YEDF/CRE/04/001A/2014 FORM 001 A
YOUTH ENTERPRISE DEVELOPMENT FUND BOARD
DIRECT FUNDING
Region: ___________________ County: ________________________Constituency:_____________________
Purpose of Loan Loan Amount Repayment period Affordable Instalment
months
PERSONAL DETAILS 1ST APPLICANT
Surname First Name
P.O. Box..Code Gender
Middle Name: M
Town..Phone F
ID/PP Number: Occupation: Married Single Other
PIN: Highest Level of Education
Birth Date: Number of Dependants:
Spouse Name Spouse ID NO. Phone
Residence:(draw map ) Name of Your Chief: Nature of residence
Town/Estate: ...................................... District: .............................. Rent Own Other
Division: ............................................. Location: ............................ Phone: Duration at this residence
Sub-Location..................................Village: .................................... Name of Assistant Chief: If rented,
Name of Land Lord
Phone: Phone:
Do you intend to relocate? Yes No Do your children attend school? Yes No
If so, why?
Number Attending Schools?
Any positions of leadership within the community
PERSONAL DETAILS 2ND APPLICANT
Surname Other Names P.O. Box.. Gender
M
Phone F
ID/PP Number: Occupation: Married Single Other
PIN:
Birth Date: Highest Level of Education
Number of Dependants:
Spouse Name Spouse ID NO. Phone
Residence:(draw map ) Name of Your Chief: Nature of residence
Town/Estate: ...................................... District: .............................. Rent Own Other
Division: ............................................. Location: ............................ Phone: Duration at this residence
Sub-Location..................................Village: .................................... Name of Assistant Chief: If rented,
Name of Land Lord
Phone: Phone:
Do you intend to relocate? Yes No Do your children attend school? Yes No
If so, why?
Number Attending Schools?
Any positions of leadership within the community
BUSINESS DETAILS
Business Name: Description of Business Activity/Products No. of Years in
Operation
Reg. No.......................................................
Licence No..................................................
Directors:
1.
2.
3.
YEDF/CRE/04/001A/2014 FORM 001 A
Current Business Location (Market): Legal Structure of the Business( copy of
certificates/articles to be attached) Premises
Town: Sole Trader Rent
Partnership Own
Address: Limited Other Other
Telephone :
Duration at this location? Landlord Name:
Telephone Number :
Do you intend to relocate? Yes No Number of Paid Employees
If yes, why? Full-time _______ Casual ________
Draw a map showing direction to the business on the space provided below:
Other Businesses owned by Applicant/ Spouse
SAVINGS/CURRENT ACCOUNT HISTORY
Bank/Institution ___________________________ Account No:______________________Account Balance___________
Bank/Institution ______________________________ Account No:_________________________ Account Balance___________
(Please provide copies of 6 months certified statements)
REFERENCES: Name, Address and Telephone *
List three or more references, Address & Tel.No. (suppliers, Landlords, peers, etc)
Name Telephone relationship
1.
2.
3.
CREDIT HISTORY (Prior 3-5 years)
Have you ever applied for a loan before? Yes () No (). If yes, please provide details below:
Name of Lender Date Applied Amount of Loan Duration of Loan Monthly Instalment Amount outstanding
______ ______ ___ ______ _________________
______ ______ _______ ______ ___
______ ______ _______ ______ ___
____________________ _ ______ ______________ ______ ___
Do you plan on borrowing any money from;
Creditors NGOs Banks Family members Other(specify)
If yes, please provide terms and purpose. _____
____________
YEDF/CRE/04/001A/2014 FORM 001 A
BUSINESS ASSESSMENT
Major Business Suppliers: (See receipts) Major Business Markets: (See records/sales books)
Where do you buy? Who do you buy from? Where do you sell and who do you sell to?
How often do you buy?
How long does it typically take to sell your purchases/
inventory?
How much do you buy each time?
How much do you sell in a typical week? Month?
Will this change as a result of the loan? If Yes, how?
Will this change as a result of the loan? If so, how?
GROSS PROFIT MARGIN ON BEST SELLING PRODUCTS
Product Selling Price (A) Purchase Price/Cost of Gross Profit Margin
Production (B) ( A-B) / A
1.
2.
3.
4.
Average
Average Projected on Previous Loan Application
BUSINESS MONTHLY PROFIT AND LOSS STATEMENT (business that is subject of loan)
ACTUAL PROFIT AND LOSS PROJECTED PROFIT AND LOSS
Sales Sales
Cost of Sales/Purchases Cost of Sales/Purchases
Gross Profit
Gross Profit
Rent Rent
Utilities (Electricity, Phone, etc.) Utilities (Electricity, Phone, etc.)
