Janeth:0724281341 BCM/01/2025

LOAN APPLICATION FORM

Branch: Date: DD/MM/YYYY

Loan Type: Personal Loan: Asset Finance: Mortgage Finance: Others: ...........................................................................

Applicant’s Co-op Bank Account Number (If Any)

Name of the Employer: ___________________________________________

SECTION A: PERSONAL DETAILS

Title: Mr. Mrs. Miss. Ms. Dr. Prof. Other (Specifiy):

First Name: Middle Name: Last Name:

National ID/ Passport No.: Service/Employee Number: Date of Birth: DD/MM/YYYY

Marital Status: Single Married Widowed Separated

Mobile Number: Email Address:
Home Postal Address: Postal Code: Town:

Residential Status: Owner: Tenant: Living with Parents: Housed by Employer: Other (Specify):
If tenant state rental amount:
Current Residential Area/ Estate: Town: Duration in current residence (Years):
If duration at current residence is less than 5 years state previous Area/Estate: Town:
SECTION B: REFEREE DETAILS

Details/Item Next of Kin Details Personal Referee (Not a Relative)

Full Name:
Relationship:
National ID/ Passport/ Service Number
Postal Address:
Telephone Number:
SECTION C: EMPLOYER DETAILS

Current Station/Department: Office Tel. Number:

Employer Address: Postal Code: Town:
Employment Date: Maximum Retirement Age:
Nature of Employment: Permanent Contract Expiry:

Are you a director and/or related to anyone in the Bank? YES NO If yes, provide details:
Name: Relationship:
Name: Relationship:

SECTION D: PERSONAL LOAN DETAILS

I (Name of borrower): ____________________________________________________ hereby apply for a loan of Kes (figures): ____________________________

Loan Amount in Words: ___________________________________________________________________________________________________________ _

Loan Duration: Monthly Installments:
Would you like to bundle your loan with a Credit Card? Yes No If yes, indicate desired limit: Kes ______________________________________
I hereby authorise the Bank to debit my account below with non-refundable card annual fees and Monthly repayments at a rate of:
10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Card Delivery : Co-opBank Branch Specify Co-opBank Department Specify
SECTION E: ASSET FINANCE DETAILS
Gross Vehicle Cost (as per proforma invoice/sales agreement): Deposit Amount Payable:
Trade-In Value: Net Loan Amount: Tenor/Repayment Period(Months):
Do you want the bank to finance the following costs? 1. Motor Vehicle Tracking Services Yes: No:
N.B: Additional costs where applicable will be included in the net loan 2. Motor Vehicle Insurance Premium Yes: No:
amount
MOTOR VEHICLE PARTICULARS
Make: Model/Type: Chassis Number: Engine Number:
Registration Number: Year of First Registration: Colour:

Customer Signature: _____________________ 7509

DSO Code: __________________________ ARO code: __________________
SECTION F: MORTGAGE FINANCE DETAILS
Plot No. of property to be mortgaged /allortment no(Street name and number if applicable):

Type of Mortgage: KMRC Plot Purchase Acquisition Takeover Construction Others _____________________
Name of Vendor: Postal Address: Telephone No.:
Name of Occupier: Postal Address: Telephone No.:
Have the occupants agreed to allow the bank valuer to visit the premises? Purchase price (If urban plot, state so) Kshs.__________________________

SECTION G: MOBILE BANKING ALERTS SUBSCRIPTION

Alerts to Activate (Tick Appropriately): All Debits: All Credits:

Mobile Phone Number:

