IMARISHA SACCO SOCIETY LTD BINAFSI LOAN APPLICATION FORM 1. IMARISHA SACCO CUSTOMER BIO DATA MODE OF DISBURSEMENT (Tick appropriately) M-pesa Fosa Others.. Applicants Name as per ID Date: National/ID Passport No. Nationality Date of birth Sex Female Male Marital status Single Married Widow Divorced Nationality Level of education No. of children in school: Nursery Primary Secondary Tertiary Other Dependent NHIF No. Current postal address Email NSSF No. Tel. Mobile Period of current residence.year months Residence: Town Estate House No Rented Owned Rural Residence Town Village Landmark (e.g school/church) Back name Branch C/Name A/c Name Name of spouse ID No. Phone No. Email Occupation Institution Attach a sketch map of home and business location 2. BUSINESS INFORMATION Business name Type of business Registration No. License No. Pin No. V.A.T No. Postal address (current) Email Tel (landline) Mobile Address Physical location Town Street Building Business premises ownership owned Rented if rented: lease period (Attach copy of lease agreement) Rent payable 3. PARTICULARS OF PROPRIETORS (if loan is in a Company name, PART 1 shall be filled by Director) Name of Director(s)/Partners (s)/official(s) NAME ID NO. ADDRESS DESIGNATTION NATURE OF OWNERSHIP 1 2 3 (NB: - Attach memorandum, Articles of Association, Board of Directors Resolution, Minutes- where applicable )
4. LOAN PARTICULARS Amount applied for Purpose of loan Cost of project (Kshs). Own contribution (Kshs). Repayment period LOANS IN OTHER BANKS/FINANCIAL INSTITUTION(S)- Attach Certified bank statement for the last 6 months NAME OF BANK DATE BALANCED 1 2 3 AMOUNT ADVANCED REPAYMENT PERIOD OUSTANDING AMOUNT 5. PERSONAL DECLARATION I, the undersigned hereby certify that the information provided is true. I voluntarily apply for loan from Kenya and undertake to repay it in full as per the agreement. Further, I authorize.to share my credit information with other parties and enquire my credit position for purposes of this application appraisal. Applicant s Names..Sign:.Date 6. 3 REFEREES ( At least one of them should be the next of kin. The next of kin nominated will be the beneficiary incase of insurance claim) 1 2 3 Next of kin Name Address Email Tel Relations Certified by the area Chief..Signature.. Stamp Date 7. CREDIT HISTORY APPRAISAL FORM LOAN NO. DATE AMOUNT GRANTED PAYMENT MODE PERIOD STATUS PERFORMANCE 8. BUSINESS ASSESSMENT (OFFICIAL USE) 8.1 PART I Description of business activity Number of years in operation. No. of paid employees full time..casual Average salary: Full time.casual Who are the major business suppliers: (attach receipts) Who are the major business customers:... Where and who do you buy from?...where and who do you sell to?...
.. How often do you buy (Daily/Weekly/Monthly)?... How long does it take to sell your purchases/stock. What quantity do you buy each time?.. What quantity do you sell in a week?... How much do you pay for these purchases (Average)? How much do you sell in a month?... Please describe how this loan will improve the business.. Will this change as a result of the loan if so how?. 8.3 SEASONAL VARIATIONS-the past 12 months What are the seasonal variations in monthly sales? Months Total sales Good/Average/Low Months Total sales Good/Average/Low January July February August March September April October May November June December Total annual sales: Kshs. Average monthly sales: Kshs. Total annual sales: Kshs Average monthly sales: Kshs. 8.4 GROSS PROFIT OF THE BEST SELLING PRODUCTS PRODUCT SELLING PRICE (A) BUYING PRICE/PRODUCION GROSS PROFIT MARGIN (A-B)/A COST (B) AVERAGE 8.5 DETAILS OF THE INVENTORY QTY DESCRIPTION PRICE/UNIT TOTAL VALUE Name of applicant. Credit officer.. Signature.Date.... Signature...Date. 9. BUSINESS FINANCIAL ANALYSIS (Profit and Loss) LESS (family expense) Total monthly sales (E) Cumulative income (C+D) Less cost of sales/purchase Rent (A) Gross profit School fees LESS (overhead costs) Transport Rent Food Salaries & Wages Medical Transport Salaries & Wages Utilities-water, phone, Utilities-water, electricity power, phone Taxes Entertainment
Entertainment Others (B) Total overhead costs (C ) Net profit from business (A-B) ADD (D) Income from other sources (e.g salary, rental income, pension, farming) (E) Cumulative income (C + d) Other family (F)Total family (F) Total family (G) TOTAL NET INCOME(E-F) (H) Loan installment (I) Net income after loan installment (G- H) 10. BALANCE SHEET ASSETS ACTUAL LIABILITIES ACTUAL Cash at hand/bank/sacco Creditors Debtors Bank loan/overdraft Inventory (work in progress) Other liabilities (specify) Total fixed assets Long term loans Other assets Capital Total assets Total liabilities and capital 11. RATIO- ANALYSIS (Official Use) a. PROFITABILITY- Is the business going to generate enough profits to repay the loan and expand the business? Gross profit margin: : Net profit/sales=(standard is 10%-40) Loan installment cover : ratio of net profit to loan installment= (the standard is 2:1) Return on investment: Annual Net profit/total investment x 100 (standard is 5%) 12. PROPOSED GUARANTORS (Sign the Guarantors Form attach) Name Address Tel. no. Other contact information Relationship Period know to him/her
