YOUTH ENTERPRISE DEVELOPMENT FUND BOARD
INDIVIDUAL HATCHERIES - SALARIED APPLICANTS
Region: ______County: ______Constituency:______
Loan Amount (Kshs.)...... Monthly repayments (Kshs)......Repayment period Applied...... Specific Purpose......
PERSONAL DETAILS 1ST APPLICANT
Surname / Other Names / P.O. Box……………………………………..
Phone………………………………………… / Gender
M
F
ID/PP Number:...... PIN:......
Date of Birth :...... Marital Status : Married Single Widow Divorced Other
No. Of Children:...... Their ages...... Other dependants (no.)......
Their ages......
Occupation:...... Highest Level of Education......
Spouse Name...... Spouse ID NO...... Phone......
Where do you stay: Other (specify) ______Owner Occupied Rented
Approximate monthly expenditure Kshs...... Approximate monthly Savings Kshs......
Any other source of Income( Provide evidence where applicable)
Source Monthly Income
1.
2.
3.
4.
Current Residence:(draw map )
Town/Estate: ...... District: ...... Division: ......
Location: ...... Sub-Location...... Village: ......
Rural Residence: Town ...... Village...... Home Site(Local Name)......
Duration at this residence ...... If rented, Name of Land Lord......
Mobile No. (Landlord): ......
Do you intend to relocate? Yes No
If yes, indicate your reasons?
Any positions of leadership within the community? (indicate)
EMPLOYMENT DETAILS
Name of the Employer:......
Postal Address...... Telephone......
Job Description...... Staff No...... Length of Service......
Nature of Employment
Permanent Probation Contract If Contract, State contract period ...... (Years)
Job Title ...... Group......
Station...... Department......
Constituency...... County......
No. of Years in Employment...... (If Less than 6 Months give details of previous employer below )
Name of the Employer:...... Postal Address...... Telephone......
Job Description...... Staff No...... Length of Service......
Nature of Employment. ... Permanent Probation Contract If Contract State contract period......
Job Title ...... Group......
Station...... Department......
Proposed business Location (draw map):
Physical Address: / Legal Structure of the Business( copy of certificates/articles to be attached)
Sole Trader
Partnership
Limited
Other / Premises
Rent
Own
Other
Duration at this location? / Landlord Name:
Telephone Number :
Do you intend to relocate? Yes No
If yes, why? / Number of Paid Employees
Full-time ______Casual ______
Other Businesses owned by Applicant/ Spouse
Location of Businesses:
SAVINGS/CURRENT ACCOUNT HISTORY
Bank/Institution ______Account No:______
Bank/Institution______Account No:______
(Please provide copies of recent6 months certified statements)
REFERENCES: Name, Address and Telephone *
List ofreferees:
Name Occupation Address Telephone relationship
1.
2.
3.
4.
CREDIT HISTORY (Prior 3-5 years)
Have you ever applied for a loan before? Yes () No (). If yes, please provide details below:
Name of Lender
______
______
______
______/ Date Applied
______
______
______
______/ Amount of Loan
___
______
______
______/ Duration of Loan
______
______
______
______/ Monthly Instalment / Amount outstanding
______
___
___
___
Other Terms and Conditions.
a)In connection with this application and/or maintaining a credit facility with the YOUTH ENTERPRISE DEVELOPMENT FUND, I authorize the YOUTH ENTERPRISE DEVELOPMENT FUND to carry out credit checks with or obtain my credit information from, a credit reference bureau. In the event of the account going into default, I consent to my name, transaction and default details being forwarded to a credit reference bureau for listing. I acknowledge that this information may be used by banking institutions and other credit grantors in assessing applications for credit by me, associated companies, and supplementary account holders and for occasional debt tracing and fraud prevention purposes.
b)You agree that the YOUTH ENTERPRISE DEVELOPMENT FUND may disclose details relating to your loan account to any third party including credit reference bureaus, if in the Lender’s opinion such disclosure is necessary for the purposes of evaluating your creditworthiness or any transaction with or credit application made to the Lender or such third party, maintaining your Account with the Lender or for any other lawful purpose.
c)You agree that the Lender may disclose details relating to your loan account including details of your default in servicing financial obligations on your loan account to any third party including credit reference bureaus for the purpose of evaluating your credit worthiness or for any other lawful purpose.
Applicant’s signature...... Date ……………………………......
PROPOSED GUARANTORS (at least 2)
Name, address and telephone number/other contact information: Relationship:1. ______
2.______
3. .______
4. .______
Do any of the proposed guarantors have existing direct/indirect liabilities with the YEDFB? If Yes, specify
FOR OFFICIAL USE ONLY:
SECURITY/ COLLATERAL
DESCRIPTION OF ITEM SERIAL NUMBER VALUE
......
I/We declare that all information provided as part of this application conforms to reality and assume full responsibility for its accuracy. By my signature, I hereby authorise collection of references, from any source whatsoever, concerning my person, conduct and commercial credit. I further authorise the issuance of reports regarding my credit history to Youth Enterprise Development Fund Boardand any other reference bureau and hereby absolve the reporting party of all responsibility.
1st Applicant’s Name ______Signature______Date______
2nd Applicant’s Name ______Signature ______Date ______
PROPOSED GUARANTORS (at least 2)
Name, address and telephone number/other contact information: Relationship:1. ______
2.______
3. .______
4. .______
Do any of the proposed guarantors have existing direct/indirect liabilities with the YEDFB? If Yes, specify
FOR OFFICIAL USE ONLY:
SECURITY/ COLLATERAL
DESCRIPTION OF ITEM SERIAL NUMBER VALUE
......
I/We declare that all information provided as part of this application conforms to reality and assume full responsibility for its accuracy. By my signature, I hereby authorise collection of references, from any source whatsoever, concerning my person, conduct and commercial credit. I further authorise the issuance of reports regarding my credit history to Youth Enterprise Development Fund Board and any other reference bureau and hereby absolve the reporting party of all responsibility.
1st Applicant’s Name ______Signature______Date ______
2nd Applicant’s Name ______Signature ______Date ______