ANNEX 3

YOUTH ENTERPRISE DEVELOPMENT FUND BOARD

VIJANA BAHARIA LOAN APPLICATION FORM

REGION COUNTY CONSTITUENCY

Loan Amount: Repayment period in months Monthly instalment

amount
Expected Monthly Gross
Income
DESCRIBE PURPOSE OF THE LOAN

PERSONAL DETAILS FOR APPLICANT

GENDER

______________________ ________________________ ___________________ M F

Surname First Name Middle Name

P.O. Box……………CODE ………….. TOWN: ……………Phone No: …….……….…

Applicant’s E-mail:
ID/PP Number: Occupation: MARITAL STATUS
Married Single Other
PIN: Highest Level of Education:

Birth Date: Number of Dependents:

SPOUSE DETAILS

__________________ _____________________ ________________ ________________

Surname First Name Middle Name ID/PP Number:

P.O. Box……………..… CODE ……………….. TOWN: ……………….Phone No: ……………….

NEXT OF KIN DETAILS

___________________ _____________________ ________________ ________________

Surname First Name Middle Name ID/PP Number:

P.O. Box……………..… CODE ……………….. TOWN: ……………….Phone No: ……………….

Relationship To The Borrower ……………………………………….

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 BUDGET

ITEM AMOUNT
1. Medical Fees
2. Bandari Maritime Academy
3. Vaccine
4. Visa application Fees
5. Miscellaneous
TOTAL

BANK ACCOUNT DETAILS

Bank/Institution __________________ Branch Name_____________________ Account

No:__________________
CREDIT HISTORY
Have you ever applied for a loan before? Yes () No (). If yes, please provide details below:
Name of Lender Date Applied Amount of Duration of Monthly Amount outstanding
Loan Loan Instalment
___________ _____ ___ _____ _________________
___________ ___________ ______ ___________ ___
_________________ _____ ______ _____ ___
_________________ ___________ ____________ ___________ ___
______

(PLEASE PROVIDE A CERTIFIED BANK STATEMENT)

CREDIT REFERENCE AND CONSENT TO SHARE DATA WITH CREDIT REFERENCE

BUREAU
In connection with this application and/or maintaining a credit facility with the Youth Enterprise
Development Fund, I authorize the Youth Enterprise Development Fund to carry out credit checks
with or obtain my credit information from, a credit reference bureau. In the event of the account going
into default, I consent to my name(s), transaction and default details being forwarded to a credit
reference bureau for listing. I acknowledge that this information may be used by banking institutions
and other credit grantors in assessing applications for credit by me, associated companies, and
supplementary account holders and for occasional debt tracing and fraud prevention purposes.
a) I agree that the Youth Enterprise Development Fund may disclose details relating to my loan
account to any third party including credit reference bureaus, if in the Lender’s opinion such disclosure
is necessary for the purposes of evaluating my creditworthiness or any transaction with or credit
application made to the Lender or such third party, maintaining my Account with the Lender or for any
other lawful purpose.
b) I agree that the Lender may disclose details relating to my loan account including details of my
default in
servicing financial obligations on my loan account to any third party including credit reference bureaus
for the purpose of evaluating my credit worthiness or for any other lawful purpose

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 c) I declare that all information provided as part of this application conforms to reality and assume full
responsibility for its accuracy.
d) By my signature, I hereby authorise collection of references, from any source whatsoever, concerning
my person, conduct and commercial credit.
e) I further authorise the issuance of reports regarding my credit history to Youth Enterprise
Development Fund Board and hereby absolve the reporting party of all responsibility.

TO BE SIGNED BY APPLICANT

Name ______________________________Signature_________________ Date__________________

Co-borrowers i.e. spouse

Name ______________________________Signature_________________ Date__________________

GUARANTOR FORM (PARENT/GUARDIAN)

GUARANTOR PERSONAL DETAILS

Guarantor Name: ___________________________________________

ID/PP No__________________________ Relationship to Applicant: _________________________

Postal Address: _________ Code:________ Town: _______________ Phone No: ________________

Next of Kin Name:______________________Relationship _______________ ID No______________

Draw/Attach Map to Residence and Business

Town/Estate:___________________ District_________________ Division:___________________

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 Location: ________________ Sub-Location: __________________ Village: ____________________

Employment: ___________________ Employers Name:_____________________________________

Business: _______________________ Business Name: _____________________________________

Physical Location of Employment/Business:______________________________________________

__________________________________________________________________________________

Signature of Guarantor __________________________Date: _______________________________

SEAFARERS UNION OF KENYA (SUK) GUARANTEE AND UNDERTAKING

We, SEAFARERS UNION OF KENYA (SUK) offer to guarantee this loan as per the terms and
conditions of the letter of offer. We undertake to disclose any information regarding the applicant which
may affect the performance of this loan. We also confirm that the applicant is a member of our union and
is duly registered.

