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T _ O_ O _ L___ K_ I _ T | |
IV APPLICATION | |
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PERSONAL INFORMATION | ______________________________ |
Name of Applicant | ______________________________ |
Home Address | ______________________________ |
Business Location | ______________________________ |
National I.D. Number | ______________________________ |
Age | ______________________________ |
Gender | ______________________________ |
Highest Level of Education Reached | ______________________________ |
ECONOMIC ACTIVITY OF THE BORROWER | ______________________________ |
What is your main income activity? | ______________________________ |
How long have you been doing it? | ______________________________ |
How many months a year? | ______________________________ |
How many hours per day/week do you do this activity? |
______________________________ |
Where do you do this activity? | ______________________________ |
Describe your products or services. | ______________________________ |
What are your sales on a good day? | ______________________________ |
..on a slow day? | ______________________________ |
..on a regular day? | ______________________________ |
What is your average monthly income from this activity? |
______________________________ |
Do you pay anyone outside your household to help you? How many and how much do you pay them? |
______________________________ |
What are your average monthly expenses (materials)? |
______________________________ |
What plans do you have for your activity in the future? |
______________________________ |
ECONOMIC ACTIVITY OF THE HOUSEHOLD | ______________________________ |
How many people are there in your household? |
______________________________ |
Do your family members help? | ______________________________ |
In your household, what are the different activities conducted by all members? Please stipulate frequency and estimated income. |
______________________________ |
CREDIT | ______________________________ |
How will you use your loan? | ______________________________ |
How much do you want to borrow? |
______________________________ |
What is the loan term? | ______________________________ |
From what other sources have you borrowed money? |
______________________________ |
How many times have you borrowed before from this project? |
______________________________ |
Were your payments on time or sometimes late? | ______________________________ |
Did you experience difficulties in paying back your loan? If yes, why? |
______________________________ |
ASSETS/SAVINGS | ______________________________ |
How much do you have in savings (cash and in-kind)? |
______________________________ |
Where are the savings located? | ______________________________ |
Do you own land? How much? Is it arable? |
______________________________ |
What equipment used for your economic activity do you own? |
______________________________ |
APPROVAL | ______________________________ |
The Field Agent must read aloud the loan guarantee to each member of the Credit Group. | We, by signing below, agree that we are responsible for the payment of any and all principal and interest owed by this applicant to [Organization name]. If the borrower cannot or will not repay a loan, we agree to make the payments and understand that we are not eligible for any new loans until all outstanding debts of the borrower to [Organization name] are paid in full. |
signed: | signed: |
signed: | signed: |
signed: | signed: |
Field Agent verifies information is accurate | signed: |
SUMMARY | ______________________________ |
Loan Amount | ______________________________ |
Loan Term | ______________________________ |
Interest Rate Per Month | ______________________________ |
Loan Payment | ______________________________ |
Frequency | ______________________________ |
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