SECTION H: BORROWER’S DECLARATION

1. I hereby declare that the foregoing particulars are true and accurate. I affirm that I have not entered into a separate agreement with any entity not disclosed, including the
Bank for a personal loan based on my salary. Additionally, there has been no fact, event, or circumstance that, whether alone or in conjunction with other events
or conditions, has had a material adverse effect on my employment.
2. I agree that the loan and my obligations to the Bank under the terms and conditions shall be effective immediately upon the Bank approving the sum applied
for or any other amount as may be determined by the Bank, subject to any security requirement as a condition precedent by crediting or applying the same to
my account with the Bank or otherwise for my account. In consideration of the Bank agreeing to grant me the loan applied for or such lower sum, at such interest
cost, and the terms and conditions set out in this application.
a. If the loan is to be repaid via check off: I hereby request and irrevocably authorize my employer_______________________________________________________
to deduct monthly from my salary the principle, interest and costs as all advised by the Bank and remit the same to the Bank for such period as the Bank shall
advise from time to time.
b. If the loan is to be paid via a standing order: I hereby irrevocably authorize my employer to direct my salary and all benefits to my account at The Co-
operative Bank of Kenya Limited. The employer will process any change of pay point request only upon receiving written confirmation from the Bank that I
have fulfilled all my loan repayment obligations. I further request and instruct the Bank to debit my account number ____________________________________
with the Bank with Kes ________________________ (Amount in words) ________________________________________________________________________________ or
such other sum as will be required by the Bank to meet the approved monthly loan repayment and to pay into the loan account on the __________of every month
effective 30 days after the loan has been disbursed.
3. For as long as any such loan shall be outstanding, I hereby assign all my final terminal dues excluding pension of whatsoever nature with my
employer______________________________________________________________________ to the Bank as additional security for the payment of the loan, and any
balance upon such payment, to be credited by the Bank to my account with the Bank and accordingly hereby request and authorize my said employer to pay
out the said dues to the Bank whenever they become due and payable unless otherwise advised by the Bank.
4. The Bank may grant me lesser loan than that applied for and that my obligations herein and under such terms shall be effective immediately upon the Bank
crediting my account with such loan sum.
5. I agree that I will personally remain liable to pay any installment of the loan and the entire loan notwithstanding any delay or failure by my employer to deduct
and/ or remit the payments to the Bank or any insufficiency thereof.
6. I further agree that if, for any reason whatsoever, I am unable to pay the loan instalments and/or any other charges or costs related to the loan as required by the
Bank or on occurrence of any act of default as described in clause 9 of the Terms and conditions hereunder, the Bank may exercise recovery measures which
include but are not limited to repossession and/or auction of any asset that I may have pledged to the Bank as security or collateral.
Customer Signature: ____________________________________________ Date: _______________________________________________
Witness Name: ____________________________________________ Witness Signature: _____________________ Witness Signature Date: _________________
SECTION I: CONFIRMATION BY EMPLOYER HT/DHT SIGN & STAMP
I confirm that the Borrower is an Employee of (name of employer) _____________________________________________________________________________and that the
employment details given above are true and confirm having noted the instructions/ request to deduct and pay monthly payments from the employee’s monthly
salary, and hereby take notice of the assignment of all the final terminal dues excluding pensions to the Bank. Furthermore, the employer agrees to abide by all the
conditions set forth in this agreement and unconditionally accepts the instruction to direct the Borrower’s salary and all benefits to his account at The Co-operative Bank
of Kenya Limited. The employer will process any requests for a change of pay point only upon receiving written confirmation from the Bank that the Borrower has fulfilled all
loan repayment obligations.
I recommend/ do not recommend Give reasons if not recommended.
YES NO
this loan application
Employer Officer’s Name: Designation: Signature: Date:

OFFICIAL STAMP:

SECTION J: TERMS AND CONDITIONS

the Repayment Date for that month shall be the last day j) “Credit Life Insurance” means, such insurance
1. DEFINITIONS
of the month and “Repayment Dates” shall have a covering the insured for the risk of death or total &
a) “The Bank” means, The Co-operative Bank of Kenya
corresponding meaning. permanent disability to the extent of the outstanding
Limited and its successors and assigns.
f) “Agreement” means, the Borrower’s Application, when loan amount.
b) “Borrower” means, the applicant(s) specified in this
duly approved by the Bank and these conditions as may k) “Credit Life Insurance Premium” means, the cost of
application form and their personal representatives and
be amended, supplemented, and restated or otherwise such Credit Life Insurance.
assigns. Where there is more than one Borrower, their
notified from time to time at the sole discretion of the l) “Statement” means, a statement of the Borrower’s
obligations are joint and several.
Bank. account showing the debits and credits and includes a

