Retail Clinic Sale Information Form

1. SELLER DETAILS

2. CLINIC INFORMATION

3. FINANCIAL & LEGAL INFORMATION

Valuation fee is 200,000 RWF and paid before service due date.

4. ADDITIONAL INFORMATION

5. DOCUMENTS REQUIRED(Tick if available)

6. DECLARATION

I confirm that the above information is true and complete to the best of my knowledge. I understand that BENDIK Clinic Consultancy Ltd will keep this information confidential and use it solely for the purpose of clinic sale facilitation.