HAND IN HAND - Safaricom Foundation

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.
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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
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Giving Hope, Dignity and Choice