finance a Project related to "Strengthening Women, Youth and People with Disabilities' Micro-Entrepreneurship for Green Jobs in Natural Resources (MicroGREEN)" with funding source from the Fund for African Private Sector Assistance (FAPA) and Youth Entrepreneurship and Innovation Multi-Donor Trust Fund (YEI MDTF). The broad objective of this project is to strengthen the capacity of 1,000 young women, youth and persons living with disabilities (PWDs) aged 15-35 years, to take up opportunities in agroforestry, fisheries and biodiversity, and enhancing intersectoral linkages in and between these sectors; in Ghana and Senegal. All MSMEs are hereby invited to express their interest in the programme by completing and submitting their Enterprise Data Form.
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Step
1
of 5
Select Country
*
Ghana
Senegal
BUSINESS INFORMATION
Name of Enterprise
*
Form of Business
*
Please Select
Sole Proprietorship
Partnership/Cooperative
Private Limited Company
NGO
Government Agency
Other
Year Business was Registered
Business Registration Number
Sector of Operation
*
Please Select
Agro-forestry
Agriculture
Fisheries
Biodiversity
Other
Market Coverage
*
Local
Regional
National
International
Tax Identification Number (TIN)
Description of Products/Services
*
Stage of Business
Please Select
Startup Stage [Proving the core idea and building a basic product]
Growth/Early Stage [Rapidly acquiring customers and scaling revenue]
Expansion/Take-Off Stage [Significant scaling, entering new markets, or launching new products]
Maturity Stage [Stability, efficiency, and maximizing profitability]
Renewal or Decline Stage [Strategic adaptation for revival or managing downturn]
Region
Geographical Location
*
Dakar
Dakar
Diourbel
Fatick
Kaffrine
Kaolack
Kédougou
Kolda
Louga
Matam
Saint-Louis
Sédhiou
Tambacounda
Thiès
Ziguinchor
District
Town/City
Physical Location (Closest landmark)
*
Digital Address
Website
Name of Contact Person
Telephone of Contact Person
Email of Contact Person
Total Sales/Revenue for 2025 (GH¢)
Total Sales/Revenue for 2025 (Francs CFA)
Moins de 1 000 000
Moins de 1 000 000
1 000 000 - 10 000 000
10 000 000 - 20 000 000
Plus de 20 000 000
Total Capital Invested in the Business (GH¢)
Total Capital Invested in the Business (Francs CFA)
Moins de 1 000 000
Moins de 1 000 000
1 000 000 - 10 000 000
10 000 000 - 20 000 000
Plus de 20 000 000
Please provide your handle or page link for each social media platforms (If applicable)
Social Media Handle - Facebook
Social Media Handle - Instagram
Social Media Handle - LInkedIn
Social Media Handle - Other (Specify)
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BUSINESS OWNERSHIP INFORMATION
Name of Business Owner
*
Gender
*
Male
Female
Email
*
Phone
*
Position in Business
*
Disability Status
*
Please Select
None
Mobility Impaired
Visually Impaired
Hearing Impared
Other
National ID Number
Other Disability Status
*
Age of Business Owner
Please Select
18 - 24 Years
25 - 35 Years
36 - 40 Years
41 Years and Above
Provide details of other business owner (if applicable)
Name of Business Owner 2
Business Owner 2 - Gender
Male
Female
Business Owner 2 - Email
Business Owner 2 - Phone (copy)
Business Owner 2 - Position
Business Owner 2 - Disability Status
Please Select
None
Mobility Impaired
Visually Impaired
Hearing Impared
Other
Business Owner 2 - National ID Number
Business Owner 2 - Other Disability Status
Age of Business Owner 2
Please Select
18 - 24 Years
25 - 35 Years
36 - 40 Years
41 Years and Above
Provide details of other business owner (if applicable)
Name of Business Owner 3
Business Owner 3 - Gender
Male
Female
Business Owner 3 - Email
Business Owner 3 - Phone
Business Owner 3 - Position
Business Owner 3 - Disability Status
Please Select
None
Mobility Impaired
Visually Impaired
Hearing Impared
Other
Business Owner 3 - National ID Number
Business Owner 3 - Other Disability Status
Age of Business Owner 3
Please Select
18 - 24 Years
25 - 35 Years
36 - 40 Years
41 Years and Above
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MANAGEMENT AND STAFF TEAM COMPOSITION
Provide management team composition.
