a7) PAP. 1126 PERSONAL LOAN - CHECK OFF APPLICATION/AGREEMENT FORM [Rev Feb. 20 Lei) ByNN AFFIX PERSONAL LOAN - CHECK OFF APPLICATION/ PASSPORT AGREEMENT FORM SIZE PHOTO TO BE COMPLETED IN DUPLICATE APPLICANT'S DETAILS (Please fill in / tick appropriately) Branch: Date of Application KCB Account No: Date Opened: Name of Account to be credited: [Individual |] Joint PART 1; PARTICULARS OF APPLICANT — Attach copy of ID (Please fill in / tick appropriately) | Title: Mr/Mrs/Miss/Dr/Prof/Eng. [Surname: ‘Other Names: ID No. (Mandatory! 7 ' Nationality: TPIN(I/Tax} No.: Date of Birth: Gender: Male Female Marital Status: | |Single [Married Widowed Other | specify Postal Address: 7 Postal Code: _| Telephone (Hormel: | Mobile No.: | Email a Physical Address Country: Town: Estate: ‘Street: Block No.: PART 2: EMPLOYMENT DETAILS (Please fill in tick appropriately) Current Employment Details [ JeEmptoyed ‘Self Employed | Name of Employer: Date of Employment: ___—_—_| Personal/Staff No. | Station: Designation: Department: Terms of Employment Permanent [Contract If on Contract, state expiry date: Gross Salary (kshs!: Net Salary(kshs} Employer's Physical Address _ | Building: Oo Street: Block No. ] |Postatadiress; ——~=~S*«*daal Code; —*( Toe TJenorty: | Office Tet. Fax No. | Website: | Emait: - - SO 7 | Previous Employment Details [_JEmptoyed |_|Self Employed | Name of Employer: “| Date of Employment: Personal/StaffNo: ‘Station: Designation: rt = PART 3: DETAILS OF REFEREES Other Names: 1D/Passport Number: Relation to applicant: - PostalAddress: Office Te | | Mobile No.: [emit “Occupation: | Non-Relative’s Surname: _ Other Names: ID/Passport Number: Relation to applicant: == Postal Address: Office Tel: Mobile No.: - | Email: Occupation: Regulated by the Central Bank of Kenya vewmhcoaroupcom —— @ 8M5:22522 0711057 o00/a752 167000 QW comscrentrearcreore BENETPART 4: LOAN DETAILS. Original || Top Up [JRetinance —[] 2ndtoan (Tick as appropriate) Loan amountlshs} Cost of items to be financedlshs) Purpose of loan Repayment Period {No. of months] Interest Rate (96) Monthly payments. Ishs} pm Negotiation fees (96) Risk Margin Premium (96) Default Rate %) Other Loans (Both KCB and other Institutions) [Seaeenaten 7 | (Tick as appropriate] Account Number | Outstanding Loan Balance [Fermeraret Loans to be cleared { I I —— | | —- | I I I Totals I {Please attach documentary evidence) PART 5: CUSTOMER DECLARATION a. IMe certify that the information contained in this application is true and correct to the best of my/our knowledge and belief b. [We authorize you to obtain any information you may require relating to this application from my/our employers, Bankers, Mortgagers or Financial institution mentioned herein, ¢. We also confirm that |/We understand that this application shall be processed by way of an automated credit scoring procedure and in case of a decline, you shall advise no specific reason for such a decline 4. We hereby:tonfirm that I/We have read and understood the Terms and Conditions outlined overleaf forming part of this application and which will govern the loan and hereby accept and agree to be bound by the same and We have accordingly endorsed the same. e. We agree that the loan and my obligations to the Bank under the terms and conditions shall be effective immediately upon the Bank approving the sum applied for or as may be determined by the Bank and subject to any security requirement as a condition precedent by crediting or applying the same to my account with the Bank or otherwise for my account, f.lMe will provide security by way of Charge or Mortgage or assignment as the case may be or any other security in a form or substance required by, or acceptable to the Bank as a condition precedent for the disbursement of the loan and I/We will do all such things and take such action necessary to precedent for the disbursement of the loan and I/We will do all such things and take such action necessary to perfect such security, including obtaining any requisite clearances, consents and approval at my cost. g. In consideration to the Bank agreeing to grant me/us