YOUTH ENTERPRISE DEVELOPMENT FUND BOARD

DIRECT FUNDING
Region: ___________________ County: ________________________Constituency:_____________________ Repayment period Purpose of Loan Loan Amount Affordable Instalment months PERSONAL DETAILS 1 Surname
ST

APPLICANT Gender M Phone F Occupation: Married Single Other Highest Level of Education Number of Dependants: Spouse ID NO. P.O. Box..

Other Names

ID/PP Number: PIN: Birth Date: Spouse Name

Phone Nature of residence Rent Own Other Duration at this residence If rented, Name of Land Lord

Residence:(draw map ) Name of Your Chief: Town/Estate: ...................................... District: .............................. Division: ............................................. Location: ............................ Phone: Sub-Location..................................Village: .................................... Name of Assistant Chief:

Do you intend to relocate? If so, why?

Yes No

Phone: Phone: Do your children attend school? Number Attending Schools?

Yes No

Any positions of leadership within the community PERSONAL DETAILS 2 Surname

ND

APPLICANT Gender M Phone F Occupation: Married Single Other Highest Level of Education Number of Dependants: Spouse ID NO. P.O. Box..

Other Names

ID/PP Number: PIN: Birth Date:

Spouse Name

Phone Nature of residence Rent Own Other Duration at this residence If rented, Name of Land Lord

Residence:(draw map ) Name of Your Chief: Town/Estate: ...................................... District: .............................. Division: ............................................. Location: ............................ Phone: Sub-Location..................................Village: .................................... Name of Assistant Chief:

Do you intend to relocate? If so, why?

Yes No

Phone: Phone: Do your children attend school? Number Attending Schools?

Yes No

Any positions of leadership within the community

BUSINESS DETAILS Business Name: Reg. No....................................................... Licence No.................................................. Directors: 1. 2. 3.

Description of Business Activity/Products

No. of Years in Operation

Current Location (draw map): Address: Telephone : Duration at this location? Do you intend to relocate? If yes, why?

Legal Structure of the Business( copy of certificates/articles to be attached) Sole Trader Partnership Limited Other Landlord Name: Telephone Number : Yes No Number of Paid Employees Full-time _______ Casual ________

Premises Rent Own Other

Other Businesses owned by Applicant/ Spouse Location of Businesses: 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. _____ ____________ BUSINESS ASSESSMENT Major Business Suppliers: (See receipts) Where do you buy? Who do you buy from? Major Business Markets: (See records/sales books) 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) 1. 2. 3. 4. Average Average Projected on Previous Loan Application

Purchase Price/Cost of Production (B)

Gross Profit Margin ( A-B) / A

BUSINESS MONTHLY PROFIT AND LOSS STATEMENT (business that is subject of loan) ACTUAL PROFIT AND LOSS Sales Cost of Sales/Purchases Sales Cost of Sales/Purchases Gross Profit Gross Profit Rent Utilities (Electricity, Phone, etc.) Transportation Labour Loan Repayments (Other) Other Rent Utilities (Electricity, Phone, etc.) Transportation Labour Loan Repayments Other PROJECTED PROFIT AND LOSS

Monthly Profit/Income

Monthly Profit/Income

BUSINESS BALANCE SHEET (business that is subject of loan) ASSETS Actual SHORT TERM Cash (on hand and in Banks) Debtors Stock LONG TERM Total Fixed Assets Other Assets LONG TERM Bank Loans Other Liabilities CAPITAL TOTAL TOTAL NET HOUSEHOLD BUDGET MONTHLY INCOME Actual Borrower (net salary) Spouse (net salary) Business (from above) Pensions Other Businesses
(Applicant or Spouse)

Projected SHORT TERM

LIABILITIES & CAPITAL Actual

Projected

Creditors (Trade) Bank Loans

Projected Housing

MONTHLY EXPENSES Actual

Projected

School Fees (average per

month)

Transportation/Vehicle Food Utilities

(Phone, Electricity, medical, entertainment, etc.)

Other Income Total Household Income Net Household Income

Other Debt Repayments Total Expenses

PROPOSED GUARANTORS Name, address and telephone number/other contact information: 1. 2. ______ _____ ______ ______ Relationship: ____________________________ ____________________________

Do any of the proposed guarantors have existing direct/indirect liabilities with the YEDFB? If Yes, what?

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:____________

I/We declare that all information provided as part of this application conforms to reality and assume full responsibility for its accuracy. By my signature, I hereby authorise collection of references, from any source whatsoever, concerning my person, conduct and commercial credit. 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. 1 Applicants Name ____________________Signature________________________ Date___________________ Co-Borrowers Name____________________Signature________________________Date___________________ 2
nd st

Applicants Name ____________________Signature________________________ Date___________________

Co-Borrowers Name_____________________Signature________________________Date___________________

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 Security (Title deed, log book etc) where guarantor is providing security for the loan

No Description 1 2 3 4 5 6 7

Serial No.

Estimated Value

Discounted Value

Signature of Guarantor __________________________Date: ____________________