Customer Signature: _____________________ DSO Code: __________________________ ARO code: __________________

c) “Application’ means, the Borrower’s application for a g) “Account” means, the Borrower’s current/ Transaction/ summarized certified account balance signed by a Bank
Coop Personal Loan included and attached to these Savings account with the Bank. officer.
conditions and which forms an integral part of the h) “Security” means, any security required by the bank m) “Determine” means, with respect to interest and
Agreement. offered as a condition for disbursement of the loan. charges to the loan, such rate of interest and charges as
d) “Conditions” mean, these Conditions. i) “Loan” means, the aggregate of the approved Loan the Bank will in its sole discretion apply to the loan from
e) “Repayment date” means, the day corresponding to the Amount and the applicable Credit Life Insurance or time to time and subject to the minimum specified in (s)
date of first disbursement of the Loan or any part of the Comprehensive Motor Vehicle Insurance Premium, or so below.
Loan in each calendar month following the date of such much thereof as may have been disbursed and is from
disbursement provided that if there is no such time to time owing by the borrower and includes all the
corresponding day for the month in question, Borrower’s obligations.
[Link] be responsible for the loss or destruction of or any
n) “Approved” means, the acceptance by the Bank of the 3. APPROVAL, EFFECTIVENESS OF THE LOAN, AND damage to the vehicle(s) and to keep the Bank
loan applied for or such lesser sum as it may in its sole LOAN REPAYMENT INSTALLMENTS
indemnified from all claims arising out of accidents
discretion agree to advance to the Borrower, including any a) The Bank may approve the full loan applied for, or a
either to persons or property caused by the vehicle(s)
terms of such approval as to the costs and the applicable lesser sum, or decline the application in its sole
or the borrower or any of his/her agents in charge or
interest rate or otherwise “Approval” shall have a discretion without giving any reasons. Such decision
in control of the said vehicle(s) at the time.
corresponding meaning. of the Bank may by endorsement to that effect in the
[Link] to allow the vehicle(s) out of his custody of
o) “Disbursement” means, the crediting of the approved relevant part of the Application, or by a separate
control, or to sell, let, change, or dispose of the
loan into the Borrowers account or by any other mode letter, and in either case it shall be effective to bind
vehicle(s) or to present himself as sole owner of the
making payment of the principal loan to the Borrower for the parties without any further act by the Borrower.
vehicle(s) or take or send or allow the vehicle(s) to be
his account. b) Where a customer has applied for a vehicle purchase
taken out of Kenya without notifying the Bank.
p) “Notify” means, notified in accordance with clause 10 of loan and the application has been approved, the
[Link] immediately notify the Bank with full details of any
the conditions Bank shall include the Comprehensive Motor Vehicle
accident occurring to or major defect arising in the
q) “Collateral” means, all real and personal property insurance premiums payable for the first 12 months
vehicle(s) and any event or circumstance which
whether belonging to the borrower or a third party which is as part of the total loan amount approved. The
might endanger the Bank’s title to the vehicle(s) or the
subject or intended to become subject to security granted borrower shall be responsible for payment of
Bank’s ability to recover it in good condition upon
to the Bank to secure the Borrower’s obligation. subsequent premiums.
default or termination of this agreement.
r) “Obligation” means, (a) all loans, advances, debts, c) The loan and these conditions shall become
effective and the Borrower’s obligation to the Bank 3B. The signature and delivery of the loan application
liabilities owed by the Borrower, including all interest, fees,
shall commence immediately upon the Bank by the borrower is deemed conclusive evidence of the
expenses, principal, premium; (b) any and all sums
disbursing the approved amount by crediting the borrower’s agreement to be bound by the terms of the
advanced or payable in order to effect or preserve the
Borrower’s Account or otherwise, by applying the loan as to the amount of the loan and interest as
collateral or exercising any right under the collateral; (c) in
principal loan proceeds for the Borrower’s account. approved and determined by the Bank.
the event of any proceeding for the collection or
d) The Borrower will repay the Loan in terms of the 4. APPLICATION OF PAYMENT PROCEEDS
enforcement of the obligations after an event of default
Bank’s approval or as specified by the Bank together a) All payments received by the Bank in respect of the
shall have occurred, the expenses of realizing the
with the interest by the number of equal (or Loan shall be credited only when the payment shall
collateral together with Advocates costs and court fees.
substantially equal) Monthly Repayment have been received in cleared funds. Any payments
s) “Interest” means, a minimum of the Bank’s Base Rate
Installments in cleared funds on the Repayment otherwise credited by the Bank in respect of the
