Loan Application MAFISA

Loan Application MAFISA

Client Number:

Application Number:

Loan Number:

Province: ______District Municipality: ______

Local Municipality: ______Ward:______

Amount Required: R______Number of repayments: ______

Interest 8% per year Simple: R______Repayment frequency: ______

Total Repayable:R______Repayment per cycle: R______

Term: months Loan Type:______

Section A: Personal Details

Surname:……………………………………………Initials:…………Title……………….
Full Names:…………………………………………………………………………………
ID Number: Date of birth:
Ethnic Group: Asian Black Colored White
Marital Status: Single Divorced Widowed Married: In Community
Out of Community Customary/common law
Have you applied for or are you under administration? Yes No
Have you ever been Insolvent? Yes No
Applying on behalf of: Individual Legal Entity Association

Section B: Business Details

Type: Sole Trader Close corporation Private Company Trust
Co-operative Section 21 Company Partnership
Common property Association Voluntary Association
Trading Name of Business:………………………………………………………………..
Registered Name of Business:…………………………………………………………….
Registration Number:…………………………………………………………………….
Registered for Tax? Yes No Tax Reference Number:…………………………..
Registered for VAT? Yes No VAT Reference Number:………………………...
If registered company, please attach list of Names of all Directors/ Members /Shareholders or trustees, their positions, ID Numbers, monthly incomes, resolution to borrow and to nominate some to enter into contract on behalf of the entity.

Section C: Contact Details (Individual & Business)

Home Tel: (………)……………………… Cell Number:……………………………..
Work Tel: (………)……………………… Fax Number:……………………………...
E-mail:…………………………………………
Residential/Business Address:……………………………………………………………
……………………………………………………….Postal Code:……………………..
Postal Address:…………………………………………………………………………...
………………………………………………………Postal Code:……………………...
Please attach proof of residential address

Section D: Occupation

Legal Entity:
Do you have any other business interests apart from planned venture? Yes No
Is the purpose of this loan for funding an existing or new business?......
Do the members earn monthly incomes? Yes No
Annual Turnover of existing business: R…………………………………......
Individual:
On what basis do you farm? Full time Part Time
Do you earn a monthly income? Yes No
Occupation:…………………………………...
Name of employer:…………………………………………………………………...
Address:………………………………………………………………………………
……………………………………………………….Postal Code:………………….
Telephone Number: (………..)……………………..
Years employed at current employer: ………Years at previous employer:………......
Annual Gross salary: R……………………….. Annual Turnover: R…………………..
Tax Reference Number:………………………………………..

Section E: Banking Information

Bank Account? Yes No
Bank Name:……………………………….Name of account…………………………
Account Number:………………………...Branch Name:……………………………..
Branch Code:……………………………..Type of account:…………………………
Please attach copies of 2 (two) months bank statements.

Section F: Land

Access to land? Yes No Type: Lease Permission to Occupy Own
Please attach proof of access to Land.

Section G: Technical/ mentor Support

Please provide a list or letters with Names, Positions and Contact Numbers, of sources providing technical support for the business/venture.
Attach copy of Memorandum of Agreement in case of mentorship and support.

Section H: Income and Expenditure (Individual & Legal Entity)

Income / Monthly / Annual / Comments
Sale of Goods / R
Salary / R
Pension / R
Social Grants / R
R
R
Total / R
EXPENSES / R / Monthly / Annual / Comments
Transport / R
Telephone / R
Loan Repayments / R
Municipal Services / R
Insurance / R
Rates & Taxes / R
Rent/Bond / R
Maintenance / R
Food / R
Salaries / R
R
R
Total / R
Total Income/Total Expense / %

