AFRICA POOLING RESOURCES TOGETHER. Transforming Africa Together. Date of application Application no. Type of loan. Number of dependants

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1 AFRICA POOLING RESOURCES TOGETHER Transforming Africa Together» Business Loans & Capital Solutions» Investment Advisory and Management» Entrepreneurship Training REF: APRT/2E/2017 THE MALL, 2 ND FLOOR-WESTALANDS, ALONG WAIYAKI WAY. PO BOX NAIROBI, MOBILE: / LOAN APPLICATION FORM KSHS. Date of application Application no. Type of loan PERSONAL DETAILS Surname Other names Age. ID/Passport Number Pin No Number of dependants RESIDENTIAL ADDRESS; Owner occupier/rental. LR/plot No House number. Estate Road/ street. Town... Nearest landmark. Mobile No. address... Postal address postal code. Town. Other contact person (besides spouse and guarantor.) 1. Name Mobile

2 Relationship 2. Name Mobile Relationship. OCCUPATION OF THE APPLICANT If business person. Name of the business Date started Nature of business Street/ location Building Date registered Cerficate Reg No Insurer Policy no Type of policy.. If employed Surname other names Age. Relationship. Occupation ID/passport. Pin number Mobile no address. Postal address postal code town. Referees Name relationship Mobile no . Amount applied. Security offered

3 Purpose of the loan. Repayment period Security I declare that the information given above is true to the best of my knowledge and reflect my undertaking on this facility. Signed Spouse details Surname. Other names ID/passport no pin no. Residential address Owner occupier/ rental LR/plot no House no. estate Road/ street town Nearest landmark Mobile no address Postal address postal code...town Financial details Net salary... Other income Total income p.m. Total assets total liabilities.. Net amount. Rent expenses other expenses total monthly expenditure.. Other existing loan facilities Lender.Amount Current balance Repayment period Remaining period.monthly instalment. Type of security (1) value (2) Value

4 Security offered; type 1. motor vehicle Reg no engine no chassis no ownership year value insurer 2. Title deed current owner plot/lr no ownership search report PURPOSE OF THE LOAN (PLEASE TICK A BOX) 1 Asset purchase 2 working capital 3 vehicle purchase 4 repayment of other name 5 other purpose FOR OFFICIAL USE ONLY LOAN DETAILS Applied amount Period repayment Approved amount Approved period Reason for approval/decline CONSENT CLAUSE;

5 Customer declaration: In connection with this application and/or maintaining accredit facility with the APRT limited, I authorise the APRT limited to carry out credit checks with or obtain my credit information from, a credit reference bureau. In the event of the account going into default, I consent to my name, transaction and default details being forwarded to a credit reference bureau for listing. I acknowledge that this information may be used by this company (APRT LTD) and the credit grantors in assessing applications for credit by me, associated companies, and supplementary account holders and for occasional debt tracing and fraud prevention purposes. Disclosure of information: I agree that the lender may disclose details relating to my loan account including details of my default in servicing financial obligations on my account to any third party including credit reference bureaus for the purpose of evaluating my credit worthiness or for any other lawful purpose. I hereby apply for a loan of Ksh (In words) repayable in Instalments subject to terms and conditions in this credit application form and letter of offer. I understate to provide the security as required. Signature Date. OFFICIAL COMMENT Signature Date..