FILE NO. NON - CHECK OFF LOAN APPLICATION / AGREEMENT FORM A. APPLICANT’S PERSONAL DETAILS SURNAME: OTHER NAMES: CELL PHONE NO: ID/NO: MEMBERSHIP NO: PERSONAL ADDRESS: P. O. BOX E-MAIL ADDRESS: POSTAL CODE: DATE OF BIRTH: MARITAL STATUS: COUNTY: TOWN: SINGLE MARRIED WIDOWED ESTATE: STREET: BLOCK NO: KRA PIN NO: OTHER DETAILS EMPLOYED SELF-EMPLOYED UNEMPLOYED HOUSE WIFE STUDENT EMPLOYER ADDRESS : TERMS OF SERVICE: PERMANENT TEMPORARY CONTRACT IF CONTACT / TEMPORARY FOR WHAT PERIOD: MONTHS DATE OF EMPLOYMENT: DESIGNATION: PAYROLL NO: DEPARTMENT : WORK STATION: COUNTY: YEARS SUB-COUNTY: BANK DETAILS A/C NAME: A/C NUMBER: BRANCH: BANK NAME: B: LOAN DETAILS LOAN APPLIED FOR KSHS MONTHLY PAYMENT: AMOUNT IN WORDS: PURPOSE OF LOAN : LOAN TYPE INTEREST RATE MAXIMUM REPAYMENT PERIOD Premium loan 1.5% per month 60 months Development Loan - 01 1% per month 60 months Development Loan - 02 1.5% per month Remaining months in Development Loan -01 Development Loan - 03 2% per month Remaining months in Development Loan- 2 Education Loan - 01 1% per month 24 months Education Loan - 02 2% per month 24 months Instant Loan 2.5% per month 12 months Household - 01 1.5% per month 24 months Household - 02 Pata Manufaa Loan 2% per month 5% Up front 24 months 6 months Advance poa - 01 Advance poa - 02 Fuel Advance 5% per month 5% per month 10% Up front 3 months 1 month 1 month Do you have any other loans that you are currently servicing with us? If Yes, Would you like to buy off / consolidate your loans? PREFERED PERIOD Yes Yes Specify; ………………………………………………………………………………………………………………………………………………………….......... No No TICK C: INCOME AND EXPENSES Income Economic activities Expenses Amount (Kshs) Amount (Kshs.) Description Net Salary Rent Farming Mortgage Payment Business Water, Phone, Electricity Others income (state source) Transport / Fuel Education/Medical Entertainment Monthly loans Repayments Monthly hire purchase repayment Other Expenses Total Total Net surplus/Deficit Kshs. NB: Supply copy of receipts or statement where applicable D. BORROWER’S DECLARATION AND DISCLOSURE I hereby declare that the foregoingparticulars particularsare aretrue truetotothe thebest bestofofmy myknowledge knowledgeand andbelief. belief.I Iagree agreeto toabide abide to to the the society’s society’s credit credit policy. policy. II further further I hereby declare that the foregoing declare that I have understood the terms of this loan product and I also authorize necessary deductions to be made from my salary as repayment declare that I have understood the terms of this loan product and I also authorize necessary deductions to be made from my salary as repayment for forloan. this loan. also declare that incase the employer delays the deductions, will be paying personally to UOKOAJI SACCO month this I alsoI declare that incase the employer delays the deductions, I will Ibe paying personally to UOKOAJI SACCO everyevery month until until is action taken by the employer. I retirecompletion before completion of repayment, hereby authorize the balance to be deducted my action takenisby the employer. Should IShould retire before of repayment, I hereby I authorize the balance to be deducted from my from terminal terminal or by attachment of my or from shares in the society owned by me. benefits or benefits by attachment of my property orproperty from shares in the society owned by me. hereby authorize authorize and and instruct account with with the Sacco with Ksh………………………………… words I I hereby instruct the the Sacco Sacco to todebit debitmy my account the Sacco with Ksh……………………… inin words …………………………………………………………………………………………………………….. such other sums required Sacco …………………………………………………………………………………………………………….. or or such other sums as as willwill bebe required by by thethe Sacco to to meet my approved monthly repayment meet my approved monthly loan loan repayment and to my loan account on the …………… day of every month effective 30 days after the loan has been disbursed. I also authorize and instruct the Sacco to deduct an upfront insurance loan guard fee of 1.5% of the loan applied. DISCLOSURE DISCLOSURE I hereby