LOAN APPLICATION & AGREEMENT FORM
A. APPLICANT’S PERSONAL DETAILS
Surname: Other Names:
Date of Birth: ID/No: KRA PIN:
Current Postal Address: Mobile No: Email Address:
B. EMPLOYMENT DETAILS (for employed members only)
Terms of Service: Temporary Contract
Permanent
If Contract/Temporary for what period: Years Months Work Station
Date of Employment: Designation: County:
Payroll/Employment No: Department: Sub-County:
LOAN PARTICULARS:
Loan Applied for Kshs: Gross Monthly Income (Ksh.) Repayment
Period:
Amount in words:
LOAN PURPOSE
MODE OF DISBURSEMENT
Disbursement of the approved loan amount will be to _________ Savings Account or ________________ paid in cash, tick as appropriate.
K. MODE OF REPAYMENT (Tick one)
Checkoff Standing Order Direct Debit M-pesa Paybill
LOAN SECURITY
(i) Guarantors:
In consideration of guaranteeing the above loan or any lesser amount that may be approved, we the
undersigned here by acknowledge to have understood the terms and conditions of this application and accept
jointly and severally the liability for repayment of the aforementioned loan in the event of the borrower’s
default. We understand that the amount in default may be recovered as an offset against our salary. And we
shall not be eligible for loan unless amount in default is cleared in full. We are ready to assist the lender to
ensure that borrower repays the money advanced to him/her with interest within specific period. We hereby
confirm:
TO BE FILLED BY GUARANTORS
Guarantor’s Name I.D No. Mobile No. Payroll No Amount Signature Date
Guaranteed
BORROWER’S DECLARATION
I.............................................................................(name) hereby declare that the foregoing particulars are true to the
best of my
knowledge and belief. I agree to abide by all the terms and conditions governing this loan and any other future
amendments as may be reasonably made from time to time. I further declare that I have understood and
accepted the terms of this loan product and I hereby authorize the lender to credit the proceeds of this loan to
my account /cash, I also authorize necessary deductions to be made from my salary as repayment for this loan.
Signature…………………………………. ID No: ……………………………. Date: …………………………………….
N: IRREVOCABLE AUTHORITY:
Authority to employer to recover loan through check off system/ Salary Standing Order.
I….....................................................................whose particulars are shown above, do hereby accept the loan on the terms and
conditions contained
herein and hereby give my employer ………….……....................................... of P.O. Box......................Irrevocable authority
to
deduct from my salary the principal approved amount for the period of the loan in the event of termination from
employment for whatever reason authorize my employer to deduct and pay any outstanding loan from my final
dues
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Signature: …………………….........................… Date:…………………….………………
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