plus margin as the Bank in its absolute discretion may
Dates. Loan shall be subject to receipt of cleared funds
determine from time to time. “The Central Banks Rate
e) The Bank will upon determination of the interest and in default shall not be deemed credited until
(CBR)” means, the publicly quoted rate subject to change
payable calculate the amount of each subsequent receipt of cleared funds.
from time to time.
monthly repayment installment so as to amortize the b) All payments received in respect of the Loan shall
t) Total Cost of Credit means, the total cost of credit as
balance of the loan and the amount of interest be applied in or towards first, cost and expenses
defined in the Central Bank of Kenya Prudential Guidelines
payable. payable by the Borrower under these Conditions:
on Consumer Protection 2013.
f) The statement of the Bank of the amount of each Secondly, the amount of interest and thirdly, the
u) “Vehicle” means the motor vehicle described in part E
monthly Repayment Installment payable pursuant to Loan.
on the application form herein.
these Conditions shall in the absence of manifest 5. PREPAYMENT
v) “NTSA” means, National Transport and Safety Authority.
error be conclusive. The Borrower may prepay the whole or any part of the
w) “Comprehensive Motor Vehicle Insurance” means, such
g) Time for payment of each Monthly Repayment Loan subject to any payment being applied in order
insurance covering the vehicle from all claims as may be
Installment is of essence. specified in condition 4.
specified in the insurance claim form.
x) “Comprehensive Motor Vehicle Premium” means, the h) All payments shall be in Kenya Shillings in cleared 6. COST AND EXPENSES
cost of such Comprehensive Motor Vehicle Insurance funds during the normal banking hours. If any sum a) The Borrower shall pay all fees, commissions and
2. INTEREST falls due for payment on a day which is not a day on charges set out in Agreement and more specifically
a) The Borrower will pay interest (as well after or before which the Bank is open for business in Nairobi it shall on the Total Cost of credit schedule. All the charges
any demand or judgment or the bankruptcy of the be made on the immediately preceding day on which fees, commissions shall be exclusive of the
Borrower) on the loan at the rate per annum the Bank is open for business in Nairobi. applicable excise duty and other taxes.
determined by the bank. Interest shall be calculated 3A. SECURITY: b) The Borrower shall pay to the Bank forthwith upon
on daily balances and debited monthly by way of a) The Bank may, upon approval of the loan, accept the demand all costs, (including all stamp duties and
compound interest according to the usual mode of security offered and/ or require other additional legal expenses) on a full indemnity basis incurred in
the Bank but without prejudice to the right of the Bank collateral as a precondition and perfect it as security connection with the negotiation, preparation and
to require payment of such interest when due. which shall remain valid and binding. execution of the Letter, Conditions and the Security,
b) The Bank shall have full power in its sole discretion to b) Where the Bank grants the Borrower a loan for the fulfillment of all conditions of all conditions of
change and /or vary the rate of interest from time to purchase of motor vehicle, the Borrower the Facilities, any amendment or extension of
time and at such intervals as it may determine such undertakes: granting of any waiver or consent under and the
interest shall be secured in the same manner as the [Link] ensure the successful registration of the vehicle discharge of the Letter, Conditions and/or in
loan PROVIDED ALSO AND ALWAYS THAT the Bank in the joint names of the Borrower and the Bank contemplation of or otherwise in connection with
shall within a reasonable time advise the Borrower with NTSA the enforcement of or preservation of any rights
prior to any change in the rate of interest so payable. [Link] keep and maintain the vehicle(s) and all parts in under the Letter, Conditions and/or any Security or
However, any delay or failure by the Bank to advise the good order, repair, condition, to replace all in the payment of charges, fees, levies etc. due and
Borrower as aforesaid prejudice in any way howsoever missing or unfit parts and not to permit or use the payable by the Borrower but which the Borrower
the recovery by the Bank interest charged subsequent vehicle(s) for racing, pace making, reliability trial fails or neglects to pay on the due date or otherwise
to any such change. speed testing, record attempting or in any in respect of any monies owing under or in respect
c) The statement of the Bank as to at the amount of competition of any nature whatsoever. of the Facilities.
interest payable or as to the rate of any interest To carry out all repairs and replacements arising from any The Borrower shall indemnify the Bank forthwith upon
payable pursuant to these Conditions shall be cause, at his/her own expense provided that the borrower demand for any costs incurred by the Bank in taking any
conclusive. shall not have or be deemed to have any authority to steps to obtain payment of moneys due under this
Agreement including cost of enforcement of any

