FORM 1A

LOAN APPLICATION FORM

Indicate loan product applied Application Date: ………………………
VUKA GO GREEN V-TALANTA AGRIBIZZ ASSET FINANCE VIBE MIGRATION COMPANY LPO

COUNTY: CONSTITUENCY: WARD:

Loan Amount: Repayment period months: Affordable Installment Amount:
DESCRIBE PURPOSE OF THE LOAN

LPO/ASSET FINANCE INVOICE:

INSTITUTION: ………………………….…………LPO/INVOICE NO: …………………….AMOUNT: ........................

INSTITUTION:………………………….………….LPO/INVOICE NO: ……………………AMOUNT: ............. ……..

Legal structure of the Business: Sole Proprietorship Partnership Limited Company
PERSONAL DETAILS APPLICANT FOR SOLE PROPRIETORSHIP ONLY

Applicant’s Name: ………………………………………………………………………………………………………

ID/PP Number: Postal Address: No. Of Dependents:

PIN Number: Postal Town: Code: Education Level:

Date of Birth: Telephone No: Gender: M F
Nature of residence:
Rented Own Other Name of Chief/Ass. Chief: …………………..…………Telephone No: ……………
Email Address: Marital status: Single Married Widowed
LIMITED COMPANY/PARTNERSHIP
Registered Name:
Trading Name: …………………………………………………………… Years in Operation: ………………………
P.O. Box..............................Code .....................................Town……………………………Telephone No:
……………………………
Official Email Address: ……………………………………………………………………
COMPANY/PARTNERSHIP REGISTRATION NUMBER KRA PIN NUMBER

NO. NAME OF DIRECTOR(S) / PARTNER (S)ID NUMBER TELEPHONE NO. NAME OF NEXT OF KIN
1.
2.
3.
4.
5.
NEXT OF KIN/SPOUSE’S NAME FOR SOLEPROPRIETORSHIP:
ID/PP Number: Postal Address: Town: Code:
PIN Number: Email:
Relationship: Telephone No: Gender: M F

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 FORM 1A
REFERENCES: Name, Address and Telephone
List At Least Three Referees (suppliers, landlords, agents, peers, etc)
Name Telephone Relationship
1.……………………………………………… …………………………… ………………. ……..
2.……………………………………………… …………………………… ………………. ……..
3.……………………………………………… …………………………… ………………. ……..
BUSINESS DETAILS
Description of Business Activity/Products: NO. of Paid Employees

Full-time_________Casual____________
Current Business Location (Market): Business Premises
Town: …………………. Street: …………..…Building…………………. Rented Own Other
Duration at this location?
............................ Landlord’s Name: …………………………….. Telephone No: …………………
Other Businesses owned by Applicant/Spouse

SAVINGS/CURRENT ACCOUNT (COMMERCIAL BANK/SACCO/MERCHANTS) PROVIDE COPIES OF 6 MONTHS CERTIFIED

STATEMENT)
Bank/Institution: ………………………………………………………….... Account No: ……………………………………

Bank/Institution: ………………………………………………………….... Account No: ……………………………………

Bank/Institution: ………………………………………………………….... Account No: ……………………………………

CREDIT HISTORY. Have you ever applied for a loan before? Yes () No (). If yes, please provide details below:
Name of Lender Date Amount of Duration of Monthly PURPOSE
Applied Loan Loan Installment (Indicate specific purpose that was financed )

BUDGET BREAKDOWN FOR THE LOAN REQUESTED

NO. PARTICULAR/ITEMS COST PER UNIT QUANTITY TOTAL
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
GRAND TOTAL
Explain how you anticipate the loan will change/transform your business

