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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]