KITUTU CHACHE NORTH BODA BODA SACCO LTD

P.O BOX 816 – 40200 KISII

TEL: 0729 960 998
Email address: kcnbodaboda@gmail.com

LOAN APPLICATION AND AGREEMENT FORM IN RESPECT OF NORMAL EMERGENCY,

SCHOOL FEES, SPECIAL LOANS AND IMARIKA NA BIKE

Any person who when filling an application form, knowingly makes false statement whether orally or in
writing relating to any matter affecting their request for loan shall be quality of an offence and shall be
liable to a fine as per section 32 of cooperative societies act Cap 490

SECTION A

Personal details

Please attach a copy of your national ID/passport

Name as per ID No* ………………………………………………………………………………………..

Tel No* ………………………………………. Email …………………………………………..

Box No. ……………………………………… Date of Birth*…………………………………..

Member Number* ………………………… Position in the society (Specify position held) ………….

Gender* Male Female

County* …………………………. Sub-county …………………….. Ward …………………

Location ………………………… Base/Stage ……………………..

Self-Employed ………………….. Employment ……………………

Amount applied for Ksh …………………….. in words ……………………………………………………

……………………………………………………………………………………………………………….

Type of loan applied for ……………………………………. Repayment period ………………………….

Purpose of loan ………………………………………………………………………………………………

Employment Name …………………………………….. Employee’s Number …………………...

Permanent residence details

Nearest public primary school ………………………………………………………………………………

Current residence details

Nearest public primary school ………………………………………………………………………………

Member’s Signature …………………………………………..

TERMS AND CONDITIONS OF:

(I)NORMAL, EMERGENCY, SCHOOL FEES

ELIGIBILITY DETAILS
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 a) Deposit Ksh ……………………………………………………… x3 = Ksh ……………………...
b) Loan Outstanding …………………………………………………………………………………...
c) Amount currently requested Ksh …………………………………………………………………...
d) New total loan will be Ksh …………………………………………………………………………
e) Members
Income ……………………………………………………………………………………………
f) Total monthly/Weekly repayment ………………………………………………………………...
g) Loan duration ……………………………………………………………………………………….
h) Purpose of the loan …………………………………………………………………………………

(2) IMARIKA NA BIKE LOAN

a) Minimum deposit Ksh 10,000

b) Guarantors are
i. Parents/Guardian
ii. Area chief
iii. Stage chairman
iv. Three sacco members
c) Loan repayment period no exceeding 78 weeks
d) Daily loan repayment of Ksh 400 for 6 ddays in a week
e) Log book will be surrendered to the borrower upon clearance
f) The credit committee must visit and survey the home of the borrower before being given the Loan
g) ID copies/Kenyan passport of the borrower, parent/guardian and the three guarantors must be
attached
h) Failure to pay the loan there is a penalty of Ksh 600 per week and in arrears of two weeks the
motorbike will be impounded by the Sacco.

I ……………………………………………………………. Of ID ………………….. Phone …………….

Sign ……………………….. Stage ……………………………. Have depositedKsh …………………….

In words ……………………………………………………………………………………………………..

For IMARIKA NA BIKE loan and have accepted terms and conditions of the loan

Chairman comments

This loan application may be granted for the amount ksh ………………………………… Repayable in

…………………………………. Months. The loan application may be rejected or amount reduced for the
following person’s ………………………………………………………………………………………….

Signature …………………………………………………….. Date ……………………………………….

Management committee

Loan approved ksh …………………………………………………………. Recoverable in ……………...

Monthly installments at interest rate ……………………… %per month reducing balance

THIS LOAN HAS BEEN APPROVED/DEFERRED/REJECTED FOR THE FOLLOWING

REASONS

Management committee minute No ……………………………. Date ……………………..

Chairman’s Signature …………………………………………..

Other than guarantors other securities for the loan (receipt of purchases or any document of ownership to
be attached).
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Name of property Description Estimated Value

Referees Parents/Guardian and Stage manager

Name …………………………………….. Stage ……………… ID No . …………… Signature ………..

Name …………………………………….. Stage ……………… ID No . …………… Signature ………..

Witnessed by: (spouse if married)

Name: ………………………………………………….. ID No: ………………………….

Signature ……………………………………………….

Security offered

All my shares, deposit and any other credit balance held in my favour by the SACCO

Guarantors to my loan

Other property security offered

Application declaration

I declare that the foregoing particulars are true to the best of my knowledge. I further undertake to abide by
the laws of the society, the loan policy and any variance by the management committee in respect of the
amount approved and repayment period.

Signature: ………………………………………………………… Date: ………………………………….

Guarantee

(To be completed by at least three guarantees where loan security is guaranteed)

Security is guaranteed Ksh …………………………………………………………………………………...

In words……………………………………………………………………………………………………….

In consideration of the society granting the whole of the loan or lesser amount that may be approved, we
undersigned accept jointly and severally, liability for its repayment in the event of the borrowers default.
We understand that the amount in the default may be recovered by an offset against our shares in the
society or by attachment of our property and that we will not be eligible for loans unless the amount in
default has been cleared in full.

Details of guarantors (Please attach copies of ID of guarantors)

Name Stage Member No. Savings Signature Date

Guarantor’s record entry

I do certify that details on this loans guarantors have been duly posted to guarantors record sheets by

…………………………………………………………… Date……………………. Signature …………

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Loan recovery

I certify that details on this loan has been affected for every recovery with effect from ……………………

Signature ……………………………………… Designation …………………………. Date ……………..

Confirmation

I confirm the action on recovery has been taken

Signature ……………………………………… Designation …………………………. Date ……………..

Assistant Chief

I certify that the applicant is resident of my sub-location and that I have checked the information given
herein and confirmed it to be true to the best of my knowledge

Name …………………………………………………………….. Signature ……………………………….

Date and official stamp

…………………………..

FOR OFFICIAL USE ONLY

Date: Application fee received:

Amount approved Membership No.

Credit chairperson ……………………………………………………………………………………………

Signature: ………………………………………………………

CMC Member ………………………………………………….

Signature ……………………………………………………….. Date ……………………………………..

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