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 FORM 1A
BUSINESS BALANCE SHEET (Business that is subject of loan)
ASSETS LIABILITIES & CAPITAL
Actual Projected Actual Projected
SHORT TERM SHORT TERM
Cash (on hand & in Bank) Creditors (Trade)
Debtors Bank Loans
Stock LONG TERM
LONG TERM Bank Loans
Total Fixed Assets Other Liabilities
Other Assets Capital
TOTAL TOTAL
NET HOUSEHOLD BUDGET
MONTHLY INCOME MONTHLY EXPENSES
Actual Projected Actual Projected
Borrower (net salary) Housing
Spouse (net salary) School Fees (average per
month)
Business (from above) Transportation/Vehicle
Pensions Food
Other Businesses Utilities (Phone,
(Applicant or Spouse) Electricity, medical, etc.)
Other Income Other Debt Repayments
Total Household Income Total Expenses
Net Household Income
GROSS PROFIT MARGIN ON BEST SELLING PRODUCTS
Product Selling Price (A) Cost of Goods sold (Purchases Gross Profit Margin
+ Cost of Production (B) ( A-B) / A
1.
2.
3.
Average

YEDF/CRE/04/001A/2024 Page 3 of 9 Revision 2

 FORM 1A

THE CHATTELS/ASSET SCHEDULE (ANNEX “A”)

CHATTEL OFFERED AS IDENTIFICATION PHYSICAL OWNERS
QUANTITY SECURITY e.g. T,V (MAKE/ COLOR/ MODEL/ LOCATION VALUE NAME AND
e.g.1 SERIAL No) e.g. Samsung,50”, OF CHATTELS e.g. e.g. Ksh. 20,000 SIGNATURE
black, S No:Fnd15548ffd Nairobi Utawala Amani
. Estate Hs No 20 .

GRAND TOTALS
I/we………………………………………………………………of ID Card/Certificate
No…………………………………… hereby declare and confirm that I/we am/are the legal and beneficial owner of the
Collateral listed herein. The Collateral are free and clear from encumbrances by way of mortgage, charge, pledge, lien
(excluding savings), hypothecation, assignment, trust arrangement or other encumbrances whatsoever. This Schedule
constitutes of instrument annexed hereto and executed by myself/ourselves. I/we undertake to comply with all the
conditions of the loan.
Individual/Directors
………………… …………………. …………………… …………………
Signature 1 Signature 2 Signature 3 Signature 4
Date:
In the Presence of Practicing Advocate (Stamp) )
)
) …………………………
Date …………………………… ) Signature

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 FORM 1A
REPUBLIC OF KENYA
IN THE MATTER OF THE MOVEABLE PROPERTY SECURITY RIGHTS ACT
LAWS OF KENYA

AFFIDAVIT

I ...................................................... of Post Office Box Number ............................... in the

Republic of Kenya hereby make oath and state as follows:

1. The paper writing hereto annexed and marked "A" is a true copy of an instrument
and of every schedule of Inventory thereon endorsed or thereto annexed or therein referred
to and of every attestation of the execution thereof, as made, given and executed by
……………………………………………………………………………………………....
(Hereinafter referred to as the "Grantor").

2. The instrument was made and given by the Grantor on the ...................... day of 20.........

3. I was present and saw the Grantor duly execute the said instrument on the ............day
of 20........

4. The Grantor resides at...........................................................................

And is a. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5. The name subscribed in the said instruments as that of the person attesting the due
execution thereof by the Grantor is in proper handwriting of me, this deponent.

6. I am an advocate of the High Court of Kenya and reside at.

……………………………………………………………….

Sworn by the said.........................................

at...................................................................

This ......................day of .................... 20........

…………………………….

Signature & ID

Before me :

Commissioner for Oath

Revision 2
YEDF/CRE/04/001A/2024 Page 5 of 9
 FORM 1A

TO BE SIGNED BY APPLICANTS/COMPANY DIRECTORS

Name ………………………………. Sign …………………. Date ………………….

Name ………………………………. Sign …………………. Date ………………….

Name ………………………………. Sign …………………. Date …………………. Seal/Stamp

TO BE SIGNED BY CO-BORROWER(S) E.G. SPOUSE (For Sole Proprietors)

Name ………………………………. Sign …………………. Date ………………….

