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AFRICAN MICROFINANCE LIMITED
APPLICATION FORM AND LOAN AGREEMENT
(To be completed by loan applicant: please put your signature on each page)
Application date: ____/____ /2013
Application fee in TZS: ______
Affix Your
Passport Size
Receipt number: _____________
Type of loan: _______________
Photo Here
Section 1: Applicant’s General particulars and contacts
Applicant’s Name: First _________________________ Surname _____________________________
Nationality ______________________________ Place of birth _______________________________
Gender (F/M):_____ Date of Birth ________________ Marital Status: __________________________
Level of education __________________________School/college attended_____________________
Your telephone numbers 1) ___________________________ 2) ______________________________
P. O. BOX ___________ your residence location (give details) ________________________________
__________________________________________________________________________________
E-mail Address _____________________________________________________________________
Spouses’ name: _______________________________ His/her Mobile phone No:.________________
Is your house owned by you or rented: __________________
Next of kin’s name: ______________________Relationship: _____________Tel no. ______________
Who referred you to AML (Full name): ____________________________________________________
Do you currently have a loan with another institution? ______________ (If yes, what is your monthly
repayment in TZS. ___________________
Have you acquired a loan from AML before? _______________________________________________
Section 2:
Your Employment Profile (for salary based loan only)
Name of Employer:___________________________________________________________________
Type of business: ____________________________________________________________________
Duration of Service (with current employer): ______ year(s) Permanent or fixed term?______________
Office Location ______________________________________________________________________
Your Position/job title _________________________________________________________________
Your Line Manager’s Name _____________________________ his/her Mobile Tel ________________
Your Monthly gross Salary TZS. ___________________ Your Monthly net Salary TZS. _____________
Your ID Number _____________Date issued______________________ Expiry Date ______________
Page 1 of 10
Section 3: Your Business Profile (for Business loans only)
Business name: _______________________________________________________________
Type of the business: ________________________________________________________________
Registration Date ________________Registration Number: _________________ TIN _____________
Business location ____________________________________________________________________
Your telephone/ Mobile: 1) ______________2) _____________Experience in Business: ______ years.
Number of workers employed: _________________ Ownership _______________________________
Who are your Customers ______________________________________________________________
Who are your Suppliers: ______________________________________________________________
Your monthly turn over (in TZSs.) ______________________________________________________
Section 4:
Loan Requirement (Details
Amount applied for TZS _______________Loan Period: _____months. Interest rate
% per month
Loan Purpose: (provide details)___________________________________________________
__________________________________________________________________________________
Loan repayment schedule
(i) Date __________________
Amount in TZS. ____________________________________
(ii) Date __________________
Amount in TZS. ____________________________________
(iii) Date __________________
Amount in TZS. ____________________________________
(iv) Date __________________
Amount in TZS. ____________________________________
(v) Date __________________
Amount in TZS. ____________________________________
(vi) Date __________________
Amount in TZS_____________________________________
Section 5:
Loan Application Requirements: Put “V” against the relevant items
Item
Employment ID
Voter’s Registration Card
Passport Size Photo
Bank statement
Salary slip
Letter from Guarantor/referees
Section 6:
v
Item
Collateral
Business licenses
Letter from local government
Home/business visitation done?
Application fee paid?
Postdated cheque
v
Applicant Declaration
I attest that the details provided above are true and correct, and by my signature below I authorize
the obtaining of any references from other places which may seem beneficial to the company.
Applicant’s Name: _________________________Signature: _________________Date____________
LOAN AGREEMENT
This Loan Agreement is made on this……… day of ……………....…. 2013.