the loan applied for, or such lower sum and at such interest and costs, and on the terms and conditions set out as part of this application, We hereby request and irrevocably authorize my/ our employers to deduct monthly from my/our salaries the principal sum, interests and costs as shall be advised by the Bank and remit the same to the Bank for such period as the Bank shall. advise from time to time towards the repayment of the loan h. For as long as any such loan shall be outstanding, I/We hereby assign all my/our final and terminal dues excluding pension of whatsoever nature with my/our employer(s) to the Bank, and I/We accordingly hereby request and authorize my/our said employer(s) to pay out the said dues to the Bank whenever they become due and payable unless otherwise advised by the Bank. i. We hereby authorize and instruct the Bank to debit my/our account no. snnineninnonenone With the Bank with KShS so someone i WOKS - - co cccowoF such other Sums 35 will be required by the Bank to meet my approved monthly ioan repayments and to pay into my loan account on the of every month effective 30 days after the loan has been disbursed. DECLARATION AND DISCLOSURE IMe hereby authorize the Bank to disclose or obtain any information relating to my/our account(s) to and from any Credit Reference Bureau or any other institution or third party as it deems necessary. (Me declare we have not been adjudged bankrupt. We understand that you may in your sole discretion reject this application without having to provide any reasons. Names scmnninnsninnnnnnennnsnennsnneee SIGMAUTELS) Regulated by the Central Bank of Kenya wmkctarvpcom — @) sws.zzsea @ orrcerooa/orseserom @Q entacceneakecore AVECPART UTHORITY TO RECOVER LOAN THROUGH CHECK - OFF SYSTEM Whose particulars are as indicated above, do hereby give my employer,. of P.O, Box. oy irrevocable authority to recover from my salary payments. of shs. ccoup.mh. over 2 period of .. months, and remit the same to KCB Bank Kenya Limited, Head Office, P.O. Box 48400, Nairobi for the credit of my loan account in branch. In the event of my termination from employment for any reason whatsoever, will make alternative arrangements to clear any outstanding loan amount owing the Bank. Signed by the applicant: Name ID Number Signature . Date FOR ALL APPLICANTS WITNESS - (Head of Department; Controlling Officer/Officer ~ In - Charge/Commanding Officer] \ confirm that the above named is @ bonafide employee of .. and all the details indicated above are correct. The Officer has ....... years remaining to serve in current rank (For DOD Officer Only) Full Name Signature... . Rank/designation Date Officer stamp ... CONFIRMING OFFICIALS - [Tick as Applicable] TSC District Personnel Officer / Principal Personnel Officer / Commandant / OCPD / Officer In Charge / Human Resource Manager / Regional Personnel Oieer/ Mecca Oficer In charge / Provincial Medical Ofer (Excluding DOD applications} | confirm that the above named is a bonafide employee of co soon and the salary details indicated are correct. Full Name . Signature .. Date Official Stamp FOR DOD APPLICATIONS ONLY - DEPARTMENT OF DEFENCE (DoD); CAD / SAD | confirm that the above named is a bonafide employee of the salary details indicated above are correct. Full Name . Signature Date sos Official Stamp on FOR OFFICIAL USE ONLY | Name of Sales Staft/Agents | Sates Code (12K: | Statt Number: | | Branch Name "Branch DAO Code: | Immediate Sales Supervisor: : Staff Number: | Name of Staff making the Sale referral L - “Sales Code (12x - | TEAR OFF CUSTOMER ADVICE Date of Application Name of Applicant: - ID No: ‘Thank you for Banking with us. Your application is receiving the necessary attention. We shall revert to you shortly. Name of Bank official: Signed: Date: Regulated by the Central Bank of Kenya wowarkebgroupcam —— Q) SMS:22522 @ 0711 007000 /0732 187000 QB contactertrookcd coke geo aPART 7: TERMS AND CONDITIONS Interest Interest wil be charged atthe prevatng rate indcsted'n part «of tis application and wil ‘cere sly and be applied mt the endo each month However in alrespects 9 