UGAITBA POLICE FORCE

EXODUS SAVINGS & CREDIT COOPERATIVE

SOCIETY LTD
REG. NO 8404
P. O. BOX 7055 Kampala
NAGURU
07 7 6855286, 07 0603 417 I
LOANAPPLICATION FORM

SECTIO\ A:
Please select the loat.r prodr-rct you intend to appl,v for
.tsset Financing Loan Basic Loan F{or-rsing Loan [-l S.nool Fees Loan
[-l [] tr

l-l ,-"rgency Loan tr GrorLp Loan I Social Loan Business Loan

SECTION B:
.\P PLICANTS PART I C ULARS
Names.Wangijja
ch
IPPS No. NiN NO ..
Force No/File t\o. . RankiTitle.
.. Station.

Duration as a member (\'rs Vlonths) Gross Salary per month

VlobileTelephoneContact: 1....... ...........2

Email:

DETAILS OF THE ACL'OUN'| 'I'O BE CREDI-I'ED

|.lames (Capital Letters)

tsank . Dranch"

Account Number

"$.tVr, i{ -r Ii il lvLL[iAKfr
{. {.} "
Pag* 118
SECTION C:
PARTICULARS OF LOAN APPLIED
Amount of loan (hgures).
Amount (in words)

Purpose (Reason) of the loan .

Ir,villpaybackin.... ..... Equal installments frrrtheperiodof .........Months,

ln case of any other loan r,vith another financial instirution apart from this applied

for, please fill and attach the quotations;

1. Lender Amount Quoted

2. Lender Amount Qr-roted

Signature of the Applicant Date of Application

SECTION D:

FOR EMERGENCY CONTACT

NEXT OF KIN
Name. ... Te[.

Date of Birth. ... .. Relationship... ..

Home District (village, sub corLnty'. district)

Occupation

SECTTON D:
RENTARKS BY LOANS OFFICER

SIGNATURE

CreditOfficer Name

"$.&v{: {" {} }q. 't' lt

{: }V [. ]- ]i.d &. ]- "
Fxs* 2l*
SECTION C:
PARTICULARS OF LOAN APPLIED
Amount of loan (figures).
Amount (in words)

Purpose (Reason) of the loan .

Ii.villpaybackin.... ..... Equal installments fortheperiodof .........Months,

ln case of any other loan r,vith another tlnancial institution apart from this applied

for, please fill and attach the qr"rotations;

t. Lender AmoLrnt Quoted

2. Lender Amount QLroted

Signature of the Applicant Date of Application

SECTTON D:

FOR EMERGENCY CONTACT

NEXT OF KIN
Name. ... Tel.

Date of Birth. ... .. Relationship. . ..

Home District (village, sub countl'. district)

Occupation

SECTION D:
REMARKS BY LOANS OFFICER

STGNATURB

Credit Officer Name

'"5,., \'L {rr} }4 i' t} *" 1v&" t rAltxi "

flxsc 2lt
 NOTE:

REOUTREMENTS THAT ]VTILI BE, ATTACHED FOR YOUR LOAN APPLICATTON TO

BE_$JICCESSFUL

1. Attach a valid copy of National ID

2. Attach a valid copy of \tr'arrant Card

3. Attach a recommendation lefter from vour unit commander

4. Attach a copy of a valid and current appointment letrer

5. Attach a copy of Salary Bank Statement shorving at least 2 recent months

6. One MUST be having OR r,viiling to have SHARES rvorth at least l5'% of the Loan amount

applied.

7. . Attach passport photos in the bo.x-es above.

Upon completing the application, please YOU can submit it to the nearist S.\CCO OFFICES ie. HEAD

OFFICE in Nagr-rru, or in any ol our regional branches of ICABALE, .vlBAR{R\, }t.\SAKA, FORTPOTA

H0INI:\, PTS KABALYE. ARUA, GUI,U, LIRA, vIoRoTo, SoRoTI, vlBALE, and IGANGA.