Kindly confirm to the Youth Enterprise Development Fund by signing and stamping this letter that the
applicant has been fully vetted by the union and in case of default, the amounts owed to the applicant in
terms of benefits shall be used to offset any outstanding loan balance. Seafarers Union of Kenya (SUK)
also undertakes to assist the Youth Enterprise Development Fund Board in recovery efforts in case of
default.

Name of Officer: ___________________________________________

ID/PP No___________________ Designation: ___________________ PF NO ________________

Postal Address: _________ Code:________ Town: _________________Phone No: _______________

Street/Estate:___________________ Building______________________ Floor No:_______________

Signature ____________________ Date & Stamp: _____________

In the presence of
Practicing Advocate
/ Company Secretary } Name …………………………………......................
}
} Date…………………….......
}
} Signature and Stamp …………………………………..

YEDF/CRE/04/001G Form 001G: Vijana Baharia Loan Application Form

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 KENYA MARITIME AUTHORITY(KMA) GUARANTEE AND UNDERTAKING

We, KENYA MARITIME AUTHORITY (KMA) offer to guarantee this loan as per the terms and
conditions of the letter of offer. We undertake to disclose any information regarding the applicant which
may affect the performance of this loan to Youth Enterprise Development Fund Board

Kindly confirm to the Youth Enterprise Development Fund by signing and stamping this letter that the
applicant has been fully vetted by the Authority and has met all the requirements deemed necessary to
access this loan. Kenya Maritime Authority (KMA) also undertakes to assist the Youth Enterprise
Development Fund Board in recovery efforts in case of default.

Name of Officer: ___________________________________________

ID/PP No______________________ Designation: ____________________PF NO ________________

Postal Address: _________ Code:________ Town: _________________ Phone No:________________

Street/Estate:___________________ Building______________________ Floor No:________________

Signature ____________________ Date & Stamp: _____________

In the presence of
Practicing Advocate
/ Company Secretary } Name …………………………………………………
}
} Date…………......
}
} Signature and Stamp ……………………………………….

YEDF/CRE/04/001G Form 001G: Vijana Baharia Loan Application Form

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MAPS FOR DIRECTIONS

DRAW A MAP SHOWING DIRECTION TO RESIDENCE OF APPLICANT

APPLICANT SIGNATURE …………………………………… DATE: ………………………………

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 FOR OFFICIAL USE ONLY
COUNTY VETTING COMMITTEE DECISION: CREDIT VETTING COMMITTEE
DECISION:
Decision date and stamp: ………………………… Decision date and stamp: …………………

Recommended Pended Declined Approved Pended Declined

Remarks……………………………………………… Remarks………………………………………
……………………………..…………………………. ………………………………………………...

Name: ……….…………… Signature: ……………. Name: ……….………Signature: …………….

Date…………………. Date ……………

Name: ……….…………… Signature: ………….… Name: ……….………..Signature: ……...……

Date …………………. Date…………….

Name: ……….……………Signature: ………...…… Name: ……….…………Signature: …………

Date …………………. Date …………….

Name: ……….………...… Signature: …………..…. Name: ……….……… Signature: ……………

Date …………………. Date ……………….

LENDING AND INVESTMENT MANAGER

Approved Pended Declined

Remarks

Name …………………………………………Signature…………………… Date ………………….

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July 22, 2021 .

THE CHIEF EXECUTIVE OFFICER,

YOUTH ENTERPRISE DEVELOPMENWT FUND
P O BOX 48610 00100
NAIROBI.

Dear Sir/ Madam,

RE: BANK ACCOUNT DETAILS FOR THE APPLICANT

I advise you to use the below account details for any payment or settlement of funds. (Customer to open an
account with a Commercial Bank for purpose of disbursement of Loan)

Account Name
Account Number
Bank Name
Bank Code
Branch Name
Swift Code

Yours Faithfully,

Name ………………………………………………. Signature …………………. Date ……………….

Name ………………………………………………. Signature …………………. Date ……………….

Name ………………………………………………. Signature …………………. Date ……………….

July 22, 2021 .

THE CHIEF EXECUTIVE OFFICER,

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YOUTH ENTERPRISE DEVELOPMENWT FUND
P O BOX 48610-00100
NAIROBI.

Dear Sir/ Madam,

RE: BANK ACCOUNT DETAILS FOR MEDICAL SERVICES PROVIDER (TO BE FILLED BY
THE DOCTOR)

I advise you to use the below account details for any payment or settlement of funds. (Doctor to provide an
account for a Commercial Bank for purpose of disbursement of Medical Examination Fees)

Account Name
Account Number
Amount
Bank Name
Bank Code
Branch Name
Swift Code

Yours Faithfully,

Doctor’s Name …………………………………………Signature …………………. Date ……………….

TO BE FILLED BY LOAN APPLICANT

I ……………………………………………………..the undersigned request and authorize the YOUTH

ENTERPRISE DEVELOPMENT FUND BOARD to remit the stated amount being charges for medical
examination fees to the Doctor whose account details have been provided above.

Name ………………………………………………. Signature …………………. Date ……………….

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