Customer Signature: _____________________ 7509

DSO Code: __________________________ ARO code: __________________
Without prejudice to condition 2b, a late payment charge pledge the Bank’s credit for the repairs or to create a lien security held and including costs of advocates on an
will be solely fixed and / or charged by the Bank on any upon the same in respect of such repairs. advocate and own client basis.
amount that remains unpaid after its due date.
c) If a demand is made by the Bank under paragraph (a) or (b) c) The Bank has reason to believe that the Borrower or
above and the Borrower does not make the payment within any of them is or are likely to become insolvent or c) The Borrower shall advise the bank
seven days of the date of such demand, the Bank shall have otherwise committed an act of bankruptcy. immediately of any changes in his business
have the right to apply all related cost to the Borrower’s d) The borrower’s employment is terminated by his or or employment or any material or major
Account accordingly and the Borrower hereby so confirms. her employer for whatever reason. happenings that may affect the Borrower’s
d) On or before the date of approval of this application the repayment obligations.
Borrower will be required to deposit an appropriate e) The borrower is deceased. d) The Borrower acknowledges that no
amount of money in the Account for the purpose of Or in the case of a motor vehicle purchase loan: representations or inducements to enter
meeting preliminary expenses for example professional f) The borrower abandons the vehicle. this Agreement have been made whether
and other services and costs. orally or otherwise other than those
7. SET OFF g) A third party takes steps to levy a distress or if the specifically referred to herein.
a) The Borrower hereby agrees and authorizes the Bank to, distress is levied or threatened to be levied upon the 11. NOTICES AND PLACE OF PAYMENT
without prior notice, combine or consolidate any or all premises where the vehicle may be for rent, rates or Any notice to be given to the Borrower in
accounts held by the Borrower with the Bank, including but taxes, connection with the Agreement shall be in
not limited to savings accounts, current accounts, fixed h) Where a judgment creditor of the borrower takes writing and may be communicated to the
deposits, or any other type of account, and to set off or steps to levy execution upon the vehicle. Borrower in which event it shall be deemed to
transfer any sum or sums standing to the credit of any such i) The borrower fails to pay Comprehensive Motor have been duly given at the time of receipt or
account in or towards the satisfaction of any obligations or Vehicle Insurance premiums for the second and may be given by prepaid registered post to the
liabilities, including overdue loan payments, that the subsequently years of insurance coverage. Borrower’s postal address specified in the
Borrower owes to the Bank under this Agreement. j) Where the borrower allows the vehicle(s) out of his Application or such other postal address as
b) All sums payable by the Borrower to the Bank shall be paid custody and control, or sells, lets, changes or disposes of may be notified by the Borrower to the bank.
without any set-off, counterclaim, withholding or deduction the vehicle(s) or takes or sends or allows the vehicle(s) to Any such notice shall be deemed to have been
whatsoever unless required by law in which event the be taken out of Kenya without notifying the Bank. duly given on the seventh day following the
Borrower will simultaneously with making the relevant 9A. CONSEQUENCES OF DEFAULT date of posting. Proof of posting by a receipt or
payment, pay to the Bank such additional amount as will Upon occurrence of an event of default, the Bank shall have certificate of posting of a registered letter
result in the receipt by the Bank of the full amount which the right to exercise any or all of the following remedies addressed to the Borrower at the address in the
would otherwise have been received had no such deduction without prejudice to any other remedy available to it. Application, or such other address as the
or withholding being required. a) The Bank may initiate asset recovery measures which Borrower may notify shall be conclusive proof
c) The Borrower further acknowledges and agrees that the include but are not limited to repossession and/or that the said notice has been duly posted
