APPLICANT’S SIGNATURE: P1

K20 – application form (non- refundable)

TIMANGE ZAMBIA LIMITED

No. 01 Chambishi Flats, Mbiya Road
Off Great East road, Northmead.
Lusaka, Zambia
Tel: +260 975 972012, +260 976 898202
Email: leo1musukwa@gmail.com

BLOCK AND CEMENT LOAN CONTRACT

APPLICATION NO: …….

Ref: NM/01/ ……….
PART A: PERSONAL INFORMATION
Personal Details
Full Name:

NRC Passport No:

Passport Expiry Date

Residence/Work Permit Number (Non-Citizen) Permit Expiry Date

Marital Status: Single Married Divorced Widowed

Next of Kin Relationship

Contact Details

Tel (Mobile) Email Address

Phone Number (next of kin) Plot location

Residential Address

Employment Details

Current Employer’s Name Date Employed

Employment Terms Permanent Contract

Contract Expiry Date

PART B: PAYMENT INFORMATION

Payment Details

Bank Name Branch

Monthly Deduction DDACC Start Date

Number of Blocks Required Payment Period

Number of Bags of Cement Required Payment Period

BUILDING THE NATION

 APPLICANT’S SIGNATURE: P2
PART C: REQUIRED DOCUMENTS ATTACHED
Last 3 months bank statement for salary account Payslips for the last 3 months

Copy of NRC/Passport/Work permit Introductory letter from the employer

DDACC copy

PART D: AUTHORITY TO EMPLOYER/ ASSIGNMENT OF BENEFITS

For the duration of my loan and until notice is received from Timange Zambia confirming full payment of the loan:

Please arrange to deduct from my gratuity/terminal benefits any monies still owing to Timange Zambia in the event

of my separation from employment while my loan is still running and pay directly to Timange Zambia.

I agree to take repayment protection if my income ceases due to death through insurance between Timange Zambia

and an insurance service provider.

PART E: DECLARATION
I hereby declare that:

i. All the information given by me is true and complete to the best of my knowledge. I therefore understand that any false
and/or incomplete information may provide grounds for the withdrawal of the offer of the loan.
ii. I have read and understood the payment plan for blocks and cement as availed to me and contained herein.
iii. I have read the terms and conditions governing this contract and agree to be bound by them. I authorise Timange Zambia
Limited to make enquiries deemed necessary in connection with this application.

Applicant’s Signature Date

PART F: EMPLOYER’S CONSENT

Is the applicant a bonafide employee? Yes No Is the applicant under any current Yes No

or intended disciplinary action

Will the loan expire at least 3 months Yes No Is the applicant earmarked for Yes No

before the applicant’s retirement age separation from employment?

and/or end of the contract period?

We confirm that based on the instruction (Authority to Employer/ Assignment of Benefits), we will pay any other allowances/
benefits/gratuity towards settlement of the loan outstanding directly to Timange Zambia in the event of the applicant leaving the
company. We also confirm that we will inform Timange Zambia about the employee’s resignation or termination of his or her
employment. We also confirm that we will not accept any changes to these instructions without prior written communication from
Timange Zambia.

Company Name

Name of Company Official

Phone Number

Company

Signature (company official) Date Stamp

 APPLICANT’S SIGNATURE: P3

PAYMENT PLAN FOR BLOCKS

DURATION 3000 - 4500 BLOCKS 4500-6000 BLOCKS 6000-10000 BLOCKS ABOVE 10000 BLOCKS
3 MONTHS K3.49/per block K3.59/per block K3.69/per block K3.79/per block
6 MONTHS K3.59/per block K3.69/per block K3.79/per block K3.89/per block
9 MONTHS K3.69/per block K3.79/per block K3.89/per block K3.99/per block
12 MONTHS K3.79/per block K3.89/per block K3.99/per block K4/per block

SPECIAL OFFER FOR BLOCKS

DURATION 1000 BLOCKS

3 MONTHS K3.5/per block

PAYMENT PLAN FOR CEMENT

DURATION 50-100 BAGS 100-200 BAGS ABOVE 200 BAGS

2 MONTHS K72/per bag K71/per bag K70/per bag

3 MONTHS K71/per bag K70/per bag K69/per bag

PART E: FOR OFFICIAL USE ONLY

Accept Decline

Name Designation (Receiver) Signature Date

Name Designation (Approver) Signature Date

BANK INFORMATION
Payment Details

Account Name TIMANGE ZAMBIA Branch

MULUNGUSHI

Bank Name STANBIC Sort Code 040015

Bank Account Number 9130001902605 Swift Code SBICZMLX

BUILDING THE NATION