Name ………………………………. Sign …………………. Date ………………….

Name ………………………………. Sign …………………. Date ………………….

GUARANTORS
Name ………………………………. ID NO. …………………. Phone no: ……………..Sign …………… Date ……………

Email address: ……………………………………Postal address: …………. Code……..….Town ……………..…………

Name …………………………… ID NO. …………………. Phone no: …………..Sign …………………. Date ……………

Email address: ……………………………………Postal address: …………. Code……..….Town ……………..…………

Name ………………………………. ID NO. …………………. Phone no: …………..Sign ……………. Date ……………

Email address: ……………………………………Postal address: …………. Code……..….Town ………..………………

FOR OFFICIAL USE ONLY

RECOMMENDATION FROM THE COUNTY VETTING COMMITTEE

RECOMMENDED PENDED DECLINED

______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________

NAME DESIGNATION SIGN DATE

1. ______________________ ________________ _____________ ___________

2. ____________________ ________________ _____________ ___________

3. ______________________ ________________ _____________ ___________

4. ______________________ ________________ _____________ ___________

Revision 2
YEDF/CRE/04/001A/2024 Page 6 of 9
 FORM 1A
VERIFICATION OF PREVIOUS BORROWING BY HEAD OFFICE OFFICERS
BORROWED
NAME SIGN DATE
BEFORE(YES/NO)
VUKA

AGRIBIZZ

VIJANA BAHARIA

TALANTA

LPO

GROUP LOAN

OTHER

REMARKS (If yes state amount and balance)…………………………………..……………………………………

……………………………………………………………………………………………………………………………
APPROVAL FROM CREDIT RECOVERY AND RISK MANAGEMENT COMMITTEE

APPROVED PENDED DECLINED

_________________________________________________________________
_________________________________________________________________
______________________________________________________________
_________________________________________________________________
_________________________________________________________________
______________________________________________________________

NAME DESIGNATION SIGN DATE

1. ______________________ ________________ _____________ ___________
2. ______________________ ________________ _____________ ___________
3. ______________________ ________________ _____________ ___________
4. ______________________ ________________ _____________ ___________
5. ______________________ ________________ _____________ ___________

APPROVAL BY MANAGER, CREDIT RECOVERY AND RISK MANAGEMENT

APPROVED PENDED DECLINED

-----------------------------------------------------------------------------------
---------------------------------------------------------------------------------
---------------------------------------------------------------------------------
NAME: _______________________________ SIGN:____________________ DATE:_____________

