PAP, 1126 PERSONAL LOAN - CHECK OFF APPLICATION/AGREEMENT FORM [Rev Au, 2019] NRIAM — D454 q6l dso AFFIX PERSONAL LOAN - CHECK OFF APPLICATION AND PASSPORT AGREEMENT FORM SIZE PHOTO TO BE COMPLETED IN DUPLICATE (Original for Bank, Copy for Customer] APPLICANT'S DETAILS (Please fill in all blank spaces) Branch: Date of Application: KCB Account No: Date Opened: Name and A/c to be credited: Name Ale No. _ a PART 1: PARTICULARS OF APPLICANT (Please fill / tick appropriately) Title: Mr/Mrs/Miss/Dr/Prof/Eng. | Surname: (Other Names: ID No. [Mandatoryl: | Nationality PINII/Tax) No.: Date of Birth: 00.MM.YY Gender: Male |_| Female |_| | [Marital Status: Single [ Married Widowed |] Other| |lspecify: Postal Address: Postal Code: Town/City “Mobile No.: a a | County: _ {Sub County: |Nearest Town Estate: Street Block No.: PART 2: EMPLOYMENT DETAILS (Please fill in / tick appropriately) Current Employment Details Employed SatfEmplowed| Pensioner [| | Name of Employer: Date of Employme Personal/Staff No.: Station: 7 Designation: Department: - 7 Terms of Employment: Permanent Contract Ion Contract, state expiry date: Gross Salary (Kshs) Basic Salary|Kshs} Net Salarylkshs) Employer's Physical Address Building Sireet Block No. Postal Address: Postal Code: Town: Country: Office Tel Website: Email: Previous Employment Details Employed Self Employed | Name of Employer: Date of Employment: Personal/Staff No. Station Designation: ee Department: | PART 3: DETAILS OF REFEREES (Mandatory) Relative's Surname: Other Names: ID/Passport Number: Relation to applicant: Postal Address: Office Tel: Mobile No. Email: Occupation: Non Relatives Surname: Tiber Neves TDiPassport Names | Relation to applicant: | Postal Address: Office Tel: Mobile No: Email Occupation: Applicant's Signature: Regulated by the Central Bank of Kenya wmekcbgroupcom QD sus: 22522 | 071127 co /orsa 17 o00 @Q) conactanrethcgrouncam 1 abanPART 4: LOAN DETAILS (All these fields are mandatory) [J originat Top Up Refinance 2nd loan {Tick as appropriate) Loan amount{Kshs} Cost of items to be financed{kshs) Specific Purpose of toan Repayment Period (No. of months) Interest Rate %p.a Monthly Repayments (Kshs) pm. Negotiation fees % Risk Margin] Premium _% Default interest Rate Yopa Other Loans (Both KCB and other Institutions) Lending Institution | Account Number | Outstanding Loan Balance | Repayment Amount | Loans tobe cleared (Kshs) (Kshs) (ick a appropriate) Totals [Please attach documentary evidence-preferably 2 12 months loan account statement] PART 5: CUSTOMER DECLARATION a. certify that the information contained in this application is true and correct to the best of my knowledge and betiet. b.t authorize you to obtain any information you may require relating to this application from my employer, Banker or Financial institution mentioned herein. c. hereby confirm that | have read and understood the Terms and Conditions outlined overleaf [part 8) which will govern the loan and hereby accept and agree to be bound by the same and | have accordingly endorsed the same. U.t agree that the lua and rly obligations W the Bank under the Werins aid Condltlons stall be effective fraiediately upon the Bank approving the sum applied for or ather amount as may be determined hy the Rank; nr suihject tn any security requirement as a condition precedent to crediting or applying the same to my account with the Bank or other- wise for my account. e.IF this loan request demands that | provide security by way of Charge or Mortgage or Assignment as the case may be or any other security in the form or substance required by, or acceptable to, the Bank as a condition precedent for the disbursement of the loan, | will do all such things and take such actions necessary to fulfill the same to enable the disbursement of the loan. | will also do all such things and take such action necessary to perfect any such security, including obtaining any requisite clearances, consents and approval at my cost. 1. Inconsideration to the Bank agreeing to grant me the loan applied for, or such lower sum and at such interest rate and costs, and on the terms and conditions set out as part 8 of this application, | hereby request and irrevocably authorize my employer to deduct monthly from my salaries the principal sum, interest 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. 49.For as long as any such loan shall be outstanding, | hereby assign all my final and terminal dues [excluding pension] of whatsoever nature due from my employer to the Bank, and | accordingly hereby request and authorize my employer to pay out the said dues to the Bank whenever they become due and payable unless otherwise advised by the Bank, h.I declare that | have not been adjudged bankrupt. i. Lunderstand that the Bank may in its sole discretion reject this application without having to provide any reasons. Applicant's Name .... ... Signature Regulated by the Central Bank of Kenya peso vwwtcdgroupcom Q@) sws:225z2 QB o711 007000 /0722 127000) conaccenreakcdgroup.com 2PART 6: AUTHORITY TO RECOVER LOAN THROUGH CHECK - OFF SYSTEM al, ‘wise par ucutats are as inaicated above, do hereby give my employer,. of P.O. Box, con con irrevocable authority to recover the loan’s monthly instalments from my salary payments through payroll check off over the period indicated under part 4 of this application and remit the same to my KCB loan account. 