Republic Bank | Application Form

Please fill out your information below and one of our representatives will contact you soon.

Primary Contact First Name:

Primary Contact Last Name:

LP_Country:

Email Address:

Contact Number:

Customer Type:

Business Name:

Type of Business:

List Shareholder Names:

BIR Number:

VAT Number (if applicable):

Annual Revenue:

Loan Amount:

Your Branch:

Best time to call:

I declare, I am the registered owner of the business and in possession of:
- Annual Gross Revenues between TT$1 million to TT$20 million
- Minimum of five (5) employees
- Up-to-date BIR and VAT payments
- Up-to-date NIB contributions
- A VAT registration number, where applicable

I understand that ineligible submissions based on these mandatory requirements will not be considered, nor will they be contacted.

I/We authorise you to disclose any information in relation to this Facility to the Government of Trinidad and Tobago and its agents solely for the purpose of Audit, Compliance and Evaluation of the operation of this special Loan Facility.

I confirm that I have neither applied for nor was granted any loan under the SME Stimulus Loan Facility.

By submitting my information, I agree to receive future communication from Republic Bank.