ICDC - Industrial & Commercial Development Corporation

LOAN APPLICATION FORM

Name of Applicant

Business Name

Date of Application

Applied Amount

Purpose

1.0 PERSONAL DETAILS (FOR SOLE PROPRIETOR ONLY)

Name(As per National ID Card)

Identity Card Number

Pin Number

Marital Status(tick only one)

Single Married Others

If married

Name of Spouse

Telephone Number

Occupation

Email Address

Mobile Telephone

Landline

Next of kin

Name

Relationship

Contact Address

Mobile Number

Present Physical Residential Area

Area

Road

Estate

House Number

Length of stay at present address

Previous Residential Address

NB: For Partnerships: Please attach a partnership deed.

Name	Contacts	Designation	Occupation	% of share holding	Value of shares	Age	Period of Bond

BUSINESS PARTICULARS

2.1 Business Mailing Address

Postal Address

Telephone Number

Fax Number

Email Address

Business Location(Attach sketch maps & latest electricity bill)

Town

Street

Building

Plot Number

Is the premises owner occupied / rented?

Are stocks/machinery/premises/insured?

	Yes	No	Insuring Company	Date of Expiry
Stocks
Machinery
Premises
Others (Please name)

Business Ownership (tick whichever is applicable) Partnership Sole Trader Date of Registration/ Incorporation Number of certifacates of Registration/ Incorporation Company PIN Number

OTHER SOURCES OF INCOME

E.g Rent	Frequency...Monthly	Ksh...20,000

MANAGEMENT OF THE BUSINESS(Attach copies of C.V’s or profiles of Directors)

SOLE PROPRIETORSHIP
Who manages the business
What experience has the manager got on this type of business

PARTNERSHIP (Attach details of the partners)

Name	Age	Address	Qualifications	Relevant Experience

LIMITED LIABILITY COMPANY (Give details of the management)

Name	Age	Address	Qualifications	Relevant Experience

PURPOSE OF LOAN

Give a brief description of the purpose for the loan & proposed budget

Purpose	Proposed Budget

BANKING DETAILS

CURRENT BANKING DETAILS (Attach Statements for the last twelve months)

Account Name	Account Number	Type of Account	Bank Name	Date Account Opened

BORROWING HISTORY

PREVIOUS BORROWINGS FROM ICDC

Loan Amount	Date of Borrowing	Repayment Period	Purpose	Remarks(Finished, Balance)

OTHER INSTITUTIONS

Bank	Loan Type(Business, Personal)	Loan Amount	Outstanding Loan Amount	Monthly Instalments

3.2.3 How much is owed to creditors Kshs (Attach schedule of a list of all creditors with aging periods)

3.2.4 How much is owed to you Kshs (Attach schedule of a list of all debtors with aging periods)

SECURITY DETAILS

LANDED SECURITY

NATURE (e.g. dwelling house, shop, factory, farm, land etc) State address if third party	FREE HOLD OR LEASE HOLD	IF LEASE HOLD-state terms and rent	IF OWNER OCCUPIED/LET OR UNLET	PRICE PAID ON ACQUISITION & DATE	MARKET VALUE			AMOUNTS & DATE OF CHARGE (If already held)
	FREE HOLD OR LEASE HOLD	IF LEASE HOLD-state terms and rent	IF OWNER OCCUPIED/LET OR UNLET	PRICE PAID ON ACQUISITION & DATE	Estimate	Value	Date of Valuation & Valuer	AMOUNTS & DATE OF CHARGE (If already held)

OTHER SECURITIES

Description (e.g shares, debentures, etc)	Price paid on acquisition & date	Estimated Market Value	Amount & date of charge(if already held)