Revision 2
YEDF/CRE/04/001A/2024 Page 7 of 9
 FORM 1A
THE TERMS AND CONDITIONS OF THE LOAN FACILITY AND i. An encumbrance takes possession or exercises or attempts
CONDITIONS OF OFFER to exercise any power of sale or a receiver is appointed of
a) All payments under this facility will be made without set-off or the whole or any part of the Borrower’s property assets or
counterclaim and free and clear of any withholding or deduction (save revenues;
as required by law) for any present or future taxes, levies, imports, j. Any judgement or order is made against the borrower and is
duties and other charges. If the borrower is obliged by the law to make not complied with within seven (7) days or if any execution,
any such withholding or deductions, then the borrower will pay to the distress, sequestration or other process is levied or enforces
Fund in the same manner and at the same time additional amounts to upon or sued against any part of the borrower’s property,
ensure that the Fund receives a net amount equal to the full amount assets or revenues;
which the Fund would have received if no such deductions or with k. The borrower stops payments or agrees to declare a
withholdings had been required. moratorium or becomes or is deemed to be insolvent or
b) The borrower agrees to provide such information and documents unable to pay its debts as and when they fall due or if a
concerning the Borrower’s business, financial position and prospects as notice is issued convening a meeting of its creditors or if it
the Fund may request. The borrower agrees to avail all records to the proposes or enters into any composition with its creditors
Fund or its representatives upon reasonable notice. The review of generally or any class of its creditors;
these records may be done after the loan is paid off. l. If any material part of the borrower’s property, assets or
c) Where the borrower is a company, it shall provide a certified copy of a revenues is sold or disposed of or threatened to be sold or
resolution of its Board of Directors sanctioning the loan facility and disposed of whether in a single transaction or in a
authorizing two of its directors or one director and the Company nationalised, compulsory acquired, seized or appropriated;
Secretary to execute the offer and all other documents concerning the m. If the charge or any other guarantee, indemnity or security
loan facility together with a certified document containing their for any monies obligation or liability hereby secured fails or
specimen signatures. ceases in any respect to have full force and effect or to be
d) The borrower will maintain separate accounting records for all continuing or Is terminated or disputed or becomes in
transactions relating to the loan and provide a reconciliation to the jeopardy, invalid or unenforceable;
lender upon request. n. The borrower, without prior written consent of the Fund
e) The Fund reserves the right to demand full repayment of the loan if it cease or threaten to cease to carry out business it presently
is determined that the borrower’s performance is not in accordance carries out or any material part thereof in a normal course
with the original objective of the Fund’s loan scheme. or it changes the nature or mode of conduct of its trading in
f) Draw down shall be conditional upon the perfection of the security as any material respect;
stipulated in the offer. o. If any licence, authorisation, consent or registration at any
g) The Borrower shall provide such further information as the Fund may time necessary or desirable to enable the borrower to
request from time to time. comply with its obligations to the Fund or to carry on its
business in the normal course shall be revoked withheld or
EVENTS OF DEFAULT materially modified or shall fail to be granted or perfected or
The following events will constitute default and cause any amount shall cease to remain in full force and effect; or
outstanding under the loan facility to become immediately due and owing p. Any of the foregoing events occurs without prior consent in
and any commitments made hereunder by the Fund cancelled: writing in relation to the borrower or any third party who
a. The failure of the Borrower to observe or perform any of its obligations now or hereafter has guaranteed or provided security for or
under the offer and/or the security documents or if any representation given an indemnity in respect of any money obligation or
warranty or undertaking from time to time made to the Fund by the liability herby secured.
Borrower is or becomes incorrect or misleading in a material respect; LOAN RECOVERY
b. If any circumstances arise which in the opinion of the Fund have or a) In the event of default, the Fund shall have the right to
may have a material adverse effect on the Borrower’s ability to perform institute legal action against the Borrower for the full
its obligations under this offer and/or the security documents; recovery of all monies lent with interest thereof and exercise
c. The Borrower admits in writing of its inability to pay or the possibility powers of sale or appointment of receivers or receivers and
of becoming unable to pay its debts generally as they fall due, or managers pursuant to any security created in favour of the
become bankrupt or insolvent, or file any petition or action for relief Fund.
under any bankruptcy, re-organization or insolvency law; b) In the event of default, the Fund reserves the right to and
d. If any circumstances arise which in the opinion of the Fund have or my, if it deems it necessary to realize any security that may
may have a material adverse effect on the Borrower’s ability to perform have been offered to it by the borrower.
its obligations under the offer and/or the security documents; COSTS
e. The Borrower admits in writing of its inability to pay or the possibility a. The borrower shall pay all legal costs and other costs incurred
of becoming unable to pay its debts generally as they fall due, or by the Fund in connection with the loan or the enforcement
become bankrupt or insolvent, or file any petition or action for relief of preservation of the Fund’s rights. The borrower shall
under any bankruptcy, re-organization or insolvency law; indemnify the Fund forthwith upon demand of any costs
f. In the case of a company, if proceedings are started for the Borrower’s incurred by the Lender in taking any steps to obtain payment
winding-up, dissolution, or re-organization (otherwise than while of monies due under the letter of offer including costs of
solvent and on terms previously approved in writing by the Fund) or enforcement of nay security held and including costs of
for the appointment of a receiver, trustee or similar officer of any or all advocates on “an advocate and own client basis”
of the Borrower’s revenues and assets; b. The borrower shall bear the cost of the perfecting of such
g. Any of the Borrower’s indebtedness is not paid on its due date or security(s) as it shall have offered the Lender including the
becomes due prior to its stated maturity or any guarantee given by the fees of the “Advocates and/or Valuers appointed by the Fund
Borrower is not honoured when due or called upon; for the purposes of perfecting such security.
h. Any governmental or other consent or exemption required to enable c. The borrower agrees to reimburse the Lender forthwith upon
the Borrower to perform its obligations under the offer and/or the demand all costs (including stamp duties and advocates
security documents is withdrawn or modified or it becomes for any expenses) on the full indemnity basis incurred in connection
reason unlawful for the Borrower to perform any of those obligations; with the establishment of the security (if any) and
preparation of the necessary loan documents.

