mdv biotech application form
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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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
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/ -
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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my
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 :
1
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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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my
Reference number :
2
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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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my
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
3
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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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my
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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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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my
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)
5
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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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my
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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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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my
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
NOTES (For further details on the above, where relevant)
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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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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my
SECTION 6B : WORKING CAPITAL FINANCING
Facility RM000
Working Capital Financing required
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
Operational Track Record
FYEAudited
FYEAudited
FYEAudited
Total Current Assets
Total Accounts Receivables
Total Inventories
NOTES (For further details on the above, where relevant)
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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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my
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
Tenure (period)of loan requested
Collateral offer(Please select atleast one)
Assignment of contract proceedsDebenture
Joint & several guarantee by directors
Corporate guarantee by holding/parent/related company
Assignment of intellectual property rights
* 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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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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my
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
10
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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
Malaysia Debt Ventures Berhad(578113-A)(Wholly owned by Minister of Finance Inc.)
Level 5, Menara Bank Pembangunan1016, Jalan Sultan Ismail, 50250 Kuala LumpurT: + 603 2617 2888 F: +603 2697 8998W: www.mdv.com.my
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.
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