SERIAL NO: 03774

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International
Finance
Corporation
World Bank Group

LOAN APPLICATION FORM

Please use thisform to apply for individuals, business and smes. Applications made are subjected to terms and
conditions and only submitted with full knowledge of the individual/company/ Organization/Group/enterprise

Applicant Details

Name of Inxihridual/Comparry/OrganKatran/group/Enterprise:. V.SQM N \tMt£\f

If registered indicate business Registration no.:.

If NOT Registered indicate individual Passport or National ID card No.:

Address/Location: S5 — ^ 0 1 3 ^ ^ ( QrVM

Does you or your organization have a recurring income stream? YES NO \/\

Do you or your organization offer employment opportunities? YES \ / \O

Are you or is the organization a member of African Investment & Development Fund? YES ^ NO

Contact Person Details

Full Names:

Phone [sf. _

Your Role In the Organization: ^ATVNI f\Gdfcj£~ R E C ( ^ ft ,

Loan Details r \r\

Amount you wish t o apply (KSH. 1M - KSH. 100M): O [j J

Have you or your organization applied for a loan within the last 12 months? YES £ NO\f\

If yes please specify the intended use of the loan (the "Project"):
Please specify the main town/suburbs in which the Project will occur: _

|T<lMl U N^tU^gT
Will the Project have an overall benefit for the community? YES £ NO \S\

If the project will benefit a section of the community please describe that section (for example, the elderly,

people with disabilities, youth, families etc):.

If we unable to fully fund your application would you accept partial funding? YES NO [P

What Amount of partial funding would assist? 3K\

Please attach:

• Clear passport photo:

• National ID card
• Business registration certificate if registered

If you or your organization have a recurring income stream do attach a copy of your bank statement.

Any Other information relevant to your application: _

Declaration

I declare that the information given herein is true to the best of my knowledge and belief and acknowledge
that the decision of the Approval Board is final.

Signed:

Full Name:

Date:

NOTE:THIS FORM MUST BE DOWNLOADED,FILLED IN INK PEN AND SIGNED BEFORE IT IS SUBMITTED

WORLD BANK GROUP