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Application for a Free Business Diagnostic

This application is for a free diagnostic conducted by a Business Advisory Services Provider (BASP)
from PEAK -data-base to help you assess the strengths and weaknesses of your business and decide how best to
improve it. This opportunity is provided by PEAK, a business innovation center which has recently been established
and funded by UK Aid of the United Kingdom government, and DAI, a UK-based international consulting firm.
To be eligible to receive assistance, this application must be completed in its entirety for prompt consideration.
Information submitted will be held in strictest confidence and used only for the purpose of assessing your business’s
eligibility for assistance and to provide targeted support to your company, should you be approved for participation
in this programme. If you have any questions regarding this form or other aspects of the PEAK project, please feel
free to contact Anar Orozobaeva by email at anar_orozobaeva@dai.com

How and from whom/where did you hear about the subsidy programme covering business advisory services:

Company Information

Business or company’s name:

Location of business headquarters:

City:

Province:

Postal Code:

Name and title of primary company representative:

Last name*:

First name*:

Job position:

Contact information of primary company representative:

Phone:

Email:

Website:

Mobile Phone:

Primary Industry or Sector the business is operating in

Legal form of business (please check
one)

Limited Liability CorporationIndividual Entrepreneur CertificatePatentNot yet registered (but willing to legally register as a condition of receiving BAS support)

Year when business began commercial
activity

Year when business
was registered, if applicable

Names of current owners and principal officers. For owners, please indicate the ownership percentage for each person.

Note: Please attach a copy of the I.D. of each of the owners and main officers.
For returning migrants* please attach a copy of the Passport pages that show the Passport stamp(s) with the dates of return within the last 2 years.
*A returning labour migrant has returned to his/her native country (Kyrgyzstan or Tajikistan) within the last 2 years.

1) Name:

Position:

Ownership %:

Gender:

MaleFemale

Age:

Are you a returning labour migrant:

yesno

2) Name:

Position:

Ownership %:

Gender:

MaleFemale

Age:

Are you a returning labour migrant:

yesno

3) Name:

Position:

Ownership %:

Gender:

MaleFemale

Age:

Are you a returning labour migrant:

yesno

Did the company introduce any good
practices or innovative business models*
in the last 12 months?
*Examples of good practices or innovative business models may include: good business management practices (e.g., computerized management of products/services, computerized accounting system or income/expenses tracker, use of software applications that connect with clients, etc.); entering new online sales market (including via social media, e-commerce website, etc); use of energy efficiency/savings practices in business operations (eg. use of solar energy); application of new technologies to increase efficiencies and productivity to save time and resources (i.e. using modernized machinery or new processes); introduction of new services or products
Please check all that apply:

Yes, new or significantly improved product (good or service)Yes, new or significantly improved business modelYes, new or significantly improved business operations and processesNo new good practices or innovative business models have been introduced

Do you have ideas for new/improved products or services or new/improved processes or methods which you would like to introduce?

YesNo

Have you ever used the services of an
external Business Advisor in the past?

YesNo

Please provide contact details of a business consultant for the business diagnostic.
Note: Business Advisor should be registered in PEAK-data-base of the business-consultants

Last Name:

First Name:

Company Name, if applicable:

City:

Province:

Phone:

Email:

Size and makeup of workforce:

Total number of workers* :
*Total number of workers includes all workers whether formal/informal, temporary, seasonal, or contract workers

No. of female workers:

No. of youth* workers:
*Youth are aged 18-28 years in Kyrgyzstan / 18-30 years in Tajikistan.

No. of returning migrant workers*:
*A returning labour migrant has returned to his/her native country (Kyrgyzstan or Tajikistan) within the last 2 years.

No. of workers with disability:

Company’s annual sales for 2019

0 – 200,000 KGS200,001 – 4 mil KGS4,1 mil – 8 mil KGS8,1 mil – 30 mil KGS>30,1 mil KGS

Approximately what percentage of your 2019 sales were:

National (domestic) sales %:

Indirect exports (sold domestically to third party that exports) :

Direct exports:

Attachments
The following documents should be attached: 1)copy of the Patent/ Certificate 2) Passport, 3) Signed Self-Declaration(download), 4) Tax Identification number 5) Passport stamps for migrants

Copyright © 2021 DAI Europe. All rights reserved

Copyright © 2021 DAI Europe. All rights reserved