PHOTOGRAPH

STRIDE DEVELOPMENT CO-OPERATIVE
SAVINGS AND CREDIT SOCIETY LTD
REG.NO.10553/RCS
																																	                                               
Photograph 
BRANCH: ______________________     DATE: ___________________

            PRODUCT	:          BUSINESS LOAN APPLICATION FORM                          CYCLE NO.: ___________
	            (Tick as appropriate)	
  Personal Information:	                           NO OF SHARES: ___________REQUIRED: ___________
Name: _____________________________ Address: ________________________ ID No. _____________
Account No. _______________________ REFERENCE No. ____________ Mobile No. _______________
Date of Birth: ____________________ Gender/Sex: _________________ Home Location: ____________
Village/Estate/Town: _______________________ Nearest Landmark: ____________________________
Next of Kin: _____________________________ Relationship: _______________ Tel ________________
Marital status: __________________ No. of Dependants: ________________ Ages: ___ ___ ___ ___ ___
Work place Information:        Work Place: ____________________________________________
           Location of work place: ______________________ Nearest Landmark: __________________ Employment No: ___________
           Occupation: ________________________ Employment type/ sector: ___________________ Years employed: ____________ 
           Loan Amount Requested: _______________Period ________ Purpose of the Loan: __________________________                    

          How much can you easily pay per week/ month (tick appropriate?)                                                                                                      

          Are you able to pay the Loan on Weekly / monthly Basis? (Tick as appropriate) Wkly       Mthly     Specify _____________________
LOAN SECCURITY:                                                                                                                                                                        
 LOCATION:                                                                                           OMV:                                             FSV:                          
          Business Activity: (For business loan only)
1.	 Income on sales/ sales receipts
Day	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday 	Sunday	
Sales								
Weekly total sales		Total monthly sales 
(ie Weekly*4)		
2.	 Receivable (only regular)                Shs.                                                                                   

3.	        Other sources of Income:
Source 	
Monthly Average Income (UGX)	

Husband/Wife’s income/Salary	

Farm/Secondary business	

Other 	

TOTAL	

4.	TOTAL MONTHLY INCOME (sales + receivables + other incomes)
Shs.                                                                                             

5.	Business Expenses:( all loans)

How often do you purchase your stock?                                                                   Per week/months

What amount do you purchase? Minimum Shs                                            Maximum Shs                                         

Average Purchases (Costs Of Sales) …………………………………………………….  Shs                                         
Operational expenses/ cost per month: 
Expense	
Monthly Average Expense (UGX)	

Total salaries	

Total wages	

Rent/Market charges	

Electricity 	

Water	

Other loan repayments	

Medical costs	

Food costs (family)	

Total Costs	

6.	TOTAL MONTHLY EXP. (cost of sale+total costs)                                                                              

7.	LIABILITIES AND Equity

a)	 Supplier Credit.
Name of supplier	
Frequency of supply	
Date of repayment	
Amount in Shs.	

	

	

	

	

b)	 Credit history.
Name of institution	
Amount Granted 	
Loan period	
Installment 	
Outstanding Balance 	

	

	

	

	

	

	

8.	BALANCE SHEET AND CASH FLOW SUMMARY

a)	                                                        Balance Sheet 
Particulars                                     Shs.                     Particulars                                    Shs.
Assets                                                                        Liabilities
Current Assets:                                                        Current liabilities:
Cash at hand                                                             Stride outstanding loan                                                
Account balance(strd)                                              Other Loans                                                                   
Cash at bank (others)                                              Supplier Credit                                                               
Stock                                                                           Other current liabilities                                                 
Receivables                                                              
Total current assets                                                   Total current liabilities                                                 

Fixed assets                                                                Long term Liabilities
Furniture & fittings                                                      Long term loan/debts                                                 
Equipment & Machinery                                         
Motor vehicle                                                           
Land and Buildings                                                 
Other fixed assets                                                   
Total fixed assets                                                        Total Liabilities                                                           
                                                                                       Total Net worth                                                          
Total assets                                                                  Total liabilities                                                            

Officer’s recommendations and brief business description:            Amount………………………Period……….…Previous Installment…………………..Current Installment …………………

……………………………………………………………………………………………………………………..……………………

…………………………………………………………………………………………………………………………………………
 
……………………………………………………………………………………………………………………………………………

Initials ……………………………………………………….. sign ……………………………………………..………………

A)	Comments by the Committee Officials:
Amount approved ………………………. Loan product ………………………………………….. Period ……………………..

	

B)	Comments by the Board Committee :( Above 4m )
Amount approved ………………………. Loan product ………………………………………….. Period ……………………..

	

C)	Guarantor’s Names and Signatures:

    I/ We fully understand our loan repayment responsibilities and STRIDE’s loan repayment rules and regulations.

I/ We the undersigned under take/guarantee the payment of the loan facility advanced to…………. …………………………………………………………… together with interest and penal interest in case of default /inability by the borrower to repay. 

  I/we authorize the recovery of monies in default from my/ our savings account with or without notice.

Guarantor’s Names	
Signature	
Date	
a/c no.	
Telephone	

1.		

	

2.		

	

3.		

	

	

Member’s/ client’s name ……………………………………………………………….. Signature ……………………………

                                                        Loan Request Decision:
Committee approval and Conditions
Management committee members
Date:	
Board Committee members
Date:	

Name                                                    Signature	
Name                                                    Signature	

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