SHORT TERM LOAN APPLICATION

					                SHORT LOAN APPLICATION FORM
PART 1:- MEMBER’S DETAILS:

NAME……………………………………………………………………                          SURNAME……………..……………………

RESIDENTIAL ADDRESS…………………………………………………                   POSTAL:………………………………………………..

CONTACT TELEPHONE No………………………… FIXED MOBILE:…………………………….                       CELL: ……………………..

ID NUMBER :……………………………………                             DATE OF BIRTH :………………………..

MEMBERSHIP No…………………………                              EMPLOYMENT No……………………………….

STATION………………………………                                  SECTION……………………….

PART II:- LOAN AND PURPOSE:
LOAN AMOUNT REQUESTED E…………………………..

REPAYMENT PERIOD IN MONTHS ………………..(MAXIMUM 3 MONTHS AT 10% P/M COMPOUNDED INTEREST)


PART III:- MEMBER’S BANK DETAILS:

NAME OF BANK………………………………………………….. BRANCH ………….……………………….

A/C N0…………………………………………………………….                       BANK CODE………………….

PART IV: - CHECK OFF SYSTEM DECLARARTION:

I DECLARE THAT ASUM OF E……………………….… SHALL BE DEDUCTED EVERY MONTH FROM MY SALARY BY MY
EMPLOYER AS A MEANS OF REPAYMENT OF THE ABOVE LOAN UNTILL IT IS PAID IN FULL. I HEREBY ATTACH MY
SALARY ADVICE SLIP FOR PURPOSES OF CREDIT ASSESMENT.

APLLICANT’S SIGNATURE:……………………………………                             DATE:………………………..

PART V:- OFFICE USE:
LIKUSASA SAVINGS BALANCE: E………………………..              SHORT TERM LOAN BALANCE: E…………………..

COMMENT:………………………………………………………………………………………… SIGNED: ……………………..

PART VI:- LOAN APPROVAL :

AT THE MEETING OF THE CREDIT COMMITTEE HELD ON THIS DATE OF ………………………………………, IT WAS
RESOLVED THAT THIS APPLICATION BE:

APPROVED/DEFFERED/REJECTED:…………………………………………

Comments…………………………………………..…………………………………………………

CHAIRPERSON………………………………………….                     DATE:…………….………..................


SECRETARY:……………………………………..……                     DATE …………….……………………

PART VII:- PAID BY TREASURER :………………………………               DATE:………………………………



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posted:4/18/2011
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