Section I: Assets & Liabilities

Assets / Description / Value (R)
Fixed
Movable
Cash
Shares
Produce delivered
Debtors
Crops on hand
Surrender Value of Policies
Other
Total Assets
Liabilities / Description / Commitment
Bonds
Hire Purchase
Family Debt
Overdraft
Credit Card Debt
Interest Free Loan
Other Debt (Specify)
Co-Operative
Carry-Over
MAFISA Assistance
Other
Total Liabilities
Net Assets = Total Assets minus Total Liabilities / R
Section J: Credit References
Please specify your current debt commitments
Institution (& account number) / Outstanding Debt / Contact Number
Total
Section K: Additional Information
Full name of Spouse:…………………………………………………………………………………
ID Number of Spouse: Occupation:……………………….
Work Tel: (...... )…………………..Fax Number: (……)………………Cell:……………………
Employer Name:……………………………..Address:……………………………………………
Name of relative (not staying with you):…………………………………………………………
Cell Number:………………………………Work Tel: (…….)………………………………………
Home Tel: (……..)…………………………Employer:……………………………………………
Name of friend (not staying with you):…………………………………………………………
Cell Number:………………………………Work Tel: (…….)………………………………………
Home Tel: (……..)…………………………Employer:……………………………………………
Section L: Business Plan (Applicant may solicit assistance from Mentor or Extention officer)
Nature of Business:
Location of Land:
Type & Suitability of Land:
Climate:
Production Equipment required:
Water Supply required: (Copy of access to water rights)
Farming and Business knowledge:
Strategy and goals:
Expected Proceeds:
Source / Crop session / Date of Yield / Expected Income
How and to whom will produce be sold?
How will produce be delivered to the buyer?
Market Contract? Yes No If yes Cession on produce should be provided.
Number of employees who will be directly involved in the business and their responsibilities and experience.
Assistance from commercial farmers? Yes No
Please elaborate on safety of land in terms of livestock, and any possible risks involved eg. Diseases, drought, theft of produce, etc
Additional Information:
Section M: Repayment
Loan Amount / Repayment Cycle (monthly/quaterly) / Repayment Amounts / Repayment Dates / Repayment Method
If client earns a monthly income, agreed monthly repayments will be required based on
income vs. expenses. The actual repayment cycles and amounts should also be clearly indicated.
Section N: Items offered as collateral (especially for loans of > R25 000)
Item / Current Market Value / Pledged to another lender?
Declaration
I/We hereby declare that all information is to the best of my/our knowledge true, Complete
and correct. I/We understand that any information supplied, which proves to be false
or misleading could lead to the disqualification of my/our application, of any further
assistance from MAFISA. Information found to be false/misleading after disbursement,
may result in the termination of the loan facility with the requirement of full and final
settlement of the amount outstanding immediately.
I hereby give permission to ______(institution name) to perform a credit enquiry on my personal and business details and share any information on the performance of this loan, with other credit providers and credit bureau.

Applicant 1:

Full Name in Block Letters:
Signature / Date / Place

Applicant 2:

Full Name in Block Letters:
Signature / Date / Place
Spouse (if married in community):
Full Name in Block Letters:
Signature / Date / Place

Legal Guardian (If younger than 21 but older than 18)

Full Name in Block Letters:
Signature / Date / Place

For Office Use:

I, Full Name in Block Letters:
Certify that this application is properly completed and has been signed in my presence
Signature (MAFISA representative) / Date / Place

3

Section P: Cash Flow Projection

(at 100% operation efficiency)

Name:

12th month period from/ to

Month / Total
Income (Produce) : / R / R / R / R / R / R / R / R / R / R / R / R
Other (* )
Total
* Specify
Expenses:
Total
Net Cash in flow

3

For office use only

Verification of MAFISA requirements:

A. Client/Legal Entity must be

CRITERIA / YES / NO
Historically disadvantaged individual (HDI)/wholly owned by HDI’s (100% shareholding of members interest)
South African Citizen
21 Years of age (If 18-21 legal guardian to co-sign)
Max 10 members where entity is voluntary associations
All directors/members of entity must be motivated and actively involved in venture
Entity to have formal constitution or articles of association, with board committee and management structure
Resolution attached (in respect of legal entity)

B. Client/LeGAL ENTITY must have

CRITERIA / YES / NO
Valid ID
Proof of Access to land (own/communal/lease)
Non-farming household income of < R 20 000 per month
Annual turnover of < R 300 000 (individuals)
Annual turnover < R 700 000, above R 300 000 VAT registered (Legal entity)
Willingness & ability to pay

C. Affordability

CRITERIA / YES / NO
Income must be greater than expenses (at least120%)
Value of personal Assets must be greater than Liabilities
Cash flow projection must be positive
Client must be able to meet installments as per agreement
Clearly defined repayment frequency and duration/term

D. CREDIT WORTHINESS

CRITERIA / YES / NO
Credit enquiry Positive
Savings history
Willing to open savings account?

