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
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:
Yes No
Yes No
APPLICANT Gender M Phone F Occupation: Married Single Other Highest Level of Education Number of Dependants: Spouse ID NO. P.O. Box..
Other Names
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:
Yes No
Yes No
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 ________
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.
GROSS PROFIT MARGIN ON BEST SELLING PRODUCTS Product Selling Price (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 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
Projected Housing
Projected
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)
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
Co-Borrowers Name_____________________Signature________________________Date___________________
No Description 1 2 3 4 5 6 7
Serial No.
Estimated Value
Discounted Value