Invoice Discounting Application | Royaltop Financial Services

Section A: Business Details

Please ensure all information matches your PACRA registration documents

Registered Business Name *

Trading Name (if different)

PACRA Registration Number *

Year of Incorporation *

Business Physical Address *

Business Email Address *

Business Phone Number *

Industry / Sector *

Section B: Directors / Owners

Director / Owner 1

Full Name *

NRC / Passport Number *

Mobile Number *

Email Address *

Ownership Percentage (%) *

Section C: Banking Details

Bank Name *

Account Name *

Account Number *

Branch *

Relationship Length with Bank (Years) *

Section D: Invoice Details

Invoice Number *

Invoice Date *

Invoice Amount (ZMW) *

Amount Requested for Discounting (ZMW) *

Invoice Due Date *

Name of Invoice Debtor (Customer) *

Debtor Contact Person *

Debtor Phone *

Relationship with Debtor (Years) *

Section E: Debtor Information

Debtor Business Name *

Debtor Industry *

Debtor Physical Address *

Is the Debtor Government / Corporate / NGO? *

Government

Corporate

NGO

Other

Has the Debtor previously settled invoices on time? *

Yes

No

Section F: Document Uploads (Mandatory)

All documents must be clear, legible, and in PDF, JPG, or PNG format. Maximum file size: 5MB per document.

Copy of Invoice(s) *

Click to upload

Contract / Purchase Order *

Click to upload

Proof of Delivery / Completion Certificate *

Click to upload

Company PACRA Certificate *

Click to upload

Directors' NRCs *

Click to upload (multiple files)

Business Bank Statements (Last 6 months) *

Click to upload

Section G: Declaration & Consent

Please read and confirm the following:

We confirm that the invoice is valid, undisputed, and payable.

We authorise Royaltop Financial Services Limited to verify the invoice with the debtor.

We agree that repayment may be collected directly from the debtor.

Authorised Signatory (Digital) * Type the authorised signatory's full name

Position *

Date *

By submitting this form, you agree to the terms and conditions of Royaltop Financial Services Limited.