Personal & Background Full Name Mobile Email Residential postcode Current occupation Years in current role Are you an Australian citizen? YesNo If not, are you authorised to work in Australia? YesNo Have you ever owned a business? (If yes, specify) Do you have any retail food industry experience? (If yes, specify) Have you ever been a shareholder in a business? (If yes, specify % ownership and structure) Why do you want to partner with Jolly Miller? Why are you interested in a structured joint venture model rather than sole ownership? Experience & Capability Have you managed a team of more than 10 staff? YesNo What is the largest revenue business you have been responsible for? Have you ever been responsible for P&L performance? YesNo Have you ever been involved in budgeting or forecasting? YesNo Do you intend on working full time in the business? YesNo If no, please indicate the number of hours per week you intend to work Investment Capacity & Timing How much capital can you contribute toward a JV opportunity? $100k–$250k$250k–$500k$500k–$750k$750k+ Is this capital: Cash savingsEquity releaseCombinationOther Would you require external finance? YesNo Do you have pre-approval capacity? YesNo How soon would you like to get into your own business? I’m ready to go now3–6 months6–12 monthsI’m just exploring at the moment Are you interested in any particular area?