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 FORM 1A

SHARING OF INFORMATION WITH CREDIT REFERENCE BUREAUS GOVERNING LAW

The offer shall be in accordance with the laws of the Republic of
The Borrower expressly hereby consents to the Fund sharing and accessing Kenya and the Borrower hereby submits to the jurisdiction of the
the Borrower’s personal data and full file credit information with licensed Kenyan Courts. The submission to jurisdiction of the Borrower
credit reference bureaus in accordance with the Credit Reference Bureaus shall not prevent proceeding being brought in any other
Regulations, 2013. competent court.

GENERAL
Any Notice or request given by any party under the offer to the
other party shall be in writing. It shall be deemed to have been
duly given or made when it shall have been delivered by hand,
mail, cable, email, telex or telefax to the party to which it Is
required or permitted to be given or made at the relevant address
for communication of such party which is specified in the offer or
at such other address for communication as such party shall have
designated by notice to the party giving such or making such
request. Where it is impossible to contact the borrower directly
due to the information to be passed relates to large pool of
borrowers, a notice in a widely circulating daily newspaper will
be deemed to be sufficient notice.

MISCELLANEOUS
a. No indulgence by the Fund in respect of any rights hereunder
will constitute or operate as a waiver of its said rights.
b. No amendment or variation of the offer shall be valid or
effective unless it is in writing by both the Fund and the
Borrower.
c. The Borrower acknowledges that no representation or
inducements to enter into the Offer have been made whether
orally or otherwise other than those specifically referred to
herein.
d. Any reference to the masculine gender shall include a
reference to the feminine gender and vice versa. Reference to
the singular shall include reference to the plural and vice
versa.
e. The borrower undertakes to notify the Fund immediately if its
financial condition materially deteriorates from the date of its
loan application
f. Save as otherwise expressly provided, the terms of any other
agreement entered into between the borrower and the Fund
to the extent of any conflict or inconsistency shall be
superseded by the Letter of Offer.
g. If any of the provisions of the Offer is proved to be wholly or
REPAYMENTS partly invalid or unenforceable this shall not affect the validity
or force of the other provisions of this Agreement. In such
a. The borrower will make all payments under or in respect to this facility on case the borrower and the Fund shall replace such invalid or
the due date to the Fund at such account as he Fund may from time to un-enforceable provision by another being in effect as nearly
time instruct the borrower. similar to the original provision as possible
b. All repayments received by the Fund in respect to the loan shall be credited h. The borrower shall ensure that the loans will at all times
only when payment is received in cleared funds. Any payment otherwise constitute the direct, unconditional and general obligation of
credited by the Fund in respect to the loan shall be subject to receipt of the borrower.
the cleared funds and shall not be deemed credited until such clearance. i. The Borrower acknowledges receipt, reading and
c. The Fund shall apply all payments received in respect of the loan in the understanding of the terms and conditions of the loan facility
following order: costs and expenses payable under this facility, accrued and conditions of offer
and unpaid interest, and principal.

Name ………………………………. Sign …………………. Date ………………….

Name ………………………………. Sign …………………. Date …………………

Name ………………………………. Sign …………………. Date ………………… Company Seal/Stamp

Name ………………………………. Sign …………………. Date …………………

Revision 2
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