Loan Application Form

DEFENCE SAVINGS & CREDIT COOPERATIVE SOCIETY
ULINZI HOUSE, LENANA ROAD.

P.O. BOX 40668-00100, REVISED
NAIROBI, KENYA
TEL: 0793281989
EMAIL: contactus@defencesacco.com
PAYBILL: 907116
LOAN APPLICATION FORM Customer Care Stamp
INSTRUCTIONS
1. Loan application form to be printed back to back.
2. Complete the form in block letters.
3. Attach the required documents (Copies of current pay slips, service ID and copies of the guarantors’ service ID.
4. Once the form is duly filled and signed, send to CAD/SAD offices for further action.
1. APPLICANTS’ PERSONAL INFORMATION
FULL NAME: M/NO: SVC/NO:

NATIONAL ID NO: FORMATION/UNIT: MOBILE NO:
EMAIL:
2. LOAN DETAILS (PLEASE TICK AS APPROPRIATE)
NEW LOAN TOP-UP LOAN
LOAN TYPES
Karibu Loan (12 months) Emergency Loan (12 months) Sharia Emergency (12 months)
Elimu Loan (12 months) Fosa Unsecured (36 months) Sharia Loan (36 months)
Personal Loan (36 months) Development Loan (48 months) Premier Loan (72 months)
Current Deposits in Figures: Deposit Purchase Amount In Figures:
Loan Amount Applied For In Figures:
Loan Amount Applied For In Words:
PURPOSE OF THE LOAN: Manufacturing and Servicing Industries Consumption and Social Services
Education Agriculture Land & Housing Asset Financing Human Health
Others (Specify):
3. REPAYMENT DETAILS
Mode of Loan Repayment: Check off Standing order

NB: Salary must be channeled through Desacco FOSA for standing order
Repayment Period (Years): Months:
4. PAYMENT MODE (PLEASE TICK AS APPROPRIATE)

(i) To DESACCO Fosa current account
(ii) IFT/EFT: Same day from co-op to co-op and two working days to other banks (charges 72/=)
(iii) RTGS: Same day from co-op to other banks (charges 600/=)
NB: If you choose (ii) or (iii) indicate bank details below
NAME OF BANK: BRANCH:
ACCOUNT NAME: ACCOUNT NUMBER:

5. DECLARATION
I hereby authorize Defence Sacco Limited to confirm my credit information in other financial institutions and also any registered
Credit Reference bureau (CRB) before processing this loan and also during repayment. I therefore, consent to my name,
transaction and defaultdetails to be forwarded to CRB for listing in the event my account goes into default. I acknowledge that
this information may be used by banking institutions and other guarantors in assessing application for credit by me, associated
companies, and supplementary account holders and for occasional debt tracing and fraud prevention purposes. I also
authorize Defence Sacco Ltd to use any registered debt collector to recover any outstanding liability owed. I hereby declare
that the foregoing particulars are true to the best of my knowledge and belief. I agree to abide by the laws of the Society, the
loan policy provision and any other variation by the Board of the Society in totality. I will inform the Society whenever I am
transferred from my current work station. I willingly grant consent to DESACCO to verify, use, share and/or disclose the
information given in accordance with the Society’s By-laws and the Laws of Kenya. I authorize the necessary deductions,
including interest on the loan, to be made from my salary or account as repayment for this loan.
NAME: SVC NO: SIGNATURE: DATE: / /

6. REPAYMENT GUARANTEE
(GUARANTORS ARE REQUIRED TO CAREFULLY READ THROUGH THIS LOAN APPLICATION FORM AND UNDERSTAND THE
LIABILITY BEFORE SIGNING)
We, the undersigned, hereby accept jointly and severally, the liability for repayment of this loan of kshs
in the event of the borrower’s default. We understand the amount in default may be recovered from our salaries, offset
against our deposits within DESACCO
NAME Service No MOBILE NO Guaranteed Amount (in Figures) SIGNATURE
7. EMPLOYER’S (UNIT) RECOMMENDATION

I hereby confirm that the attached are true copies of the applicant’s:
i. National/Military ID card
ii. Payslips (Current)
iii. Guarantors National /Military ID card
Name: Rank: Designation:
Signature and Official Stamp: Date:
8. CAD/SAD
Name: Rank: Designation:

Signature and Official Stamp: Date:
FOR OFFICIAL USE ONLY
9. LOAN PROCESSING
Verified By: Rank Name: Date: / /20 Signature:
Captured By: Rank Name: Date: / /20 Signature:

Approved By: Rank Name: Date: / /20 Signature:
Disbursed By: Rank Name: Date: / /20 Signature: :
Audited By: Rank Name: Date: / /20 Signature:

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DEFENCE SAVINGS & CREDIT COOPERATIVE SOCIETY

ULINZI HOUSE, LENANA ROAD.

LOAN APPLICATION FORM Customer Care Stamp

FULL NAME: M/NO: SVC/NO:

2. LOAN DETAILS (PLEASE TICK AS APPROPRIATE)

NEW LOAN TOP-UP LOAN

Mode of Loan Repayment: Check off Standing order

4. PAYMENT MODE (PLEASE TICK AS APPROPRIATE)

ACCOUNT NAME: ACCOUNT NUMBER:

NAME: SVC NO: SIGNATURE: DATE: / /

7. EMPLOYER’S (UNIT) RECOMMENDATION

Name: Rank: Designation:

Verified By: Rank Name: Date: / /20 Signature:

Captured By: Rank Name: Date: / /20 Signature:

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