OUR Bfu{NCH NETWORK -COUNTRY \l'IDE

....
L IC{Bz\LE.......... 0704 192 I8l
2 N,[BARARA,.. .. . .... 0778 02A 667
3 VIASAK;\, ............ 0:35 89-5 4.+e
4. FORTPOTAL. ........ 11782 990 ll L

5. HOIlvlA . ....07013ll 187

6 PTS IC\BALYE . O7t)O 5 19 2.i4
7. ARUA.. ... . .0785 864 6_59

8. GULLJ, 0789 012 864

9. LIRA,... ... ....0719 996 g4-l
I0. MOROTO,... ........ . t12 i47 561)
...0
i1.soROTr........... 0752 139688
12. VItsALE, .. .,....... 07-5 955 667
1l IGANGA". ... ....... 0788 827 50.t
'' t':, ',, I i.. i,'!..) ji 'i :,t il
i.r,::,318
 *ldr ?qr#
EXODUS SAYINGAND CREDIT COOPERATIYE SOCIETY LI
REG. NO 8404
P. O. BOX7055 KamPala
Location: Naguru
rel:0773 415327,0773 002 061

PERSONAL DATA OF APPLICANT:

Name of Applicant.
Tel....
IPPS No. Bank: AJC No.

Warrant CardNo.
NIN.... . .. .. . ....Station. "Unit'
Home District (vi1lage, sub county, district)

Date of Bir-th:
Marital Stalus.
Name olspoLise (ii anY)

Section 1. CAP-\CITY TO REPAY THE LOAN

r Affordabilityas Per PCA

ATMOLNT (UGX)
lvlonrhly Installment
Loan -\mottnl

Section 2. C.\PI-IAL

. The required shares to qualily tbr amount applied?

No. Wofih 'Share r':.ttc (Utlr):

Section 3: CO5DITIONS: (Tick Boxes)

Api;ointntent Recommendation Passporl photo: Bank Statcrnent
Warant
Card/ [ -.t-rr itomUnit
National[D Commander

."}i.\v{i r{}&. Tffir, w

*'xg* 418
 SECTION 4: FOROFFICIAL USE T,,t\, y.\'

Yourloan has been:-

(a) Rejected
Reasons forrejection

(b) Recommended Amounf

Amount recomrnended (in r,vords)

Loan Amount
Principle (Ug Shs) .. .... Inrerest (Ug Shs)
OtherCharges (Ug Shs) ,.
Total (P+I+C) (Ug Sh

willbedeductedfrom yoursalaryin .... . eqLral installments of shillings .....

Per month [rom..

D ECI,ARATTON

1 ............... AI,OANS OTF'ICER IN EXODUS

SACCO Ltd CONIIIRMS THAT THE INFOR-VTATION PERTAINTNG'IHE
APPLTCANT FILLED In. IS TRLI.E TO THE BEST OFNTY Tfu\owLEDGE.

DATE: SIGNATURE

FOR N'loRE Ii\FORNIATION OR INQUTRIES ON LOAN APPLICATION AT f{[AD OFF ICE

CONTACTT

Otficer 1.0112 6i2 418

Oitlcer 2: 0788 563 978
Offlcer l: 0708 968 84,+
Officer 1'.0751 311676
Ottlcer i: 0784 12i 733
Ott-icer 5: 070-1 162. 331
Otficcr 7: 0779 358 958
Officer 8:0774 945 30- [ln charge Online Applications)
Oftlcer 9: 078,r 216l3l

"SAVf, IItl R "{" t{ i. \1'gL }r.\ !LE,'

l,xge 518
 APPROVAL AND RECO\TERY CONSENT DECLARAT'ION

A
POLICE OFFICER CONFIRM
TIIAT THE INFORMATION FILLED ABOVE IS TRUE TO THE BEST OF MY
KNOWLEDGE
AND
ALLOW EXODUS SACCO TO MAKE DEDUCTIONS ON MY SAI-ARY FOR
RECOVERY OFTHIS LOAN I APPLIED ONLINE

DATE: SIGNATURE .........

