SKYLINE SACCO SOCIETY LTD.P.O. Box 660-20103 ELDAMA-RAVINE.

IN THE MATTER OF OATH AND STATUTORY DECLARATION ACT (CAPS 15) LAWS OF KENYA

IN THE MATTER OF SKYLINE SACCO MICRO-CREDIT FINANCE PROGRAMME

AND

IN THE MATTER OF .................................................................................. SELF HELP GROUP

AND

IN THE MATTER OF: NAME ...................................................................................................

ID No.: ........................................................................

I ...................................................................... of P.O. Box ......................................... in the Republic of Kenya, make oath and state as follows:1. That I am the holder of ID/No. ........................................... and that I am the deponent herein.2. That I am an active member of .................................................. Self Help Group a registered Group under

Ministry of Social Services Certificate No. .........................................3. That I do hereby states that I have been and I will always abide to the Rules, Laws and By-Laws and

Constitution governing my above mentioned self help group.4. That Skyline Sacco Ltd. finance program has upon and that the loan so extend my loan facility to me through

............................................... self help group and that the loan so extended shall be secured by other members group known.

5. That I do undertake to do all that which is under my power and ability to service that loan advance to me.6. That I have therefore agreed to provide the items shown in the attached lists as my security for the loan.7. That the loan security items belongs to me and I without fear of contradiction swear that no any other person

even my spouse can lay claims over the items I have provided as security.8. That in case I fail to service the loan and or any part there as agreed between Skyline Sacco Micro-Finance

Program the group and myself, I do state that I will forego and surrender for sale by way of Public Auction or by private treaty all my properties listed in the attached list of properties.

9. That if for any reason Skyline Sacco Ltd Micro-Finance Program does not receive that full amount of any one or more of the said installment on the due date for payment there, then the whole balance of the principle sum and unpaid balance of accrued interest shall immediately become due and shall be payable to Skyline Sacco Micro-Finance Program demand with fine of Kshs. 3,000.

10. That in case the value of assets pledged does not cover the amount due I will provide further securities.11. In case the items pledged are not traced for any reason whatsoever my Group and Skyline Sacco Ltd. Micro-

Finance will be free to auction any other movable business or personal assets to recover the total outstanding amount and other charges.

12. That pursuant to default I further state that on oath that I expressly give authority to my group ...................................................... self help group to attach, repossess my properties and sell them to recover the defaulted amount of the loan and interest which will be due.

13. That in case of my short fall on the process realized upon the sale of my properties listed herein attached do further state that my self help group and Skyline Sacco Ltd Micro-Finance Program shall be at liberty to take me to court to recover the difference and I do further state that I will not have any defense to such a suit so filed against me.

14. I further state that neither take my group or Skyline Sacco Ltd Micro-Finance Program to court if either or both ever repossess and sell my so listed properties due to default on my repayment of the loan advanced to me.

15. That all what is deposited herein is true to the best of my knowledge, belief and information

Sworn by the said ............................................................... Day of ....................................... 20 ...................

Before Me:

16. I ............................................................................. Commissioner for oaths do certify that the above named person(s) appeared before me on the date mentioned above, freely and voluntarily exercised this instrument after I clearly explained to him/her/them the content and application.

Signed: .................................. STAMP

Date: ......................................

MAGISTRATE SIGN .........................................

COMMISSIONER OF OATHS DEPONENT HEREIN

MICRO FINANCE LOAN APPLICATION FORM

CERTIFICATION AND LOAN GUARANTEE

We the undersigned member of ........................................................................ Group hereby certifies that the information

given by the applicant is true and in our assessment, this applicant is able to service the loan as indicated. We further

confirm that the applicant has complied with all the Group rules and regulations. In the event that the applicant fails to

meet the repayments and / or defaults in repaying the loan we jointly undertake to forfeit our current savings as stipulated in

the scheme in the regulation, until the loan is fully paid.

In the event of the group savings fails to recover the outstanding balances, we further authorize Skyline Sacco Society Ltd

to recover the defaulted balance and charge penalties using other means.

APPLICATION PARTICULARS

GROUP OFFICIAL APPROVAL

GROUP NAME : ..........................................................................................................................................

APPLICANT’S NAME : ..........................................................................................................................................

ID NUMBER : ..........................................................................................................................................

ACCOUNT NUMBER : ..........................................................................................................................................

PHONE NUMBER : ..........................................................................................................................................

DATE : ..........................................................................................................................................

I ................................................................................. hereby apply for a loan of Kshs. ....................................... in words

.......................................................................................................................... and further undertake to repay this loan in

............................................ monthly instalments with effect from .................................. of Kshs. ....................................

(Amount in words)................................................................................................................................................................

I the undersigned declare that the foregoing particulars are true to the best of my knowledge believe and agree to abide

by the By-Laws of the Society and the loans policy.