BETWEEN
AFRICAN MICROFINANCE LIMITED of P. O. Box 35901, Dar-es-Salaam (herein after referred to
as the “Lender;” a term which includes his heirs and assignees and any other persons claiming
under him to have the power over the loan) of the one part;
AND
Mr/Ms. ……………………………………………………….of ………………………… area P. O. Box ………… Dar es
Salaam, (hereinafter referred to as “Borrower;” a term which includes his heirs and assignees
and any other persons claiming under her to have the power over the loan) of the other part;
NOW IT IS HEREBY AGREED as follows:
1. THAT, Subject to and in accordance with this agreement, its terms, conditions and covenants
the Lender agrees to lend to the Borrower on ……………………. 2013 (the “Loan Date”) the
principal sum of Tanzanian Shillings ……………………………………………………………………………….only
(TZS. ……………………../-)
2. THAT, this loan shall be repaid (settled/returned) with interest of ______ per month to the
Lender on or before …………………., 2013 in line with the agreed repayment schedule
3. THAT, The Borrower shall be in default if any payment due hereunder is not made on or
before the date indicated on the repayment schedule
4. THAT any amount, either principal or interest delayed in payment as per para 3 above shall
attract an interest of 0.5% of the amount delayed per day
5. THAT, any extension of payment after the said period will attract an interest of 0.5% of the
total sum per day plus interest accrued
6. THAT, it is further agreed and confirmed by the Borrower that his/her ……………………………,
with particulars attached herewith as schedules to this agreement, shall be a security
(collateral) for this loan. The particulars of the schedules shall form part to this agreement
7. That the borrower shall bear the cost of registering the collateral and all other legal fees
associated with the signing of the agreement
8. THAT, the Borrower undertakes to ensure that, the stated security for the loan is free from
any kinds of encumbrances and that spouse/ family/ clan consent is duly sought from his/her
spouse/ family/ clan to consent the disposition of this security for the loan by way of
mortgage. The particulars of the schedules regarding this consent, if any, shall form part to
this agreement
NOTE THAT, the Borrower shall swear/affirm an Affidavit to state that he/she does not have
a spouse (husband or wife) or the spousal consent has been sought at the time when
application for this loan was made. The Affidavit of this nature, if any, shall form part to this
agreement
9. THAT, the said security for this loan shall be disposed of by way of sale to recover the loan
and the interest thereof in case the loan is not paid by date stipulated under the provisions of
this agreement
10. THAT, the Lender shall keep the original documents of the property used as collateral for this
loan for the whole duration of the loan agreement and that, the original documents shall only
be surrendered back to the Lender as soon as the loan is paid in full
11. That the borrower shall not make any alteration on the collateral or shift to another location
without a written consent from the lender
12. THAT, the collateral might be changed/substituted by the borrower upon agreement with the
lender
13. THAT, if the borrower’s collateral pledged as security to the loan is VEHICLE, the borrower
shall not transferred/shifted/moved to another region unless the Lender is requested and
approved in writing
14. That the lender shall have the authority to have another property of the borrower as
alternative collateral without any further agreement provided that the lender cannot locate
the collateral at it original position
15. THAT, signatures of both parties to this agreement, shall signify full acceptance of the terms
and conditions of the agreement, which commences immediately from the date of signatures
of both parties
16. THAT this agreement shall be governed by, construed and enforced in accordance with the
laws of the United Republic of Tanzania
17. THAT, in case of any dispute, the matter shall be handled by a Court of competent
jurisdiction capable of trying the same
IN WITNESS WHEREFORE, the parties have signed this agreement the day and year first above
written
SEALED with the COMMON SEAL of the Said
AFRICAN MICROFINANCE LIMITED and
DELIVEED at DAR ES SALAAM in the presence of us
This ……..day of …………………..2013
……………………….
(SEAL)/Lender
Name:
REGINALD MASSAWE
Signature:
……………………………………………………
Postal Address:
P. O. BOX 35901 DAR ES SALAAM
Qualification:
MANAGING DIRECTOR
Signature:
……………………………………………………
Postal Address:
P. O. BOX 35901 DAR ES SALAAM
Qualification:
COMPANY SECRETARY
SIGNED and DELIVERED by the Said
....…………………………………………..
who is known to me personally/Identified
to me by ……….……………………………… the
Later known to me personally this
……..day of …………………..2013,
……………………….
Borrower
AS WITNESS TO THE ABOVE SIGNATURES:
Signature:
……………………………………………………
Postal Address:
……………………………………………………
Designation:
COMMISSIONER FOR OATHS……
SCHEDULES TO THIS AGREEMENT
[PURSUANT TO CLAUSES 6 OF THIS AGREEMENT]
SCHEDULE I – PARTICULARS OF THE MOTOR VEHICLES
[MADE PURSUANT TO CLAUSE 6 OF THIS AGREEMENT]
a) Make …………………………………………………………………………………..
b) Model…………………………………………………………………………………..
c) Model number ………………………………………………………………………..