authorize the Sacco to disclose and or obtain any information relating to my account(s) to and or from any Credit Reference Bureau or any other institution or third as to it deems I hereby authorize theparty Sacco disclosenecessary and or obtain any information relating to my account(s) to and or from any Credit Reference Bureau or I declare I have not been adjudged any other institution or third party bankrupt. as it deems necessary I understand that you your solebankrupt. discretion reject this application without having to provide any reasons. I declare I have not may beeninadjudged I understand that you may in your sole discretion reject this application without having to provide any reasons. Names;…………………………………………………………………………………………… Signature(s)……………………………………. Names;…………………………………………………………………………………ID No:……………..……………………. Signature(s)……………………………………….. Date:…………………………………………… E. GUARANTEE (Completed by Guarantors) (i) Guarantors (if applicable ignore if NOT ) In consideration of guaranteeing the above or any lesser amount that may be approved, we the undersigned herewith accept jointly and severally the liability for repayment in the borrower’s default. We understand that the amount in default may be recovered as an offset against our shares in the society or by attachment of property or salary. (Attach extra sheet if guarantors are more) NAME MEM NO: TOTAL SHARES AMOUNT GUARANTEED IN FIGURES AMOUNT GUARANTEED IN WORDS SIGNATURE TOTAL Certified by: Signature: (ii) Collateral Title deed Title Name: Title No: Size (Ha) : LR No: Log book Log book Name: Log book No: Model: Chasis No: Color: Engine No: Insured by: F. ACCEPTANCE BY BORROWER Terms accepted by borrower (Tick as appropriate) I Accept I do NOT Accept Authority: I…………………...........................…..............….....................……..…....whose particulars are shown above, do hereby accept the loan on the terms and conditions contained herein and hereby agree that the loan and my obligation to the Sacco under the terms and conditions shall be effective immediately upon the Sacco approving the sum applied for or as may be determined by the Sacco and subject to any security requirement as a condition precedent by crediting or applying or applying the same to my account with the Sacco or otherwise for my account. Membership No: ………………….................Signature:……………………......................... Date:…………………………………… G: CHECK-LIST The borrowers should attach the following: MANDATORY AS PER THE PRODUCT A copy of National ID cards Other documents; - School fee structure A copy of KRA PIN An original Land Title / Car log book 3 Copy of latest payslips (Certified) Valuation report NOT more than 3 months One colored passport photo Valid Car tracking certificate FOR OFFICIAL USE ONLY 1. CERTIFICATION BY BRANCH We advise the CREDIT COMMITTEE that the Branch Delegates have met and have APPROVED this loan application. We hereby certify that the information contained herein is correct about the member and his accounts. Delegate’s Name Position Date of Meeting Sign & Rubber Stamp 2. ACCOUNTS SUMMARY SHARES ORDINARY LOANS HOLIDAY DEVELOPMENT KUSCCO SCHOOL FEES EMERGENCY + = MEMBER’S ENTITLEMENT (SHARES-LOANS) LOAN APPLIED SALARY TOTAL LOANS URGENT/OTHER + + 3 X ORDIN. SHARES OTHER CURRENT NET PAY NON-FIXED DEDUCTIONS LOAN REPAYMENT - + 1/3 BASIC SALARY NEW NET PAY = Ensure... 1. NEW NET PAY above 1/3 BASIC SAL 2. LOAN APPLIED below ENTITLEMENT OFFICIAL COMMENTS Loans Officer’s signature Manager’s Signature Date Date 3. CREDIT COMMITTEE Approved Amount / Comments Rejected Reason / Comments Chairman Secretary Member Date of Meeting Secretary Member Date of Meeting 4. EXECUTIVE COMMITTEE Approved Amount / Comments Rejected Reason / Comments Chairman 5. DISBURSEMENT Cash Amount Prepared by Date Cheque Name Received by Date Account Name Bank & Branch Account No. This form supersedes all previous forms 2016 UOKOAJI SACCO | Uokoaji Savings and Credit Ltd. | PO. Box 30793 00100 G.P.O Nairobi. Tel: 0202504474 / Cell: 0729 907048, 0732907048 | e-mail: [email protected]
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