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. b.l hereby authorize and instruct the Bank to debit any of my accounts with the Bank, with the monthly instalments indicated on part 4 or such other sums due, if my employer fails/delays to effect payroll check off recovery and to pay the amount so debited into my loan account on the due date of every month effective 30 days after the loan has been disbursed Signed by the applicant: Name ID Number... Signature seventennnne DANG PART 7: EMPLOYER SIGN OFF [For all applicants) WITNESS - (Head of Department; In - Charge/Commanding Officer) | confirm that the above named is a bonafide employee of... and all the details indicated above are correct. The Officer has years remaining to serve in the current rank (For DOD Officer Only} Full Name Signature Rank/designation .nnmnmnnsn Date Officer stamp CONFIRMING OFFICIALS ~ (Tick as Applicable) ‘TSC County Officer / Principal Personnel Officer / Commandant / OCPD / Officer In Charge / Human Resource Manager / Regional Personnel Officer / Medical Officer In charge / Provincial Medical Officer/ DOD's CAD/ SAD | confirm that the above named is a bonafide employee of soon aN all the details indicated are correct. Full Name seonnene SIQMALUTE Date Official Stamp .. FOR OFFICIAL USE ONLY Name of Sales Stafi/Agent: Sales Code (12KI: = ny Staff Number: Branch Name: = Branch DAO Code: Immediate Sales Supervisor: Vv Staff Number: Name of Staff making the Sale referral Sales Code (12K TEMROF _2, oe t CUSTOMER ADVICE Date of Application: Name of Applicant: ID Nos 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 wnikebgroupcom @) us: 22522) 071 087 o00/0732 18700 QB contaccenireakcbarupcom AED HePART 8: TERMS AND CONDITIONS Intorest Interest willbe charged atthe prevating rate inicat- din part dof this application and will accrue dally and be applied atthe end ofeach month. However. ‘llrespects,e default rate Indicated in Part of his pplication wil be charged, for amount in arrears, forthe time outstanding ‘The bank reserves the right to: alharge such rate o rates af intorest asitemay nits {ole decretion from time to te decide. The Bank Shall ghe the Borrower notice porto any change in {he rate or rates of interest payable and changes in ‘the terms and conditions in such manner as permit ted by law. retain uptoa maximum of one month's equivalent lean installment, o be deducted from proceeds of loan granted under this offer, to cater for interest payments thot shall accrue during the fist S90 ‘months of his contract Mode of Repayment Repayment of the facility wil be effected directly through check-ff from your p3y-pintThe Bank reserves the right to ensure the check-off arrangements are finalized and confirmed with your tmployer before release of funds In the event that theckcalt arrangements are not finalized 35 ‘nlcipated for whatever reason, your obligation to epay the loan wll remain and you willbe expected make direct payments into your loan account as they fal due, unt your employer effects the check-off or until the lean is repai in ful, whichever all eome carier Negotiation Fees A rnegoiaton fee will be chorged on the full tan mount atthe rate indicated on part of his applica- tion, 9n 8 once-off basis at the time of granting the (oan Loan Disbursement Ie is highly recommended that you maintain an account with KCB for ease of disbursement a loan proceeds Incase you donot maintain an account, the funds wil be released to you by way of o Banker's (Cheque or anj other means atthe prevaling cost, tah vl oe be Jit Wo Ue la occur Risk Margin Premium AA non-relundable risk margin premium wil be charged, as shown in part 4 ofthis application on a foncevof basis belore Gravdown to cover the risk of feath trom whotever couse ond also permanent isabilty arising from an accident. The amount payahleondor thie raver wil he snely For caarng the oustanding lan or part thereo as atthe time of the death or ecurence of disability and depending on the extent of disabiliy caused. You will make necessary prior arangements to ensue that the trent of an accident Involving yourself and which Fesuits inthe eventuality las ingeated above covered bythe sk margin, the mater is reported to the Bank ‘without day to faiitate lodging of calm, ay Signed byte 10s. Sigoture ate ITEMS REQUIRED | Joriainat& copy of Nationa 1D [leertified copy of PIN Certificate [7] Copy of transfer, in case of yariance of workstation [Leter ot appointment for new applicants claim made after 6 months. from the date ofthe fccdent will be time-barred and wil not be honoured. The continuance of the facity is dependent upon the account being conducted te our aitacton at alt times and on the understanding that o loan facility is always repayable on demand, shoul the Bank deem it advisable to moke such @ demand. The Bank reserves the ght fo set of or cambin all or any account ofthe