Applicant Signature : ........................................................................................................................

Date : .........................................................................................................................

Chief guarantors Name : .........................................................................................................................

ID Number : .........................................................................................................................

Phone Number : .........................................................................................................................

DESIGNATION NAME SIGNATURE DATE

CHAIRPERSON .................................................. .............................. ................................

SECRETARY .................................................. .............................. ................................

TREASURER .................................................. .............................. ................................

Approval No. ............................

S/No. NAME ID No. ACCOUNTNUMBERS

SIGNATURE PHONE No. RESIDENCE

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20.

TOTAL

S/No. ITEM PLEDGED MAKE SERIAL NUMBER YEARPURCHASED

CURRENT VALUEPRICE

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GROUP GUARANTORS

GROUP OFFICIAL LETTER CERTIFICATION OF ASSESSMENT PLEDGES ITEMSWe the undersigned group official of ....................................................................................... certifies that the assessment carried out below can repay the loan with property attached.

We also stat that the information provided above is true and further state that if one or more of the pledge item(s) are not traced, we shall be liable to repay the value of the said items or either the group and their agent to sue us in court.

SIGNATORIES NAME SIGNATURE DATE

1. CHAIRPERSON ........................................ ................................ ..........................

2. SECRETARY ........................................ ................................ ..........................

3. TREASURER ........................................ ................................ ..........................

...................................................................................................... SELF HELP GROUPI hereby wish to declare that incase of any arrears default, I authorize the members of ...................................................... ................................................................. Self Help Group to auction the items listed above to recover any owned by me.

NAME : .............................................................................................................iID NO. : .............................................................................................................DISTRICT : ............................................................................................................. DIVISION : .............................................................................................................LOCATION : .............................................................................................................NAME OF CHIEF : ...................................................... Signature ...................................... STAMPASSISTANT CHIEF : ...................................................... VILLAGE : .............................................................................................................POSTAL ADDRESS : .............................................................................................................

GROUP ASSESSMENT

CONFIDENTIAL

DETAILS OF APPLICANTS

Signature ......................................

AUTHORIZATION OF ITEMS TO BE ATTACHED IN CASE OF ARREARS / DEFAULT

Incase of items pledge are not traced for any reason whatsoever, I authorize the group to auction any other movable, business or personal assets to recover the loan(s).

Applicant’s Signature: .........................................................................................

Date: ....................................................................................................................

Name of Spouse / Guarantor: .............................................................................. ID No. ...................................................................

Signature: ............................................................................................................ Date: ......................................................................

(Responsibility applies to this loan and all subsequent loans revoked in writing to the group)

DESIGNATION NAME SIGNATURE DATE

CHAIRMAN ....................................................................... ..................................... ....................................

TREASURER ....................................................................... ..................................... ....................................

SECRETARY ....................................................................... ..................................... ....................................

GROUP NAME : ..................................................................................................................................

MEMBERS NUMBER : ..................................................................................................................................

NAME : ..................................................................................................................................

YEAR OF BIRTH : ..................................................................................................................................

MARITAL STATUS : ..................................................................................................................................

POSTAL ADDRESS : ..................................................................................................................................

PHONE NUMBER : ..................................................................................................................................

RESIDENCE (GIVE DETAILS) : ..................................................................................................................................

NEXT OF KIN : ..................................................................................................................................

RELATIONSHIP : ..................................................................................................................................

Nature of Business ............................................................................ year started ............................ Business Location (give details) ................................................................................................................................................................................................................

Business Ownership (Tick where appropriate) 1. Self 2. Family 3. Partnership

Does your Business require this loan Yes No

Is your Business premises rented? Yes No

Average daily sales Kshs. ......................................................... x 30 days .......................................

Average monthly business expense Kshs. ........................................................................................

Other source of income (specify) .....................................................................................................

Amount of loan applied for Kshs. ....................................................................................................

Reasons for the Loan applied .................................................................................................................................................................

Recommendation by the Officer ........................................................................................................................................

Name of Officer ....................................................................................... Date .................................................................

Total shares ............................................... x(..........) Kshs ............................... Maximum eligibility .................................... Amount applied for ...............................................................

DESIGNATION NAMES SIGN AMOUNT RECOMMENDED DATEAppraisal Officer : ........................................................ ....................... .............................................. .......................Program Officer : ........................................................ ....................... .............................................. .......................C. E. O : ........................................................ ....................... .............................................. .......................

BUSINESS ASSESSMENT SECTION CLIENT PARTICULARS

APPRAISAL

APPROVAL

FOR OFFICIAL USE ONLY

S/No. ITEM PLEDGED MAKE SERIAL NUMBER YEARPURCHASED

CURRENT VALUEPRICE

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