E. DISBURSEMENT

Amount Invoiced
Amount to Bank Account
Total Amount to be disbursed

F.  REQUIRED DOCUMENTATION

Verified ID Document
Marriage Certificate
Credit enquiry (credit bureau) Report
2 months Bank Statements (signed by bank branch manager if project)
Proof of access to land
Proof of Water rights (where applicable)
Proof of Address/GPS coordinates
Market Contract if applicable
Cession of crop where possible (as collateral substitute)
Memorandum of Understanding between Mentor and applicant if applicable
Registered business entity proof of registration or founding Statement
List of members, ID numbers, income if legal entity
Proof of income if applicable (salary slips if monthly x 2)
Proof of assets & liabilities
Copy of maintenance order if applicable
Other as per DFI policy

E.  RECOMMENDATION/MOTIVATION

Branch Credit Committee:

NAME / DESIGNATION / SIGNATURE / RECOMMEND: YES/NO
YES/NO
YES/NO
YES/NO
YES/NO
DFI Branch Manager / YES/NO

Manager: Credit:

NAME / DESIGNATION / SIGNATURE / APPROVE/DECLINE
APPROVE/DECLINE
APPROVE/DECLINE

Reasons for decline:

Addendum A

INCOME DEDUCTION AUTHORISATION

I, the undersigned,

Surname:______Name: ______

ID Number:

Hereby authorise my employer/project manager to deduct the monthly and or seasonal installment as agreed upon, from my salary and/or other independent income managed by the employer/project manager, and to pay these installments to the lender,

______

(name and address of the lending institution)

Should the relevant installment be adjusted by the institution as a result of a general increase or decrease in the installment, or should I request the institution to increase or decrease the installment for specified reasons, I confirm that the adjusted amount may be deducted from my salary until such time that I cancel this authorisation in writing or substitute such with a new authorisation.

DEED OF CESSION:

1. I, ______hereby irrevocably cede,

(full name & surname of borrower)

transfer and make over to the lender for the amount equal to the outstanding amount right, title and interest in and to all amounts owing by

______

(Registered name of employer/project manager)

and/or successor in title with whom I may be employed/managed, to meet the termination of my employment/project commitment for whatsoever reason, as security for the due and punctual payment by me of all amounts which I may be owing to the lender from time to time, from amounts lent and advanced to me.

2. In the event of me not punctually paying any amount due and owing to the lender as aforesaid, the lender is hereby authorised, in rem suam, then or at any time thereafter, without any further authority of consent from me to:

2.1. give notice of this cession to the employer/project manager and to claim from such employer/project manager the full or any outstanding portion of any amounts due to me, to give a valid receipt or discharge for any such payments and to take actions in its own name in any court of competent jurisdiction to collect the monies payable to me.

2.2. apply these proceeds of all payments received from the employer/project manager, after deducting all costs off, and incidental to recovery thereof (including the costs of legal proceedings), towards the reduction of my indebtedness secured hereunder.

3.  This Deed of Cession shall be irrevocable and shall remain in force until cancelled by the lender. In no case shall this Deed of Cession be cancelled whilst there are any monies secured hereunder owing by me to the lender.

4.  I hereby authorise the employer/project manager to make payment of any/or all amounts due to myself by the employer/project at the termination of my employment/project commitment for whatsoever reason and ceded hereunder to the lender and/or its successors in title on demand by the lender for the settlement of the outstanding balance on my loan account with the lender.

5.  I hereby cede and authorise the employer/project manager to receive on my behalf all amounts which have been commuted to cash from produce/pension/provident fund and/or its successors in title, and to pay such amounts as maybe necessary to settle the outstanding balance of my loan with the lender.

Signed at ______on this_____day of ______

×______

Borrowers signature and date Witness’ signature

The provisions of the above Deed of Cession are hereby accepted by the lender

Signed at ______on this_____day of ______

×______

On behalf of the lender and duly authorised Witness’ signature

Acceptance of Payroll/Project Income Deduction Authorisation for processing

______

Deduction (monthly) / Term / Balance / 1st month
Deduction / Term / Balance / 1st month
Deduction / Term / Balance / 2nd month
Deduction / Term / Balance / 3rd month
Deduction / Term / Balance / 4th
month

I, the undersigned, ______in my capacity as ______hereby accept the above authorisation and undertake to execute same.

I further undertake to:

Support and manage the borrower in the venture taken on and will do all in my power to ensure responsible repayment of the outstanding debt, and to make available where applicable, project bank statements for review by the lending institution, ______and to provide reasons for non-payment.

* Copy of project bank statement signed by branch manager & signatories attached hereto.

______

Employer/Project Manager Date

3