Loan Application Form printable pdf download

FORM NUMBER:

HARAMBEE SACCO SOCIETY LTD

Harambee Plaza, Haile Selassie Avenue, Nairobi. P O. Box 47815-00100, Nairobi.

Tel: (020) 343822, 0705-200200, 0705-300300 ; Fax: (020)2216326

Website: Email:

LOAN APPLICATION FORM

)

(NOT FOR SALE

1. APPLICANT’S PERSONAL INFORMATION

Names(as appearing on ID):

Membership No.

Personal No.

Ministry / Dept

Current Station

Mobile Number(s)

E-mail address

Home/ Permanent address P.O.Box:

Code:

Town:

2. LOAN DETAILS

Loan Type

Emergency

School Fees

Development

(Please

Emergency Topup

School Fees Topup

Development Topup

Tick)

Jisaidie

Jisaidie Buy Up

Karibu Loan

Current Shares:

Loan amount applied for (figures):

Loan amount applied for (words):

Repayment period – Years:

Months:

Shares boost amount required:

JISAIDIE TOP UP LOAN DETAILS

Loans to be bought:

*Kindly attach certified original bank statements.

Emergency

Amount:

Bank Loan 1

Amount:

School Fees

Amount:

Bank Loan 2

Amount:

Development

Amount:

Bank Loan 3

Amount:

Total amount to be cleared

PAYMENT DETAILS

(Please tick one and give details).

FOSA

Fosa Account Number:

EFT TO BANK

Name of Bank:

Branch:

Account Name:

Account Number:

4. DECLARATION

I hereby authorise Harambee Sacco Limited to confirm my credit information in other financial institutions and also any registered Credit

Reference bureau before processing this loan and also during repayment.In the event of account going into default,I consent to my

name,transaction and default details to be forwarded to credit reference bureau for listing.I acknowledge that this information may be used by

banking institutions and other guarantors in assessing application for credit by me,associated companies,and supplementary account holders and

for occassional debt tracing and fraud prevention purposes.Further I authorise Harambee Sacco Ltd to use any registered debt collector to recover

any oustanding liability owed .

I hereby declare that the foregoing particulars are true to the best of my knowledge and belief.I agree to abide by the laws of the Society,the loan

policy provision and any other variation by the Board of the Society in totality.I will inform the Society whenever I am transferred from my current

work stattion/ministry.I authorise the necessary deductions,including interest on the loan,to be made from my salary as repayment for this loan.

Signature:__________________________ ID NO:__________________

Date:__/___/_____

NB: TO BE VALID, THE TWO PAGES OF THIS FORM MUST BE PRINTED ON A SINGLE SHEET OF PAPER ( BOTH SIDES).

Witness

: Name ___________________________________________

Membership No.

______________________

Personal No. ___________________ Signature _______________ID No _______________ Date. ____/____/______

Loan Application Form

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