borrower in thei ‘oun ight, whatever their nsture Conisenti information 1.1 The Bank may hold and prcess, by computer or otherwise, any information obtained about the Borrower a¢ a consequence ofthis agreement 412 he Borrower agrees thatthe Bark may: al Include personal data in its borrower's Systems ‘which may be accessed by other companies in the bank's group for credit assesement, statistical analysis including behavior and scoring and to identiy the produets and services fneluding those supple by third partes) which maybe relevant fo the borrower; and 1b] Permit other companies within the Bank’ group to use personal data and any other information it holds about the Borrower on the Bank's customer system to bring to its attention products and Services which may be of intrest othe Borrower. 113 The Borrower further agrees that the Bark may diecose its data and/or information relating tothe Borrower including data and information relating to ‘ny tronsseion. cuments er the assets, business br affairs whether such data and /or information is blained after the Borrower ceases 10 be the Banker-customer relation or before such relation: hipwosin contemplation: 8] Fr fraud prevention purposes; To licensed Credit Reference Bureaus or another croton: dl To is external lawyers, auditors. and ther ‘agents; {I To ary person who may assume the Bak’ rights Under this Later; lf the Bank has a right or duty to disclose ors pesmited ar earnplled te do 0 byl and {For the purpose of exercising ay power, remedy, right thority, or eiseretion relevent to this facility Letter or any Transaction Document fllowing the ‘occurrence of an event of Default, to any ather person or third party as well Me The Rorrnwer acknmuledges and agrees tht, twtnthetntng the terme of any hr agreement between the Borrower ond the Bonk score of information by the Bank in the circumstances contemplated by this paragraph does nt violate any {uty owed by sther party bath in commen law and purtuant to any agreemant between the Bank and the Borrower or in ordinary course of banking business and the customs, usage and pracice related thereto 35 tothe usification for or vay of such disclosure, Inthe presence of: Name ron. Signature . Dat Coating oF £8y signing ths contract the Borrower wil be deemed to have exercised his/her freedom to enter into the agreement, understood the suitability ofthe product {and the Terms and Condtons of he contract. General 21 The Borrower may not assign al or any part of hisiher eghts, obligations or benefits under this agreement. Any notie o demand for payment by the Bonk shall be deemed to be property served if iti alvred by hand, oF sent by registered post othe dress the Sorrover may nat the Bank inviting, notice or demand i delivered by hand, shall Be deemed to have been received atthe time of delivery, if sent by registered post, shall be deemed to be feceived by the Borrower 5 days after posting. Any faire or delay by the Bark to exercise any right, power or privlege granted by law shall not be deme tobe waiver by the Bank as tthe exercise ‘of sh right, power ar privilege. You willbe required to patty the bank prompaly of any change of adress tor place of emplayment during the curency of the feel. Such notification shoul be dane in wring. 22 The Bank shall be entitled to vary these Terms fand Conditions fem tims ta ime in the event of ary change in applicable law or regulation or in the ‘application or interpretation therect or the tczurrence of any event which in the sole opinion ot the Bank, materially and adversely affects the Kenyan Banking market subject to the requirements of any statute, notlcation of any such variation shal be given to the Borrower either in writing or by publction thereof by such means as the Bank may Selecta parmitid by law anda variation soofected ‘hal be binding onthe Borrower. 23 In the event that legal opinion or other action is hecessary in relain to your account or recovery of the debt, tis agreed thal lgal costs Sndall reasonable charges wil be fer your acceut. 2 This offer is subject to the loan request being ‘approved and is valid for ane (1) month upto and provides for Tull or partial drawown of the facility. ~ Failure to accept the terms ofthis agreement or row the foi bythe date stated wll conotitute automatic cancellation of the facility approved. Deceptance ofthe Terms and Conditions contained in this agreement shall be indicated by the Borrower Providing, the Bank with the orginal of (8 Dreement duly signed as evidence of acceplance of tha terme and enaiinns ae stats The Rank recommends that the Rarer seeks independent advice onthe terms of this agreement to holp hirwher fully understand. what the faclty involves and the potential consequences andimplica- tions forthe Borrower agreing its terms. Bank fii Signnture& Stamp ate: TEAROFF_2, [7] origina 9 months mast ecent consecutive month's pay slips |_| Account statement forthe ast & months, it salary account not in KCB. [1] Copy of affidavit, n case of change in names Regulated by the Central Bank of Kenya wunchpouncom Q) sms 20522 071 087 000/732 127000 QB) contctenre@kcbroup.com