13. SECURITY/COLLATERAL I voluntarily pledge the following securities to Imarisha Sacco Society Ltd (to be described in details e.g color, make, Serial No. etc.) DESCRIPTION OF THE ITEM SERIAL NO. VALUE ESTIMATE TODAY (KSHS.) TOTAL LIQUIDATION VALUE.. ATTACH THE FOLLOWING DOCUMENTS: Passport size photo /copy of ID /Bank statement/ Proof of residence (attach a utility bill)/ Security/ Guarantee documents notified/a photo of the business and security/personal guarantors (attached)/pd Cheques. Copy of the loan agreement, chattel documents, title deed, logbook (Charged) I the undersigned hereby certify that the information provided is true. Name..Signature.Date. 14. RECCOMENDATION BY MICRO CREDIT FINANCE OFFICER BRANCH STAFF COMMITTEE / HQ S COMMITTEE APPROVAL Loan amount Name Date Signature Loan period 1 Amount approved Name of MCFO 2 Loan period Signed by 3 Status: Approved MCFO Rejected RECCOMENDATION BY MICRO CREDIT MANAGER-HQ S Name of MCM Signature.. Date.. Amount Recommended..Rejected Audit Department Loan No. Finance Department (Disbursement Bank name Date verified Cheque No. Verified by (Name) Processed by (Name & Signature): Signature Reviewed by (Name & Signature): CEO/DCEO APPROVAL AMOUNT APPROVED SIGNATURE.. DATE BOD CREDIT APPROVAL AMOUNT APPROVED Ksh. Chairman Signature.Date.. Secretary.Signature.Date.. Member...Signature.Date.. DISBURSEMENT ACKNOWLEGEMENT BY CUSTOMER here by acknowledge receipt of my loan facility of Kshs.being loan from Imarisha Sacco Society Kenya ltd Applicant Signature Date
NB: Terms and Conditions in the Policy apply. AFFIDAVIT IN THE MATTER OF THE OATH AND STATUTORY DECLARATION ACT (CHAPTER 15 LAWS OF KENYA) AFFIDAVIT I.of Post office Box Number In THE republic OF Kenya MAKE OATHS and says as follows: 1. I am the holder of National Identity card Number..and I am the deponent herein 2. Imarisha Sacco Society Limited has agreed to lend me money in accordance with terms of the loan agreement and assets schedule all signed by me. I undertake to repay the entire amount of the money lent to me or to be lent to me any time in the future together with all the applicable fees, service charges, penalties and costs of recovery. 3. in an event of Default as that term is defined in the loan agreement, I forego and surrender sale by way of private sale or public auction all my properties, whether business or personal, listed in the Asset schedule duly executed by me, which Asset schedule contains my full name, my signature, my national identity card number and the amount of loan advanced to me. The asset schedule shall be in the custody of Imarisha Sacco Society Limited. 4. I acknowledge that, if I miss any payment due under the loan agreement with Imarisha Sacco Society Limited of its agents, they may, without further consent or notice to me immediately enter upon the land or premises where my properties are located and take possession and sell all my properties by private sale or public auction. 5. in case of default as defined in the loan agreement, I consent to the lender to share my contact with Credit Reference Bureau (CRB). a. Customer Declaration: In connection with this application and/or maintaining a credit facility with the Imarisha Sacco Society Limited, I authorize the Imarisha Kenya Sacco Society Limited to carry out credit checks with our 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 banking institutions and other credit grantors in assessing applications for credit by me, associated companies, and supplementary account holders and for occasional debt tracing and fraud prevention purposes. a. Disclosure of information i. You agree that the Imarisha Sacco Society Limited may disclose details relating to your Credit facility account to any third party including credit reference bureaus, if in the lender s opinion such disclosure is necessary for the purposes of evaluating your creditworthiness or any transaction with or credit application made to the lender. ii. You agree that the lender may disclose details relating to your (credit facility account including details of reference bureaus for the purpose of evaluating your credit worthiness or for any other lawful purpose. iii. I have consented to the actions described in paragraphs 3, 4 and 5 of this Affidavit and hereby signify the said by signing here below. iv. My spouse/guardian or live in companion, if any such spouse or live in-companion exists, has consented to the actions described in paragraphs 3,4 and 5 of this affidavit. DEPONENT HEREIN. Sign Date Sworn by the above named at ) ) ) ) This day of 20 ) ) Spouse name ) ) BEFORE ME ) ) COMMISSIONER FOR OATHS ) )
GUARANTOR S INFORMATION FORM Salutation Mr. Mrs. Miss Dr Prof. Hon. Guarantor s First name Applicant First name Middle name Last name Relationship with Applicant Identification (National ID) ID Number Date of birth DD/MM/YYY Marital Married Single Others Nationality PIN No. Postal Address Postal Code Town Residential Area (Estate) Plot No. Town Tel. No. Mobile No. Email. Monthly income Salary Business Other (Net) Monthly Expenses Housing School fees Other Net monthly Assets Cash/Equivalents Vehicles Property Business Fixed Assets Liabilities Sacco/Bank loans Other Other Net Bank Accounts (s) Held At: Prior borrowing history (Imarisha Sacco or other financial institutions): Business Name: Brief Description of Activities Kindly, list all the items that you are offering the Sacco as Security... Signature of Guarantor Certified by the Area Chief: Name..Signature. Stamp Date. Note: Number of guarantors will be guided by the amount applied and security provided by the applicant.