Transportation Transportation
Labour Labour
Loan Repayments (Other) Loan Repayments
Other Other
Monthly Profit/Income Monthly Profit/Income
BUSINESS BALANCE SHEET (business that is subject of loan)
ASSETS LIABILITIES & CAPITAL
Actual Projected Actual Projected
SHORT TERM SHORT TERM
Cash (on hand and in Banks) Creditors (Trade)
Debtors Bank Loans
Stock
LONG TERM LONG TERM
Total Fixed Assets Bank Loans
Other Assets Other Liabilities
CAPITAL
TOTAL TOTAL
YEDF/CRE/04/001A/2014 FORM 001 A
NET HOUSEHOLD BUDGET
MONTHLY INCOME MONTHLY EXPENSES
Actual Projected Actual Projected
Borrower (net salary) Housing
Spouse (net salary) School Fees (average per
month)
Business (from above) Transportation/Vehicle
Pensions Food
Other Businesses Utilities (Phone, Electricity, medical,
(Applicant or Spouse) entertainment, etc.)
Other Income Other Debt Repayments
Total Household Income Total Expenses
Net Household Income
SECURITY/COLLATERAL
Kindly list all the Securities, giving a detailed description and Serial Numbers where Applicable. Where holder of
security is not an applicant, one of the guarantors must be the holder of security.
DESCRIPTION OF ITEM SERIAL NUMBER VALUE(KSH)
TOTAL LIQUIDATION VALUE
Other significant personal assets owned not listed as collateral and any liabilities against them:____________
DESCRIPTION OF ITEM SERIAL NUMBER VALUE(KSH)
YEDF/CRE/04/001A/2014 FORM 001 A
a) In connection with this application and/or maintaining a credit facility with the Youth Enterprise Development
Fund, I/We authorize the Youth Enterprise Development Fund to carry out credit checks with or obtain
my/our credit information from, a credit reference bureau. In the event of the account going into default, I/We
consent to my/our name(s), transaction and default details being forwarded to a credit reference bureau for
listing. I/We acknowledge that this information may be used by banking institutions and other credit grantors in
assessing applications for credit by me/us, associated companies, and supplementary account holders and for
occasional debt tracing and fraud prevention purposes.
b) I/We agree that the Youth Enterprise Development Fund may disclose details relating to my/our loan account
to any third party including credit reference bureaus, if in the Lenders opinion such disclosure is necessary for
the purposes of evaluating my/our creditworthiness or any transaction with or credit application made to the
Lender or such third party, maintaining my/our Account with the Lender or for any other lawful purpose.
c) I/We agree that the Lender may disclose details relating to my/our loan account including details of my/our
default in servicing financial obligations on my/our loan account to any third party including credit reference
bureaus for the purpose of evaluating my/our credit worthiness or for any other lawful purpose
d) I/We declare that all information provided as part of this application conforms to reality and assume full
responsibility for its accuracy.
e) By my signature, I/We hereby authorise collection of references, from any source whatsoever, concerning
my/our person, conduct and commercial credit.
f) I further authorise the issuance of reports regarding my credit history to Youth Enterprise Development Fund
Board and hereby absolve the reporting party of all responsibility.
1st Applicants Name ____________________Signature________________________ Date___________________
2nd Applicants Name ____________________Signature________________________ Date___________________
3rd Applicants Name ____________________Signature________________________ Date___________________
(Spouses)
Co-Borrowers Name____________________Signature________________________Date___________________
Co-Borrowers Name_____________________Signature________________________Date___________________
Co-Borrowers Name_____________________Signature________________________Date___________________
YEDF/CRE/04/001A/2014 FORM 001 A
YOUTH ENTERPRISE DEVELOPMENT FUND BOARD
Guarantor Personal Details
Guarantor Name: ___________ ___________ _
ID/PP No_________________ Relationship to Applicant: _________________________
Postal Address: ___________ Code: ___________ Phone No: _____________
Residence (draw map): ______ __
Town/Estate:___________________ District___________________________________
Division: ________________________ Location: _______________________________
Sub-Location: _____________________ Village: _______________________________
Employment or business: ___________________________________________________
Physical Location: ________________________________________________________
Monthly Income: __________________________________
Attachable copy of Security (Title deed, log book etc) where guarantor is providing security for the loan
No Description Serial No. Estimated Discounted
Value Value
1
2
3
4
5
6
7
Signature of Guarantor __________________________Date: ____________________
YEDF/CRE/04/001A/2014 FORM 001 A
YOUTH ENTERPRISE DEVELOPMENT FUND BOARD
Guarantor Personal Details
Guarantor Name: ___________ ___________ _
ID/PP No_________________ Relationship to Applicant: _________________________
Postal Address: ___________ Code: ___________ Phone No: _____________
Residence (draw map):
Town/Estate:___________________ District___________________________________
Division: ________________________ Location: _______________________________
Sub-Location: _____________________ Village: _______________________________
Employment or business: ___________________________________________________
Physical Location: ________________________________________________________
Monthly Income: __________________________________
Attachable copy of Security (Title deed, log book etc) where guarantor is providing security for the loan
No Description Serial No. Estimated Discounted
Value Value
1
2
3
4
5
6
7
Signature of Guarantor __________________________Date: ____________________
