Loan Application Form

Personal Details

Name of Entity:

Entity registration number / Incorporation number:

Applicant Name: *

National ID/Passport No: *

Marital Status: *

SingleMarriedWidowedDivorced

Directorship

DirectorNot Director

No. of shares the applicant has in the company:

Date of Birth: *

Postal Address with postal code (Current): *

Mobile: *

Email Address: *

Number of Children *

Name of School children attend: *

Number of children attending School *

Any candidate this year? *

Yes No

Which Exam?

KCPEKCSE

Location Details

Town: *

Estate: *

Ownership *

RentedOwner

House Number:

LR No:

Rent per Month (Kes without commas)

Office Location *

Office Phone Number *

Previous Office Location *

Spouse Details

Name of Spouse

Spouse Phone Number *

Spouse ID Number *

Spouse Profession *

Name & Phone Number of employer, if spouse is employed

Next of Kin Details

Name of Next of Kin

Next of Kin Phone Number *

Next of Kin ID Number *

Next of Kin Profession *

Name & Phone Number of employer, if Next of Kin is employed

Particulars of Owners of the Business

Name of Director 1 *

ID Number *

Email Address *

Phone Number *

Name of Director 2

ID Number

Email Address

Phone Number

Name of Director 3

ID Number

Email Address

Phone Number

Are you a member of any sacco? *

Yes No

Number of months in operation: *

Monthly turnover sales(KES): (without comma) *

Amount of Debtors(KES): (without comma) *

Amount of Creditors(KES): (without comma) *

Other liabilities e.g. loans/overdraft:

Contact person Phone Number:

Financial Institution *

Type of Account *

Balance as at Date of Application

Loan Particulars

Amount applied (KES)(without commas) *

Repayment Period in years *

Purpose *

Guarantors

Name of Guarantor 1 *

Relationship *

ID Number *

Phone Number *

Profession *

If employed, Name and Phone Number of Employer *

Date Today *

Name of Guarantor 2

Relationship

ID Number

Phone Number

Profession

If employed, Name and Phone Number of Employer

Date Today *

Security/Collateral and Referees

Name of Referee 1 *

Relationship *

Phone Number *

Email Address *

Name of Referee 2

Relationship

Phone Number

Email Address

Name of Referee 3

Relationship

Phone Number

Email Address

Security Type 1 *

Details *

Value(KES) *

Security Type 2

Details

Value(KES)

Required Documents

Passport size photo *

No file chosen

Company Proﬁle *

No file chosen

Certificate of Incorporation *

No file chosen

Bank statement( six Months) *

No file chosen

MPESA Statement (six Month) *

No file chosen

License or Business Permit *

No file chosen

Credit Report *

No file chosen

Personal KRA Pin *

No file chosen

Pay slips ( salary Loan only) *

No file chosen

ID Copy *

No file chosen

Business KRA Pin *

No file chosen

Proposed Security *

No file chosen

LPO Document *

No file chosen

Tax Compliance *

No file chosen

Date Today *

We the undersigned declares that the information provided including attachments to this application are correct. We are aware that as part of loan appraisal Nyali capital is at liberty to verify and collaborate the information. Compliance with documentation requirements including opening of collection account is not a guarantee of approval of the loan applied.

Fill all the Details Below

Personal Details

Marital Status: *

Directorship

Any candidate this year? *

Which Exam?