Confidential
KEWISCO REGULATED NON WDT SAVINGS AND CREDIT CO-OPERATIVE SOCIETY LIMITED
P.O. BOX 4491 – 00200 NAIROBI TELEPHONE: 0111 120600/1/2/3/4/5/6
E Email:info@kewiscosacco.org,manager@kewiscosacco.org,loans@kewiscosacco.org
LOAN APPLICATION AND AGREEMENT FORM
NOTE (LATEST ORIGINAL PAY SLIP AND A COPY OF NATIONAL ID CARD MUST BE ATTACHED) PART A:
PERSONAL INFORMATION
1. NAMES IN FULL (as it appears on the ID. Card)
2. POSTAL ADDRESS CODE …………TOWN………………………..
3. MOBILE NO……………………………………………….EMAIL ADDRESS……………………………………….
4. PAYROLL NUMBER ID/NO EMPLOYER
5. MEMBER NUMBER WORK STATION DATE OF BIRTH
6. TERMS OF SERVICE (e.g. Permanent & Pensionable/Temporary Contract/Casual etc.)
7. POSITION IN SOCIETY………………………………………………………… (Board member/ Delegate/Member/ Staff/Others)
8. NAME BANK BRANCH A/CC.NO
PART B: LOAN APPLICATION AND REPAYMENT
1. AGREEMENT
I Hereby apply for a loan of Ksh (Amount in Words)
……………. repayable in ................ ……..Months (period).
2. TYPE OF LOAN APPLIED (Tick as appropriate)
SHORT TERM LOANS
Emergency Loan Mapokezi Loan Mkombozi Loan
School fees Loan Angel Loan Masomo loan
Instant/Hapo Hapo Loan Asset Finance Loan
Other…………………
LONG TERM LOANS
Development 1 Development Reloaded 2 Senior citizen
Development 2 Super Saver Loan Super shareholder
Development Reloaded 1 Platinum Loan Others …………………
PART C: PURPOSE FOR WHICH THE LOAN IS APPLIED
Note: state the use of the loan with exact amount for each use
1. Kshs.
2. Kshs.
PART D. LOAN SECURITY (Tick appropriate)
Salary Terminal Benefits (excluding Pension)
Deposits Others (Specify)
Guarantors Collateral
Loan repayment can be done via Paybill No 902250, cooperative bank account- 01120001899200
Langata Branch or KCB account 1183115369 Moi Avenue Branch
PART E: DECLARATION
I hereby declare that the foregoing particulars are true to the best of my knowledge and belief and do agree to
abide by the bylaws of the society, the loan policy, and any variations by the Management Board, in respect of
Part B above. I hereby authorize the necessary deductions, including monthly interest to be made from my
salary as repayment for this loan.
NOTE:
KEWISCO Sacco Society is registered with Credit Reference Bureaux (CRB). The Sacco shares credit report(s) and
loan performances with the CRB. Any default will be reported to CRB.
Name……………………….……………………Signature……………………..…...Date…………………..
Confidential
KEWISCO REGULATED NON WDT SAVINGS AND CREDIT CO-OPERATIVE SOCIETY LIMITED
P.O. BOX 4491 – 00200 NAIROBI TELEPHONE: 0111 120600/1/2/3/4/5/6
E Email:info@kewiscosacco.org,manager@kewiscosacco.org,loans@kewiscosacco.org
PART F: REPAYMENT GUARANTEE
I/We, the undersigned, hereby accept jointly and severally, liability for the repayment of the loan including interest and
costs to the aforementioned loan of Ksh………………………. (Amount in words) ………………………………………………..
……………………………………. in event of the borrower’s default. Iunderstandthat the amount in default may be recovered from my
salary, deposits in the Sacco or by attachment of my property. I also authorize my employer to recover the defaulted loan from my
monthly salary.
EMPLOYEE TEL. NO. NAME Amount guaranteed in Words Amount in ID No SIGNATURE
NO.
Figures
Guarantees confirmed by D at e
PART G: COMMENTS BY THE EMPLOYER
The applicant is employed by in Station
Subject to rules and loan policy of the society, I support the application and will inform the Sacco should the
employee be transferred or discharged from the organization. The Employee retires/contacts ends on …. / /…..
Name Employer’s Sign Official Stamp…………………….Date………………….
PART H: TECHNICAL COMMITTEE REMARKS.
This loan application should be accepted/rejected for the amount of Kshs at interest rate of
%per month and repayable in months. The loan application is rejected or amount requested
reduced for reasons;
i. Name Designation ………..Signature ….Date
ii. Name…………………………………..Designation…………………Signature……………Date…………..
iii. Name…………………………………..Designation…………………Signature……………Date…………..
PART I: CREDIT COMMITTEE
We have examined the above loan application, taken into account the remarks and agreed as follows:
a) Loan amount approved Ksh recoverable in months.
b) Approved Yes No
c) Deferred/Rejected for the following reason
d) Chair ………………………….Secretary……………………….. Member Date
PART J: DISPATCH THROUGH CHEQUES/MPESA/EFT
Mode of payment
Signature Date
