Thanks

In: Computers and Technology

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THE PRESIDENCY

MINISTRY OF DEVOLUTION AND PLANNING UWEZO LOAN APPLICATION FORM
This form is to be completed in Triplicate, (Original to be sent to the Constituency Uwezo Fund Management Committee, a copy is to be retained by the group and a processed copy sent to the National Uwezo Oversight Board Secretariat)

1. GROUP DATA Group name: Date of Registration Bank

P.O. .. .Branch

.Box Code .Reg. No./Serial No Bank A/C..No

..Town .

.

.. ..

2. i) LOCATION OF THE GROUP County: .Constituency Ward ..Location: Sub-location Name of Chief/Asst. Chief: Tel: . I certify that I know the members of the group and that they are of good conduct to access public funds. Signature Official stamp .. (Mandatory) ii) LOCATION OF BUSINESS Township/Estate/Village Nearest Church/Mosque/Primary School to the business 3. MEMBERSHIP PROFILE Gender Male Female Total .Plot No./Street

. ..

No. of Members

Members with disability

4. BRIEF BACKGROUND OF THE GROUP (i) Purpose/Objective (e.g.) improve Economic well-being of members

..... ..................................................................................................................................................................................... (ii) Key activities

5. AMOUNT OF LOAN APPLIED FOR Loan Applied for Kshs NB (Refinancing is subject to repayment of the first loan)

This form is not for sale but can be copied, printed and photocopied Ahadi Yetu- Kazi kwako

6. a. b.

STATE THE TYPE OF PROPOSED BUSINESS. Is it start up or expansion? Does the group have or want to start a joint/common business? (Tick one) Yes .. If YES state Business type (Tick )

No ..

(i) Start up (New) . ii) Expansion c. If NO, state each individual business or project in the next section. 7. No

BUSINESSES INDIVIDUAL MEMBERS PROPOSE TO UNDERTAKE. Complete the table below. Name of owner Eg. Jane okumu ID No xxxxxxx Nature of Business Retail…...

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