Serial No: Applicant Membership Number:

CARITAS NAIROBI
ARCHDIOCESE OF NAIROBI – CARITAS REGISTERED TRUSTEES

LOAN APPLICATION AND AGREEMENT FORM

NAME OF SELF-HELP GROUP: IMMACULATE CONCEPTION CATHOLIC CHURCH SHG

FOR OFFICIAL USE ONLY

Available Savings

Loan Number

Received By (Name)

Max Eligible (3x Savings)

Signature

Date Received

1. Applicant Information

Name of Applicant

ID/Passport No

M/No

Marital Status

Date of Birth

Phone No

Physical Address

Area of Residence

Town

Estate/Village

County

Residence Type

Owned Rented

Monthly Payment (If Rented)

Email Address

2. Sources of Income

Employment/Business

Employer/Business Address

Employer/Business Phone

Position

Period in Current Role

City/Town

Employer Email

Average Monthly Income Description

Description	Amount (Kshs)
1.
2.
3.

3. Loan Application

Loan Product Applied For

Purpose of Loan

Amount Requested (Kshs)

Amount in Words

Repayment Period (Months)

Other Loans/Debts (From Banks, SACCOs, MFIs, or SHG)

Lender	Amount Borrowed	Balance	Installment

TERMS AND CONDITIONS

Loan application must be made on this official form, fully completed and signed.
The amount applied for shall be fully covered by the applicant’s and guarantors’ savings.
Interest on loans is 1% per month on a reducing balance basis.
Repayment periods vary by product (Development: 36, Business: 24, Education: 12, Emergency: 12).
A dormant member (no contribution for 3 months) shall not be considered for any loan.
The SHG has a right to reference this application to a Credit Reference Bureau (CRB).

4. Applicant Commitment & Witness

I/We declare that I/we have READ, UNDERSTOOD AND SHALL COMPLY with all the TERMS AND CONDITIONS…

Applicant Name

Applicant Signature

Date

Witness Name

Relationship

Phone No

5. Guarantors

Self-guaranteed Amount (Kshs)

Amount in Words

M No.	Full Name	Cell Phone	ID No.	Amt Offered	Signature
					Print & Sign
					Print & Sign
					Print & Sign
					Print & Sign
					Print & Sign

6. Official Vetting & Appraisal (OFFICIAL USE)

Guarantors Vetting

M No.	Full Name	Total Savings	Obligations	Available	Amt Offered

CREDIT OFFICER APPRAISAL

Recommended Amount

Payable in (Instalments)

Comments

Officer Name

Signature

Date

7. Executive Committee Approval

Designation	Name (In Full)	Signature	Date
Chairperson
Vice-Chairperson
Treasurer
Secretary