Revised:12/2020

LOAN APPLICATION FORM

TERMS AND CONDITIONS

1. The applicant is required to have collateral savings equivalent to 1/3 of the loan applied
2. The applicant is expected to continue saving a minimum of Kes. 300/= a month while servicing
loan.
3. The applicant is to be guaranteed by three active members of Ushindi Bora
4. Loan repayments to be done during group meetings or an earlier date through our Lipa Na
Mpesa Till 763937.
5. A loan processing fee of 5% of the loan applied will be charged. This will be deducted from the
loan applied.
6. Insurance fee of 2% is charged for every loan applied payable during loan application.
1. APPLICANT’S DETAILS
Full Names: …………………………………….. ID NO: ………………… Phone No.: …………………….

Sex: Male :( ) Female :( ) Group Name ……………… Member No.: ………………………

Marital status: …………… Name of Spouse: ………………………………… ID No.:

………………………

Phone No: …………………………

Next of Kin: ………………………………… ID No.: ……………………… Phone No:

………………………….

2. DETAILS OF SAFARICOM NUMBER TO RECEIVE LOAN

MOBILE NO: ……………………………………….

REGISTERED AS: ………………………………….
Loan will be sent to above mobile line. I accept Liability by signing below.
Signature:……………………………
3. RESIDENTIAL DETAILS

a) Owned: ( ) Location: …………………… Plot No.: …………………………

b) Rented: ( ) Location: …………………… Flat Name & House No:
……………………………..
c) Neighboring School/Church: ………………… Nearest Landmark: …………………….
4. INCOME DETAILS
Source of Income: Employment ( ) Business ( )
Average Monthly expenses: …….........................................
5. LOAN PARTICULARS
Loan applied (Ksh): ………...……… Repayable in(Months): 2 ( ) 3( ) 4( ) 5( ) 6( )
 Words; ………………………………………………. Other: ………………………………………

………………………………………………………… Loan Purpose: ………………………………………

Members’ current Savings: ……………………………………. (Less Insurance Fees 2%)

6 LOAN IN OTHER BANKS/ FINANCIAL INSTITUTIONS

Bank and Branch Details Repayment Period and Outstanding Amount

1……………………………………………………… 1……………………………………………………….

2……………………………………………………… 2……………………………………………………….

7. Repayment Guarantee.

We the undersigned hereby accepts jointly and severally liability for the repayment of the loan in the
event of the borrower’s default. We understand that the amount may be recovered by offsetting against
our savings in the company or by attachment of our property and that we shall not be eligible for loans
unless the amount in default has been cleared in full. We also agree not to withdraw our membership until
the loan is fully paid.

CLIENT CLIEN NAMES(IN FULL) TEL CURRENT EXISTI SIGNATU

NO. T ID NUMBER SAVINGS NG RE&
LOAN(I DATE
f any)

List of Items to attach incase of arrears or Default.

NO. ITEM/DESCRIPTION MAK MODEL SERIA YEAR OF APPROXIMAT

E L NO. PURCHASE E VALUE

3
 4

TOTAL

8. CERTIFICATION
I certify that I possess and own the above listed Items. I further make affidavit praying that I be
recognized as the owner of the Items despite lack of the original receipts. In the default of payment of
loan advanced to me by Ushindi Bora Limited, I give authority to Ushindi Bora Limited or her agents to
dispose off the said Property or any other Including stock and re-service such loan any part thereof or
any balance owing from me to Ushindi Bora Limited. Action will be taken after my default of 2
Installments for recovery including a penalty of Ksh.200 per day of arrears days without seeking further
instructions whatsoever.

9. DEFAULT
A loan is treated as in default if a scheduled loan payment is not made at the time required, the borrower
shall pay the entire amount of his outstanding loan balance subject to applicable taxes and penalties.

10. C.R.B CLAUSE

The Credit Reference Bureau Regulations, 2013, mandates submission of both Positive and Negative
information on the performance of the credit facilities extended to our customers. Please Note: your
name shall be forwarded to the credit reference bureaus (CRB) for adverse listing upon the lapse of 30
days’ notice of default.

11. DECLARATION
I declare that the information given herein is true to the best of My knowledge and belief. I further
authorize Ushindi Bora Ltd to verify the information given herein and make reference from any person(s),
institution(s) named herein.

Applicants Name :…………………………………ID No.:……………………… Date:………………

Signature…………………

Loan Witnessing (All loans Above Kes 100,000/= must be witnessed by Spouse)

Witnessed by: ……………………………Relationship with Applicant.: ………….………………………

ID No.: ……………………… Date: ………………… Signature……………………………..

FOR OFFICIAL USE ONLY

Loan application Received/Checked by Name: ………………Sign: ……………….. Date………….…

Loan application Assessed by: Name:……………………………Sign:………………..Date………….…

Name: ……………………………… Sign: ……………….. Date………….…

Branch Report related to the applied loan

Loan amount approved Ksh………………….……………………………............................................

Total interest for the agreed repayment duration Ksh………………………………………………….

Total interest plus principal Ksh.………………………………………………………………………

Loan servicing/repayment duration (months)………………………………………………………….

Monthly repayment Ksh……………………………………………………………………………….

ADD Monthly minimum Savings……………………………………………………………………...

Payment Frequency: …………………………………………………………………………………..

The First Loan installment will be due on ………............. Last installment will be on………….........

LOAN TO BE DISBURSED (Less 3% processing fee &1% legal fee)……………………………….

Approval and Stamping:

Staff Name ………………………………………………………………………..

Designation at Branch ……………………………… Signature………………….…...

Date……….………

Legal officer/ advocate/ lawyer: Name……………………………………………………..

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