d) Type of Body:
e) Color:
………………………………………………………………………
…………………………………………………………………………..
f) Class …………………………………………………………………………………...
g) Year of manufacture ………………………………………………………………….
h) Chassis number……………………………………………………………………….
i) Engine No: ……………………………………………………………………………..
j) Engine capacity ………………………………………………………………………..
k) Fuel used ……………………………………………………………………………….
l) Number of axles………………………………………………………………………...
m) Seating Capacity: ………………………………………………………………………
n) Tare weight ……………………………………………………………………………...
o) Cross weight …………………………………………………………………………….
p) Imported from …………………………………………………………………………..
q)
Date of Original Registration in Tanzania: …………………………………………
r)
Value of the vehicle TZS. ………………….
Vehicle Insurance Details
Date Issued: ………………………………………………………………………………….
Insurance Company …………………………………………………………………………
Value Insured: TZS. ………………………………………………………………………………
Amount paid: TZS.
…………………………………………………………………………………
SCHEDULES TO THIS AGREEMENT
[PURSUANT TO CLAUSES 6 OF THIS AGREEMENT}
SCHEDULE II – PARTICULARS OF THE PLOT OF LAND/ HOUSE
[MADE PURSUANT TO CLAUSE 6 OF THIS AGREEMENT]
a) Plot No.: ……………………………… b) Block No.: ……………..…………………..
c) C.T: ………………………………………d) L.R.O: …………………………………….
e) Place: ……………….………………………………………………………………………
f) District: ………….……………………Region/City: …………………………………….
SCHEDULE III – SPOUSE CONSENT
[MADE PURSUANT TO CLAUSE 6 OF THIS AGREEMENT]
I………………………………………………………………,
of
Box
……….……………………………..,
who
is
the
Wife/Husband of the borrower, …………………………with my full awareness and understanding, I
have read and
do understand the contents of this agreement and I agree to abide to all
requirements by this loan agreement. I also declare that this collateral is our property and shall
be used to be the collateral under this loan contract from ……………………………………………………………
SIGNED and DELIVERED by the Said
....…………………………………………..
who is known to me personally/Identified
to me by ……….……………………………… the
Later known to me personally this
……..day of …………………..2013,
……………………….
Borrower’s wife/Husband
BEFORE ME:
………………………………………….
COMMISSIONER FOR OATHS
SCHEDULES TO THIS AGREEMENT
[PURSUANT TO CLAUSES 6 OF THIS AGREEMENT]
SCHEDULE IV – HOUSE HOLD PROPERTY
[MADE PURSUANT TO CLAUSE 6 OF THIS AGREEMENT]
S/N
PROPERTY NAME
DESCRIPTIONS
VALUE
1
2
3
4
5
6
7
8
9
10
11
12
TOTAL VALUE OF PROPERIES IN TZS
Comments about property location
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
_________________________________________________________
For official use only
1. To be completed by AML officers
Date of Site/Office/Home visited____________________ (attach a detailed map and description of your
observation)
Factor
Available
Score
1
Character
2
Capacity
3
Capital
4
Condition
5
Collateral
6
Common sense
7
Identification
100%
8
Application fee
100%
9
Passport size photo
100%
10
Letter from local government
100%
11
Three months’ bank statement
100%
12
Collateral
100%
13
Home / Business visitation
100%
14
Postdated cheques
100%
15
Pay slip (for employees)
100%
16
Business Licenses
100%
Average Score
?/1600*100
Scoring
Scoring
Scoring
Loan officer
Senior LO
Ops manager
100%
100%
100%
100%
100%
100%
1. Comments by Loan Officer
____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
I recommend for approval/not recommended for approval (cross out one)
Name: _________________________________ Signature: ______________ Date: _____________
2. Comments by Senior Credit Officer
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
I recommend for approval/not recommend for approval (cross out one)
Name ____________________________signature____________________date__________________
3. Comments by Operations manager
__________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________
I Approved/not approved
Name: _______________________________ Signature: _______________ Date: ____________
4. Comments by Finance and Administration Manager ( for amount exceeding 3.0 m)
__________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Approved/not approved (for disbursement)
Name: _______________________________ Signature: _______________ Date: ____________
4. Comments by Chief Executive Officer
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Approved/not approved (for disbursement)
Name: _______________________________ Signature: _______________ Date: ____________
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