LAF Serial No. APPLICANT CONFIRMATION I ID No. here by confirm that the information provided here is true and that I agree to abide by GROUP / HiH (EA) Rules and Regulations. Incase I default, I hereby agree that the group can take any action to ensure they recover the loan either in full or partially including all principal, interests, service charge and penalties due and owing to the group/HiH (EA). Applicant Name: GROUP OFFICIALS PART Signature Date We the Officials of Group, on behalf of the group hereby confirm that the information provided above is true, and that we undertake to ensure that the applicant repays the loan in full and the group meets its obligation as far as applicant’s loan above is concerned. NAME SIGNATURE DATE Chairperson: HAND IN HAND Eastern Africa FOUNDATION HAND IN HAND EASTERN AFRICA LOAN APPLICATION FORM BRANCH PRODUCT BRO GROUP INFORMATION Name of Group: Yr of Formation Current Group Savings: Kshs. Current Group OLB: Kshs. Current Membership APPLICANTS INFORMATION ID No: Applicant Name: Date of Birth: Address: Gender: F Tel: M Treasurer: Marital Status: Married Secretary: Single Residence Type: Owned FOR HiH (EA) OFFICIAL PURPOSE Loan Decision: Approved Rented No. of Children: Declined Pended Location (Near What) Widow/er How long in the residence? Ancestral: In Sch: Pri BUSINESS INFORMATION Economic Activity Type: Reasons for the Decision: Divorced Sec College Yr Started How Long in this Location Other dependants Type of Ownership Family: Sole Proprietor Amount Approved Kshs. In Words Repayment Period BRO Signature Repayment Installment LAF/Insurance Charged Branch Manager Name & Signature Partnership Permanent No. of Employees. Temporary Female Male FINANCIAL DETAILS Operations Manager Credit Manager APPROVALS Disbursement Amount Kshs. In words: Cheque No. Date Cheque Drawn Signature Prepared by: Approved by: Kshs. INCOME Date Name Enterprise Expenses a) Sales from enterprise Per Month Rents (Residence + Enterprise) b) Income from other Economic Activities Purchases c) Income from other sources Salaries Utilities Transports Applicant Disbursement Confirmation Loan payment I here confirm receiving a loan from HiH (EA) of Kshs. by cheque No. To be repaid in months/bullet, start _____/_____/_____ at an installment of Kshs. per month. Date Sign Applicant Name i)Total Enterprise Exp. Giving Hope, Dignity and Choice Household Expenses Rent Giving Hope, Dignity and Choice Kshs. Food NAME SAVINGS KSH SIGNATURE DATE ________________________________________________________________________________ School Fees 1. ________________________________________________________________________________ Medical 2. ________________________________________________________________________________ Utilities 3. ________________________________________________________________________________ Others 4. ________________________________________________________________________________ e) Totals House Hold Income (a+b+c) ii)Total House Hold Expences 5. ________________________________________________________________________________ Net Income/loss (e-iii) iii)Total Expences (i+ii) 6. ________________________________________________________________________________ ________________________________________________________________________________ 7. LOAN PARTICULARS Loan amount applied KShs. ________________________________________________________________________________ 8. Loan Purpose Savings Value Ksh: ________________________________________________________________________________ 9. ________________________________________________________________________________ 10. Loan Payment period: Loan Payment Frequency: Month Loan Installment Amt:Ksh. Bullet GROUP LOAN GUARANTEE In an Event of Default, as the term is defined in the Group Constitution and HiH (EA) rules and Regulation, on the part of ANY OF THE UNDERSIGNED GUARANTORS, each of the undersigned GUARANTORS agrees to be personally liable for the payment of the above applicants loans with it to HiH (EA) of any and all principal, interests, service charge and penalties due and owing to the organization. Each of the undersigned GUARANTOR agrees to be jointly and severally liable for any and all of the obligations to the organization. Each of the undersigned GUARANTORS hereby expressly authorizes deductions without any notice from any of his or her existing and future savings with HiH (EA), with the group being it current or future, actual, or dividends contingent in order to satisfy any such obligation (s), in any amount owed by the borrower to the organization. An “Event of Default” shall be defined as (a). Missing a single loan payment or any part of such payment; (b.) missing a single savings contribution or any part of such contribution (d.) Withdrawal from the group/HiH (EA) with debts and without prior written notice to and from the group/HiH (EA) (f.) the death of the Borrower. We the udersigned Members of_____________________________Group hereby do agree and sign Giving Hope, Dignity and Choice ________________________________________________________________________________ 11. ________________________________________________________________________________ 12. ________________________________________________________________________________ 13. ________________________________________________________________________________ 14. ________________________________________________________________________________ 15. ________________________________________________________________________________ 16. ________________________________________________________________________________ 17. ________________________________________________________________________________ 18. ________________________________________________________________________________ 19. ________________________________________________________________________________ 20. ________________________________________________________________________________ 21. ________________________________________________________________________________ 22. ________________________________________________________________________________ 23. ________________________________________________________________________________ 24. ________________________________________________________________________________ 25. ________________________________________________________________________________ 26. ________________________________________________________________________________ 27. ________________________________________________________________________________ 28. ________________________________________________________________________________ 29. ________________________________________________________________________________ 30. Giving Hope, Dignity and Choice
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