Number of Management Team Members
*
Indicate total number of management members.
Female Management Team Members (Aged 18 – 40 Years)
*
Indicate female management members who are 18-40 years old.
Male Management Team Members (Aged 18 – 40 Years) (copy)
*
Indicate male management members who are 18-40 years old.
Management Team Identified as Persons with Disabilities (PWDs)
*
0
1
2
3
4
More than 4
Indicate total management members who are PWDs
Provide staff team composition.
Number of Employees (Full Time)
*
Indicate the number of male and female full-time employees.
Number of Employees (Part-Time)
*
Indicate the number of male and female part-time employees.
Total Number of Employees
*
Indicate the number of male and female employees.
Female Employees (Aged 18 – 40 Years)
*
Indicate female staff members who are 18-40 years old.
Male Employees (Aged 18 – 40 Years)
*
Indicate male staff members who are 18-40 years old.
Total Number of PWD Employees (Full & Part Time)
*
0
1
2
3
4
More than 4
Indicate total staff members who are PWDs
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INFORMATION ON FIRM'S FINANCIAL INSTITUTION (BANK, MICROFINANCE, SAVINGS & LOANS, ETC)
Do you have a bank account?
*
Yes
No
Account Type
*
Personal Account
Business Account
Name of Financial Institution
*
Which bank did you open your account with?
*
BICIS
BICIS
Société Général Sénégal (SGS)
Banque de l'Habitat du Sénégal (BHS)
Banque Atlantique Sénégal
Orabank Sénégal
Banque Islamique du Sénégal (BIS)
Banque Sahélo-Saharienne pour l’Investissement et le Commerce (BSIC)
Banque de Dakar (BDK)
Ecobank Sénégal
United Bank for Africa (UBA) Sénégal
Bank of Africa Sénégal (BOA)
Citibank Sénégal
Crédit du Sénégal (CDS)
Banque Agricole (ex CNCAS)Coris Bank International Sénégal
Bridge Bank Group Sénégal
CBAO
CMS (Crédit Mutuel du Sénégal)
PAMECAS
ACEP Sénégal
MICROSEN
UMECU
UIMCEC
Has your Company ever accessed any form of credit (loan) from a financial institution?
*
Yes
No
Name of Financial Institution
*
If Yes, please provide the bank details for the most recent loan
Name of Financial Institution
*
BICIS
BICIS
Société Général Sénégal (SGS)
Banque de l'Habitat du Sénégal (BHS)
Banque Atlantique Sénégal
Orabank Sénégal
Banque Islamique du Sénégal (BIS)
Banque Sahélo-Saharienne pour l’Investissement et le Commerce (BSIC)
Banque de Dakar (BDK)
Ecobank Sénégal
United Bank for Africa (UBA) Sénégal
Bank of Africa Sénégal (BOA)
Citibank Sénégal
Crédit du Sénégal (CDS)
Banque Agricole (ex CNCAS)Coris Bank International Sénégal
Bridge Bank Group Sénégal
CBAO
CMS (Crédit Mutuel du Sénégal)
PAMECAS
ACEP Sénégal
MICROSEN
UMECU
UIMCEC
Most Recent Loan Amount (GH¢)
*
Below GHS 10,000
Below GHS 10,000
GHS 11,000 – GHS 25,000
GHS 25,001 – GHS 50,000
Above GHS 50,000
Most Recent Loan Amount (Francs CFA)
*
Moins de 1 000 000
Moins de 1 000 000
1 000 000 - 10 000 000
10 000 000 - 20 000 000
Plus de 20 000 000
Capacity Building Programmes Enrolled (in the past 24 months)
None
1 - 2
3 - 5
6 or more
Please list programmes enrolled below
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DECLARATION
*
By submitting this form, I authorize Invest in Africa to share my personal information and that of my company with its partners as part of the Microgreen program in order to facilitate my access to markets, skills, and financing.
bank CFA) your
*
I acknowledge that the information provided is accurate, true, and complete to the best of my knowledge. Any false or misleading information may lead to disqualification. Thank you.
Full Name (serves as your signature)
*
Submit
