LOAN APPLICATION FORM

PERSONAL INFORMATION
Amount Affordable monthly Installment
Requested
First Name Middle Name
Date

ID / Passport No PIN No
Marital Status (tick Gender(tick Male Female
appropriately) Married Single appropriately)

Number of
Dependents
Address Postal Code

Tel No (Landline). Mobile No.

Present Residence (Location or Duration of
Estate) Occupation
Residence: 100% Owned Leased
Business. 100% Owned Leased
Sources of Income Amount(KES)
Business
Personal
Other
Estimated Annual Income
APPLICANT’S DETAILS (LIMITED LIABILITY COMPANIES/REGISTERED BUSINESSES)
Name of Business:
Date of Registration VAT No
Registration Number/Incorporation PIN No.
Number
E-mail Address Website
Mobile No. Fax No.
Telephone Office No.
Postal Address Code
Physical Address Plot No.
Nearest Landmark Town.
Town/Street/Road, Building
Main Products
Age of Business
Directors/Partners(attach copies of ID and Pin Certificates)
Name %Shares Held Pin No. Telephone ID No. Address
No.
BANKING DETAILS ACCOUNTS IN OTHER BANKS FINANCIAL INSTUITIONS.
Month/Year Bank A/C Title Account Branch Debit Credit
Name Number

NB: Attach Current Six Months Bank Statements.

FINANCIAL INFORMATION
Monthly Income from Ke Monthly expense on Ke
activity s activity s.
ACTIVITY’S MONTHLY INCOME AND EXPENSE
INCOME EXPENSES
1. 1.
2. 2.
3. 3.
TOTAL INCOME TOTAL EXPENSE
ACTIVITY’S BALANCE SHEET
ASSETS LIABILITIES
SHORT TERM SHORT TERM
Cash (on hand and in Banks) Creditors (Trade)
Debtors Bank Loans
Stock LONG TERM
LONG TERM Bank Loans/loans from
other financial
institutions
Total Fixed Assets Other Liabilities

Other Assets CAPITAL

TOTAL ASSETS TOTAL LIABILITIES

NET HOUSEHOLD BUDGET (MONTHLY)

MONTHLY INCOME MONTHLY EXPENSES

Borrower Housing/Rent

Spouse Education/Medical (average

per month)

Business (overleaf) Transportation/Vehicle

Pensions Food
Utilities (Total)
Other Businesses (Water,Phone,Electricity)

Other Income Other Debt Repayments

Total Household Income Total Expenses

Security Details.
a) Land

Title Number Registered Owner Lessor(if Size Location Estimated Market

applicable) Value

Brief Description of property(indicate whether developed or undeveloped)

b) Motor vehicle
Registration Registered Owner Year of Engine Chassis Make/Model/Colour
Number manufacture Number Number

c) Machinery & Equipment

Name of Registered Owner Year of Serial Colour Estimated Market

Equipment manufacture Number Value

d) Other Types of Security

Type of security Registered Owner Description Estimated Market
Value

I am applying for a loan of Kes. _________________________ to be repaid in ____________________

months, and to be used as follows:
___________________________________ ___ Kes: _________________________
_ _____________________________________ Kes: _________________________
I am applying for a loan of Kes. _________________________ to be repaid in ____________________
months, and to be used as follows:
___________________________________ ___ Kes: _________________________
_ _____________________________________ Kes: _________________________
_______ _______________________________ Kes: _________________________
Declaration

I/We further declare the information given here is true to the best of our knowledge and
belief/ I we further authorise Kenya Industrial Estates Ltd to verify the information given
herein and make any reference from any persons/institution named here in.

Applicant’s Name------------------------------------ Signature--------------------------Date-----------

------

FOR OFFICIAL USE ONLY. Application Form Serial No.

A. Branch Use:
Branch: Loan Summary Included: ( ) Yes ( )No
Internal Valuation Included: ( ) Yes ( ) No All Attachments (IV above) Included: (
)Yes ( )No

Generating Officer Sign: Date:

Branch Manager Sign: Date:

B. Head Office Use:

Security: ( ) Accepted ( ) Rejected
Business Appraisal: ( )Accepted ( )Rejected
Bank Statements Appraisal: ( )Accepted ( )Rejected
Photographs: ( )Accepted ( )Rejected Personal Details Provided ( )Accepted (
)Rejected

General Requirements
• Bank statements where applicable.
• Quotation/Invoice for items to be funded by KIE Loan
• Current trade Licence/Local Authority single business permits where applicable
• 2copies of identity card for all owners of the business
• 2 copies of passports photographs for the applicant
• Copy of Pin Certificate of applicant
• Copies of business registration certificate.
• Sketch map of the business.
• Sketch map of applicant’s residence& security.
• Photograph of security.
• Photograph of operations of the business.
• Audited books of accounts &Management accounts where applicable