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Group Loan ─ Application Form
(To be completed by group officials applying for individuals within a group, or when applying for a group loan).
Name of Group/CBO:

Date of Registration: Registration Number:
Physical address

Number of Members
Women (number)
Men (number)
Number of years the Group has been in existence/registered:
Chair Person (name):
Secretary (name):
Treasurer (name):
Date of Annual General Meeting:

How are Elections Conducted? (circle)

democratic / rotational / other

How do you share benefits, assets and liabilities of the group?

Management experience and technical skills available within the group / CBO:

Loan Request:

We ________________________________________________________________________
who are Chairperson, Secretary and Treasurer of the above group, do hereby apply and guarantee to
the Ministry of ____________________________________
for a loan of (shillings) _______________________ (amount in words = __________________________________________________________)
for onward lending to the following individuals in our group (attach minutes of the General Meeting which approved the loan request).
The breakdown and purpose of the loan is as follows:
Name of Member Applicant Purpose of Loan Amount

Please see the attached copies of detailed application forms from our members listed above.

Loan Security:

The balance on our savings account at date of application is (shillings) __________________.

Assets financed by the loan will be owned jointly until the loan is fully paid, and all members of the group hereby jointly pledge to pay the loan in full should any member fail to fulfil their obligations.

Group Commitment:

We members of __________________________________________________________________ Group/CBO hereby certify that we have not failed to disclose any information which might influence CMP loan committee in granting the loan. We further declare that the information given herein is true.

We understand that the completion of this form does not entitle us to a loan.


Chairperson Secretary Treasurer
Name: Name: Name:
Signature: Signature: Signature:
Date: Date: Date:

Loan Application Recommendation:
Applicant's Name (Group/CBO):
Area Local Council (LC I) Chair Person's Recommendations:

Name (LC I Chair Person):


Stamp and Date

Intermediary Agency Recommendations:

Name of Official of Intermediary Agency:


Stamp and Date

Date received at area project office:

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