MICROFINANCE LOAN PRODUCT- APPLICATION FORM

1.0 APPLICANT INFORMATION

1.1 Name of Individual applying
a. Date of Birth of Applicant

b. NRC Number

c. Physical Address or Residential Address

d. District

e. Constituency

f. Applicants Contact Number (linked to Airtel, MTN and ZAMTEL Mobile

Money). Please note that the contact number must be registered in
the Applicant name

g. Social Distribution ( Primarily targeting youths and women in rural and Youth
peri-urban areas) Youth-Female -Male Women Disabled Men

Name
h. Next of Kin details Mobile Number
Physical Address

2.0 BUSINESS AND FINANCIAL INFORMATION

Please indicate the sector for your proposed Agriculture Manufacturing Trading Services Construction
business ( tick where applicable)
Mining Energy Tourism ICT Other specify…………….
Is your business currently operational
Yes No
If yes:
How much do you make per month? ZMW
How much do you spend per month on your
ZMW
business?
How much did you spend to start your
ZMW
business? i.e. Capital
How much will be your sales per month after
ZMW
the loan?

3.0 INFORMATION ON JOB CREATION

Before CEEC Loan After CEEC Loan
Number of Workers ( including self-employment)

4.0 THE LOAN

Indicate the loan amount applied for (K5,000 to K50,000)
NB: Higher loan amount within the loan threshold will be subjected to further ZMW
due diligence to determine financing needs

Applicant Signature
Date