JESMOR VENTURES
LOAN FORM
No.
1. BORROWERS PERSONAL DETAILS
Surname
Other Names
Id/Passport Number
Residential Address
House/Lr No. Estate
Area Road/Street Town
Age Marital Status
Postal Address
P.O Box Code Town
Mobile No. 1 2.
Office Email:
Personal Email
2. NEXT OF KIN/ALTERNATIVE CONTACT DETAILS
Next Of Kin Alternative Contact Relationship To Client
Surname
Other Names
Resident Address
House/Lr No. Estate
Area Road / Street Town
Age Marital Status
Postal Address
P.O Box Code Town
2:
Office Email:
Personal Email
3employment Details
Employer
P.O Box Code Town Tell Fax
Physical Location Date Employed Current Position
4. GUARANTORS
Name Mobile No. Id/No Sign
Name Mobile No. Id/No Sign
5. SECURITIES
Item Price
Item Price
Item Price
Item Price
Item Price
5. TOTAL INCOME
Net Salary Other Income Total Income
Rent Other Personal Expenses Total Monthly Expenses
6. SELF EMPLOYMENT DETAILS
Name Of Business
Physical Business Address (Attach Copy Of Trading License)
Office Size (Sq. Ft.) (Attach A Copy Of Lease) Monthly Rent
Number Of Years In Operation Products/Services
Last 3 Years Turnover (1) (2) (3)
Last 3 Years Net Profit (Attach Management/Audited Accounts) (1) (2) (3)
Number Of Employees (Management) Others
7. LOAN AMOUNT IN WORDS/FIGURES
REPAYMENT MODE
8A. LOAN DETAILS
Loan amount ksh.......................................................
Loan tenor (Weekly) .......................................................
Weekly interest rate .......................................................
Total interest payable ksh.......................................................
Total loan amount ksh.......................................................
Monthly instalment amount ksh.......................................................
Monthly repayment date .......................................................
Mode of repayment Weekly
Dally
8E ACKNOWLEDGEMENT OF THE LOAN DETAILS
That the borrower here acknowledges the loan details applied by borrower herein: signature..........................date .................................
9. PURPOSE OF THE LOAN (Please Tick A Box)
Business Education☐ Medical☐ Asset Purchase☐ Loan Refinancing☐ Housing Development Agriculture Other (Specify)
10.HOW DID YOU GET TO KNOW ABOUT PCL (K) (Please Tick A Box)
Newspaper Flers Internet Personnel Referral Loan Agent SMS Other
11.PLEASE TELL IS MORE ABOUT YOU
Profession ____________ personal business if any. ___________No. of children ______ Marital status ________
Hobbies & Interest __________________________________________________________________________
IN AGREEMENT therefore, the borrower and the lender hereby affix their respective
signatures
For and Behalf of BORROWER:
Names: _________________________ Surname: _____________________________
Position: ________________________ Other Names: _________________________
Signature: _______________________ Signature: ____________________________
Date: ___________________________ Date: __________ Cell phone No. __________
