1.

APPLICANT’S PERSONAL DETAILS ( complete all sections in BLOCK Letters)

M F M M Y Y Y Y

1.1 APPLICANT’S CONTACT INFORMATION

Email Address Alternative Email address Mobile Phone Number

1.2. APPLICANT’S IDENTIFICATION DOCUMENTS (Tick at least one appropriate and mention ID number)
Passport No
National ID (NIN)
Firstmac ID No* others specify

Are you Employed? YES NO (If yes provide for the details below)

TIN Number
M M NSSF Number

1.3APPLICANT’S CURRENT ADDRESS

Region District County

Sub-county Parish/Ward Village/ LC1

Plot No. (Where applicable) Emergency contact Person Relationship Telephone of Contact Person
1.4 APPLICANT’S BIO-DATA

Surname First Name Other Names

1.6 APPLICANT’S HOME OF OREGION

Region District County Sub-County Parish/Ward Village/LC1

Town P.O.BOX Number

1.7 APPLICANT’S MARITAL STATUS (Please attach a document where applicable)

Single Married Others specify

(If married, Please specify the Name of Spouse, Contact, National ID No. below)

Spouse’s Name Spouse’s Telephone Contact Spouse’s National ID No

1.8 APPLICANT’S DISABILITY (Please attach a picture or Doctor’s Report)

Do you have any Disability? NO YES (If yes please indicate which of the following disabilities and the

(Extent of the disability)

 TYPE OF DISABILITY LEVEL OF DISABILI

 Communication  Slight Moderate severe

 Hearing  Slight Moderate severe
 Remembering  Slight Moderate severe
 Seeing  Slight Moderate severe
 Self-care  Slight Moderate severe
 Walking  Slight Moderate severe
 Others (specify)
 Slight Moderate severe

Are you Employed? YES NO (If yes, please attach the following below)

Name of Employer Employer’s Address Employer’s Contact

Gross Salary in UGX. UPDF Service No Police Force ID No

2.0 APPLICANT’S SOURCE OF INCOME INFORMATION (*Monthly)

Income from Employment Income from Business Income from Crops Income from Rentals Income from Animal husbandry

Income from other sources

LOAN INFORMATION

Loan Applied (in figures) Loan Applied (in words) Repayment Period(*months)

The monthly repayments will be

In figures in In words

EITHER (members of fms&ccl.ltd and non members)

ASSETS TO BE PLEDGED AS SECURITY

Name of item; Serial No.; Make; (Other Necessary Description) Value in UGX
1

2
3
Total
* Proof of ownership can be demanded and items can be inspected if need be

ACCEPTANCE AND DECLARATION OF APPLICANT

I hereby declare that the above particulars are true to the best of my knowledge and belief and that I agree to abide by the conditions of the Society Loaning policy. I further
declare that I have understood the terms of the loan. I thereby authorize the necessary deductions to be made from my salary.

I fully understand and accept that in case of default, my shares may be used to offset the outstanding loan. Should the monies be insufficient to clear the loans, the item purchased
with the loan shall form part of security and Sunbird Tourism SACCO is obliged to take custody thereof including the assets which are pledged as security. All items may be sold
to recover expenses.

Signature of Applicant:……………………………………….. Date

:………………………..……………………………..…………………..………………………………………….. Witness:…………………..………….
………………………………. Date:…………..………………………

OR (Members only)

PURPOSE(S) FOR LOAN

Purpose: In UGX
1

2 In UGX

APPLICANT’S SECURITY FOR THE LOAN

1) The applicant’s shares in the co-operative.

2) The guarantors’ shares in the co-operative.
3) Others;