Bank may exercise this right of set-off at any time and without auction of any asset that I/we may have pledged to the notwithstanding non-receipt of such notice by
prior notice, and that such action by the Bank shall not Bank as security or collateral or any vehicle jointly the Borrower. Any notice to be given to the Bank
prejudice any other rights or remedies available to the Bank registered in the name of the borrower and the Bank. shall be in writing and shall be delivered to, at
under this Agreement or at law. b) The Bank may forward the borrower’s name to a Credit the Branch of the Bank where the application
Reference Bureau & cause the borrower’s name to be was submitted or at such other address as may
d) The Bank's rights under this clause shall extend to any negatively listed therein. be notified by the Bank.
accounts held jointly with others, and the Borrower warrants c) The Bank shall have the right, upon the occurrence of a 12. COUNTER PARTS
that they have obtained the consent of any joint account default, to appoint an agent or agents to act on its behalf This Agreement may be in any number of
holders to this clause. in enforcing its rights under this Agreement. Such counterparts each of which when signed and
8. CONSENT CLAUSE agent(s) may include but are not limited to debt delivered shall be deemed an original, but all
The Customer expressly consents that the Bank may disclose collectors, receivers, managers, or trustees. such counter parts together shall constitute
any information including but not limited to information 10. ADDITIONAL PROVISIONS but one and the same instrument.
relating to my/our business and or the accounts maintained No indulgence by the Bank in respect of any of its rights 13. PRIVACY STATEMENT
by us to any credit reference bureau licensed to operate under the agreement will operate as a waiver of its said I/We acknowledge the requirement to read the
business under the Banking (Credit Reference Bureau) rights. Bank's Privacy Statement, available at the
Regulations 2008 or to any other body corporate or personal a) No amendment or variation of this Agreement shall be branches or on the Bank's website
that by law or by virtue of an order issued by a competent valid or effective unless it be in writing and signed by [[Link] and any
court or tribunal are entitled to such information. the necessary parties. amendments made from time to time.
b) A certificate under the hand of a manager of the Bank
9. EVENT OF DEFAULT
whose office need not be proved shall constitute prima By signing below, I/We confirm that I/We have
The Bank shall not be obliged to advance the Loan or where the
facie proof of any amount owing in terms of this read and understood the Privacy Statement,
Loan has been advanced, may demand immediate payment
Agreement for any purpose and at any time. including the ways in which the information
of all amounts owed under this Agreement, in the event that:
Reference to the masculine-gender shall include a provided in this form will be used. I/We hereby
a) The Borrower fails to pay any sum payable hereunder on
reference to the female gender and vice versa. Reference consent to the usage of this information as
its due date for payment.
to the singular shall include reference to plural and vice described in the Privacy Statement.
b) The Borrower fails to perform and observe any
versa.
obligations under the Agreement.

Customer Signature:______________________________________________________________________ Date: _______________________________________________

Witness Name: _________________________________________ Witness Signature: _____________________ Witness Signature Date: __________________
SECTION K: CREDIT LIFE INSURANCE (Tick where applicable)
I consent to the use of CIC Life Assurance Company & Co-op Bancassurance Intermediary Limited as the providers of my Credit Life Insurance
YES NO
on my loan in the event of the covered risk subject to the terms and conditions of the insurance policy.
If Not: Indicate name of Insurance provider from NB: Credit Life Insurance details can be found in Co-operative Bank of Kenya website: [Link]
the IRA website link ([Link]) [Link]/
SECTION L: Signed For The Bank

Name: Signature: Signature Number: Date:

Customer Signature: _____________________

7509
DSO Code: __________________________ ARO code: __________________