eteult ate Inatetea tn Part ofthis aplication wil be Charged or amounts in arvears, Yor the time suistaning. ‘Thebank reserves the righ charge such rte or Fates of intrest asi thay n Resale cieretion tom time a tine to decide. The: Sank shal gue, the Borrower hati prior te ay change inthe rate or ates tf intefet payable and changes inthe terms Sndconaiiansn such manners: permited by iow: Biretain up to a maximum of one month's faunalet of loan instalment fo be dates ‘Fam proveeds of lon granted under ts olen, teemerfor terest paymente tat shal accrue uring the tat two months a his contrac. ideal Repaynent Repayment of the facity wil be effected Greely trough eheck-f rom your pay-por ‘he Bank reserves the night Yo ehaure the Check-ol arrangements are finalized) and ontrrnes with Your employer berore release oF” funds, “inthe “event that eheckeat Srrangements are not falized as anipated {or wnsteer reason, your obleaton to fepay the oon w'emain snd you il be expected ta mate direct payments ito your loa account ether facade Gry etloer ats te heek-of or unt the loan fs tepid fl, ‘nhchever will come earn Wogotaton ees A negotaen fee will be charges an the fll tear Smaunt atthe rate ndested on part of {hee appicaton, ons oncavol basis atthe te af granting thetoan teBrdattraement leis high recommended that you maintain an ‘Account wind Tor sso of ccburzements of toon proceeds Incase you do net marta an fsccount, the unde wil bs releseed to you by way of 8 Banker's Cheque ar any other ieans Bt'the prevaling cost whieh il alo be debe ote loan account AiskWarga Premium Anonaungabl ik margin rerum il be charged, as show n part ofthis application form'on 2 oncecol basis beore drantown 0 ower deat and permanent disailty to he Sorrowse snp areng irom on scedeat. The aroun gaat urge th cve wie ey for elaarng. the autstanding” (oan or part threo! at) athe. date of the accigent, dopending onthe extent of dsabily caused You wil mane necessery prior arrangements 1 eau taf te tent of ater Ines yoursll and which reeuts nthe rontunltes (as indlated above) covered by {herisk margin the matter is reported tothe Bank without delay to faciate Wodging of 3 flaim, ‘Any claim made after bonne rom the date 8 the accent wil be Sime: bares Sr wil not be nonoured The continuance of the facity is dependent upon the account boing conductest our eatistnction aa times Signed by the Applicant: Name ... In the presence of: Name Address: Bank Official: Name: ITEMS REQUIRED {original & Copy of National ID [Certified copy of PIN Certificate [Copy of affidavit, in case of change in names. ‘andon the understanding ta aan elie Slwaye repayable on demand, shoud the Bar ‘deem advisable a make sucha semand. The Bank reserves the right fo se off or combing Sllorany accounts ofthe borrower herr Fight, whotever thei nature. Cenidentia information Li" the Banc ay hold and process. by computer or, otherwise, any ‘information blamed” about the. ‘Borrower 36s Eansequence of this agreement 12 the Borrower agrees thatthe Bank may i Include personal data in ts porroner’s Systeme nbich may be accessed. by ther hmpanies in" the bank's group for credit Ssaecsment, statistical opal ncluding Behavior and ‘coring and. to identi the prod “arg “erent Ione SUpplied by third partesl wc may be Folevant tothe borrower: and } Permit other comparies within the Bork’s Group to use. personal dsta_and any ather ‘Rrormation holds abou the Borrowsr on tho Banks” customer system to. bring. 10 ts stanton products and services WHER may be Stintrea tothe Borrower 1 he rroa fre agrees hat he Bank thay siscose Re data ond | information feng tothe Borrower cling dete and Information "relating to "any. transaction Documents or the asoet, busifess or altars of ihe Borrower outade tne Bankes group Wether such data and/or infrmaton 1s tblained alter the Borrower ceases To be the Bani’s customer or during the continuance ot the Banker customer reltion or before such Felationship was in canterplation 2) or rad arevention purges: B}Tollcensed Cred Reference Bureaus or any Shree le is external lawyers, auitors and other Subscantractors of