YERIF'IED BY

1............... ...........A RECOVf,RY OFFTCER IN EXODUS SACCO Ltd

CONFIRMTHAT THE APPLICANT HAS FTILL AFFORDABILITIT'OR THE
AMOUNTQUALIFIED FOR AS PER PCA AFFORDABILITY

DATE: SIGNATURE.......

APPROVEDBY

BOARD CRE D IT COPIT\IITTEE :

Nzrme: Sign............ ..Date

Name: Sign ..... ..Date

.\UTHORTSED BY

Name:

CHIEF EKEC UT[!'E OFFTCER

PAID BY

Name:

CHIEF FINANCEOFFICER

"5:{VE f {}& T}{f. 1Y -{.r"',&.RL"

l'ag* 518
 THE REPUBX,i,| OF UGANDA
T'his agreem.ent is madethis.....,.Da]'r-,'-.............. ....,2u... betweenEXODUS SACCO
Located in NAGURU here by referreii i,: as A LENDFJR of one parl and

. (Name) .................aresident
InlAttachedto.............. ...... herebyreferred

to as ..\ BORROIVER.

Whercas the lender is a financing agency. is desrrous of lending to the boror,ver and where
as the borrower is desirous of borrowins tiorn the lender under terms and conditions herein

belorv agreed.

THIS AGREEVTENT WITNESSETH AS FOLLO1VS:

The lender has given to the borrorver the principal surn of shs. .. .

(In rvords).

For a period of................... Ivtonths rnci to be repavable to the lender as principal and interest
thereon at the rate of .... . permonth, (and monitoring lees of 0,057oper month on loan
amount eKcept loans on straight line interest calculating rnethod.)

Loan lees (loan protection lr-rnd and ioanprocessing fees) of,.....'h of the loan amount plus
Shs.21,000/: for Stationery and EFT r'ee payable once at a time of Disbursement. The
Borror'ver shall make monthly instaliment ol Shs. . .. . . .. for a period of .. . .. . Vfonths.

Without prcjudice to the provisrons above. it is hereby agreed betr,veen both parties that in the
event olbororver lailing to pay back on the agreed time herein after agreed thr- borror,ver shall be

liabLe to pa!'lo/o on principal and interest due from the date of default to payment rn tult together
r,vith any'eKpenses incurred dLLring the recover).. process.

The borrower shall use the monev lent trv the lender for............ ............purpose
and also use Shs..... . .....(in lvords

......... ) to clear thc previous

loan Lralance that I am serving here in EXODUS SACCO and anl' other loan bu_v off
as per quotaion(s) may be attached.

"5..\ Vi:" f{}{A ? {"{ &t lYE[. FA${ N: "

*?age 718
In accordance with the purpose stated in the loan application form dully signed by the
borrower. The borror,ver s[a[| not divert the loan for any other purpose other than the
one applied for and acknowledged by him/her'

tne loans
diverts the
\reed, where the borrower dlverts
Unless othenvise agreed. lo[ for any purpose(s) other

than the one herein agreed, and fails to pay any installment on time, the lender may at any
time thereafter demand payment of the whole Sum of principle, interest and any other
charge as determined by the lender.

As security for the loan, the borrower hereby surrenders Salary for recovery of
the borrowed amount.

Additionatly, the borrower is presenting shares worth tr5olo of the approved amount as

collateral for the loan obligation therein.

It is herebyagreed between both parlies that the lender will keep record olthis trrnsactiotl'

In case of a shortfall, the lender shall consequently be free to seize the borrower sarings
a*d ultimatelythe borrorvers shares in the E,xodus Cooperative Savings and credit society.
provided that such securities shatl be sold to highest bidder at the tirne of sale, any other
eKpenses incurred by the lending during the recovery process shall be catered brv a

bomoi.ver. and any eKcess accrued during the Sale shall be handed over to the bonolver if
any.

SIGNED BY Tt{E BORRO\\'ER:

Name. . .. .. Sign.... Date" "

IN THE PRESENCE OF:

Name. Sigr-r. . Date.

Head Credit DePartment

Name . '.....Sign "' Date

C hief Executive Oflicer

FOR EXODUS SACCO

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