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INDIVIDUAL IN A GROUP
APPLICATION FORM


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Translations:
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Individual In a Group ─ Application Form
Name of Group or CBO: Photo of Applicant
Address:
Name of Individual Applicant:
Age: Gender: Male / Female No. of Dependants: Name of Next of kin:
Education level (circle one): Primary / Secondary / Teacher Training / Other
Physical Address:
Parish: Sub-county: County:
Name of Enterprise Activity: Location of Enterprise Activity:
Applicant's Experience in Enterprise Activity(years)
Name & nature of any other types of business or trade in which applicant is occasionally engaged:
Other sources of income:
Indicate loan requirements (budget):
Personal Contribution (equity):
Amount of own savings in group account (shillings): Own Savings Account No.
Balance on Account (shillings) Bank:
Have you borrowed money from friends, relatives or bank? . No or Yes (circle one)
If yes, amount (shillings) From
Outstanding Balance (shillings)
When is the loan required
1st: 2nd:
3rd: 4th:
I plan to repay the loan in __________________ months in equal instalments with interest thereon.

Security for the Loan:
As security for the loan, I pledge my savings with the ____________________________________________________________________ Bank/Group, and ____________________________________________________________________ (other assets).

Guarantors: (Trust Group)
We the undersigned members of the Trust Group hereby confirm that the above information is true and in our assessment the applicant is able to service his/her loan. We further guarantee this loan and pledge our savings in support of this Guarantee. We have fully read and understood the rules and regulations of this scheme. In case of default, we the undersigned pledge to pay this loan and accrued interest in full.

Name Sex Age Position Amt. of Savings Signature Date
1






2






3






4






5






6






7







I, ____________________________________________________, hereby certify that I have not failed to disclose any information which might influence the ________________________________________________ Group in granting me the loan. I further declare that the information given herein is true. I understand that the completion of this form does not entitle me to a loan.


Signature of Applicant: _____________________ Date: __________________ 

Group Confirmation and Recommendations:
We members of the _______________________________________________ Group hereby certify that the application and the individuals in the Trust Group are members of this group and that the group committee decided as follows: 

Recommended Rejected Deferred




If recommended,
Amount (shillings) Repayment Period Instalments (Shillings)




(Monthly or Quarterly)

Signed:
Title: Chair Person Secretary Treasurer
Name:


Signature:


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