persons ating as Bank’ ‘penta, Po ay person whe may assume the Bank's fights under this tavern aiifthe Bank has ara or duty to disclose or is permitted or compelled to dos aw, and 1) Ber the purpose of exarcsing any power, Femedy night authority. or dserlion relevant forthe faclity Letter or any. iransacton Document folowing the occurrence et an ‘event of Default to any other person of third forty az wel TI's “Borcower acknowiadge and agrees that notwithstanding the terms of any ather Boreemont betwen, the Borrower andthe Bank, adsclosure of information by the Banik inthe" circumstances, contemplated by ths paragraph does not volte any duty owed to ther Borrower ther conan, tow or Bursuant to any agreement baton the Ban find the Sorrower or in ordinary course of Banking business and the customs, usage and prac ated thee and further suory rom the Borrower and that inguiry bythe Sank a8 to the justiestion for oF valsy af uch dlecisure festing ot By signing this contract the Borrower will be senses ID NOG ssn soe SIGMBLUPE etn . . Signature deemed to have exercised his/her freedom to Enter info the agreement, understood. the Suitability of the product and the Terms and Ganaitions ofthe contract. BT the 2t i 38 Borrower may not assign all or any Part of ia/her rights, obligations or benefits ‘Under this agreement. Ary notice or demand fer payment y the Bank shall be deemed to be property served if itis delered by han, ot Sent by registered post or facsimile to the ‘dress or facsimile number set oUt in this Sareement orto any other adress o facsimile umber the Borrower may notiy the Bank in i Antico or demand if delivered by I thal be deemed to have been received atthe time of delivery f sent by registered at aha be deere to erected by the jorrower § days ater posting and if sent by facsimile, shall be deomed (9 be received at the time of trensmission. Any failure or delay by the Bank to exorcise ony righ, power of Brivlege granted by taw shall not be deemed fee waver by the Bank a to the exerelse of Such right. power or privilege. You wil be Fequieed Yo Foy the Bank rompty of any change of address or place of employment during. the currency. Sf the facility Such ification should be done in writing. 22 The Bane shal be emiod to vary these ‘Terms and Gondlions fom time to time in the vent of any" change in applicable law oF Fequlation er inthe. application or interpretation thereat or he currence ot any fevent which inthe sole opinion of the Barks materially and adversely affects the Kenyan Banking market Subject to the requirements ‘of any statute notification of any such variation Shaltbe given othe Boroner eter inwrting ‘erby publication theree! by such means as the Bank'may select ag permitted by taw and Varlation So effected shall be binding on the Borrower. 23 in the event that legal opinion or other ‘ction iz necessary in relation to your account ar recovery o the debt iis agreed thal Legal ests and all reasonable charges wil be ur account Re This offer is subject to the loan request Being approved and is vali fr one {1} month Up to and provises for fll or pari drawdown ofthe fect Failure to agcept the terms ofthis agreement or to-draw the fachty bythe date stated wi Eonsttute automate cancellation ofthe facility Spproved Reeeptance of the Terms and Conditions contained in ths agreement shall be indicated fy the Sorrower providing the Bank wih the igiel of th Rereemen duly sgned as ‘evidence of acceptance of the’ terms and Eonditions as states ‘The Bank recommends that the Borrower 4ecks independent sevice onthe terms of this agreement to hip her fly uncerstand ‘what the facility involves and the potential consequences ‘and implications for the Borrower agreeing to its terms. - Signature: .... 1 Dates nseee ID NO. sense ~ se DALE! son “ Dates... ween ROW, Original 3 months most recent consecutive month's pay slips ‘Account statement for the last 6 months, if salary account not in KCB Copy of transfer, in case of variance of workstation Regulated bythe Central Bank of Kenya wwwekebgroup.com @ ss-20522 0711087 000/0720 87000 QB comsctenteokchcs ke