REPUBLIC OF KENYA

TEL: 054-30301; P.O BOX 4211-30200

054-30302 KITALE

E-mail: countyoftransnzoia@gmail.com

COUNTY GOVERNMENT OF TRANS NZOIA

TRANS NZOIA NAWIRI LOAN APPLICATION FORM

ATTACH PASSPORT
Attach Recent
CHAIRPERSON'S
Passport Photo
GROUP LOAN APPLICATION & AGREEMENT FORM Here
PHOTO
Application No. ………………………………. Date……………………………

PART A
1. Saccos/Co-operatives/Self Help Group/ Community Based Organization/ Group Name.
………………………………………………………………………………………….
2. Certificate No..…………………….
3. KRA Pin…………………………………………
4. Year of registration…………………….
5. Email…………………………………………………………… (where applicable)
6. Phone No.……………………………………………………………………….
7. Sub- County………………………………………………………………...
8. Ward………………………………………………………………...
9. Village………………………………………………………………...
10. Nearest Market………………………………………………………………...
11. Duration of existence………………………………………………………….
12. Amount applied for Kshs……………………………………………………….
in words…………………………………………………………………………...
Payable in……………………. months
13. Purpose for which loan is applied………………………………………………………….

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PART B
MANDATORY REQUIREMENTS:
1. Copy of registration certificate
2. KRA Pin certificate
3. List of applicants and amounts applied for
4. Bank statement/ Mobile money statements (at least 3 months)
5. Valid business permit/ Daily tickets (where applicable)

PART C:
Loan agreement and Declaration
We (Group Name) __________________________________________________hereby apply
for loan of Kshs _________________________________________________________ (amount
in words)
for a period of _________months to be paid in installments of Kshs ________________ or as the
Fund Board Management Committee may decide.
We hereby declare as follows:
1) That the business has been active for at least six months.
2) That member shares and deposits in part E are sufficient to cover the loan applied for, except
for settlement loan.
3) That we hereby give authority to my/our present bank to deduct from my account every month
such a sum of money consisting of Principal loan repayment and interest as may be determined
by the fund management Board until the loan is repaid in full
4) Upon default, the Group/Sacco/Company shall dispose any collateral offered as security to
recover the amount defaulted (where applicable)
5) No member shall withdraw their deposits unless all loans are repaid and all loans guaranteed
by him cleared or replacement guarantors sought for the same. (where applicable)
6) A member who has been guaranteed by a defaulter will not be eligible for a new loan or to
guarantee any new loan unless he/she provides a replacement to the defaulter
7) That this authority is unconditional and may not be revoked during the life of the loan without
express consent of Nawiri Fund Management Board
8) That the foregoing particulars are true to the best of my/our knowledge and belief and I/we
agree to abide by the by-laws of Fund, the loan policy and any variations by the Nawiri Fund
Management Board.
9) That We agree to comply with the terms of the loan repayment as approved by the Nawiri
Fund Management Board

Applicant’s Signature ________________________________ Date………………………….

Name of Witness _______________________________________

ID No. _______________________________ Date……………………………….

Signature ___________________________

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PART E, SECURITY
GROUPS/SACCOS/COMPANY
The following shall be mandatory for Groups/Saccos/Cooperatives/CBO/SHG. Items pledged
as the loan security.

Detail Amount (Kshs.) Remarks (Official use

only)
Number of shares for whole
CBO/SHG/Cooperative/Saccos
Amount of deposits pledged as
guarantee
Repayment Guarantee
I/We, the undersigned, hereby jointly and individually accept liability for the repayment of the
borrower’s/Sacco’s loan in the event of default. I/We understand that the amount in default may
be recovered by an offset against our shares in the Society, by attachment of my/our property and
other benefits, and I/We hereby authorize the Nawiri Fund Management Board to recover the
amount from my/our shares in the society, attachment of my/our property and other benefits
equivalent to the amounts I/We signed as guarantee.
Caution – Guarantor Details
Guarantors are strongly advised to read all the information supplied in this form by the applicant
and terms and conditions contained herein, so as to understand the full implications of signing this
part
(Where applicable)
Chairman (Name)…………………………………………………Phone No……………………
Date………………………….

Signature………………………………………………….

Secretary (Name)…………………………………………………Phone No……………………

Date……………………………

Signature ………………………………………………….

Treasurer (Name)…………………………………………………Phone No…………………...

Date…………………………….

Signature…………………………………………………...

Guarantors (Name)……………………………………………Phone No………………...

Date…………………………….

Signature…………………………………………………...

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For Official Use Only

PART F: FUND BOARD MANAGEMENT COMMITTEE

Loan approved Kshs………………………. in words…………………………………………

Recoverable in……………. months
Indicate reasons for deferred/rejected loan
1. Reason for deferred/rejected loan
• Incomplete information, or lack of supporting documents [ ]
• Timeliness [ ]
• Inadequate funds to meet loan demand [ ]
2. Reasons for Rejected loan
• Inability to repay [ ]
• Loan not in proportion to share [ ]
• Ineligible Purpose [ ]
• to clear outstanding loan first [ ]
• Membership Period. [ ]
• Lack of proper guarantors or security [ ]

Fund Management Board Minute Number……………………….

Chairman’s Signature ………. ………… Date…………………

Secretary’s Signature ………………… Date………………….

Director’s Signature ……………………. Date………………..

Remarks
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………

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Requirements for Registered Self Help Group/ Sacco/ Co-operative/ Company

• Be a validly registered Self Help Group/ Sacco/ Co-operative/ Company

• The group must have an elected Chairperson, Secretary and Treasurer
• Have a list of members and a photocopy of their IDs
• Have a record of minutes for group meetings
• Have a written proposal on how to use the loan
• Must open a bank account with Family Bank
• Have a KRA Pin for the Group
• Have the form stamped by an advocate

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