SPECIAL

APPLICATION FORM FOR THE CONSTITUENCY YOUTH ENTERPRISE

SCHEME(C-YES) SPECIAL LOAN
SECTION I : Backgroundinformation
1.

Application Date:.

Group Data
Constituency

Group Name
Reg. No.
Date/Year
Registration

District
of

Location

(Attach copy of registration certificate),

2. Banking information
Bank Name:
Branch:
Account No.

Account Signatories(Name & Signature)

1. .
2. .
3.
4.
Bank: We confirm that the above banking information is correct.
Signature..Stamp.

3. Membership profile
Gender
18-35
year(Number)
Male
Female
Total

Below 18

Above 35

Members
Disabilities

with

Total Number

Attach a list of group members clearly indicating their names as they appear on their National ID, ID numbers, Date of birth, leadership position in the group
and signature ./;of each member.(The list must be confirmed by the local Social Dvpt Assistant, DSDO or Secretary of the Locational Social Dvpt
Committee)

4.

Group background:
(a) Year of formation
(b) Vision:
..
.
(c) Activities undertaken

.
(d) Achievements to date:

.............................................................
.....................................................................................................................................................................................

*Group minutes & other requirements

C-YES Special Loan Application Form 1009: Not For Sale but can be reproduced

Page 1

SECTION II: Loan Proposal

1.

Loan Particulars

i.

Loan Amount Requested(Ksh)

ii. Main product(s)/service(s)

iii. Main Customers/ target market

iv. Proposed business site(attach map)

2.

Reasons for selecting the proposed business(Comment on suitability, competition and management ability)

...
..
.
3.

(a) Business cycle

Product

Normal Maturity
period
(Months)

Normal
period
taken to sell product
and obtain payment.

Expected yield

Price per unit

Total Proceeds
Expected
(Ksh.)

i.
ii.
iii.
Total
b. After how long will the first (1st) sale be made?....................................................................................................................
c. How often will the subsequent sales be made?......................................................................................................................
4.

Budget (investment).

Item
i.
ii.
iii.
iv.
v.
vi.

Source

Cost

Total

Total
NB. Attach a copy of contract or order document (current or past)
C-YES Special Loan Application Form 1009: Not For Sale but can be reproduced

Page 2

5.

(a) Projected income flow from business

Product
i.

Sales(from 3 above)

Total Cost

Approx. Profit

ii.
iii.
Total
NB. Separate sheet may be attached.
b.

Other proposed sources of funds (if any) -please tick.

a)

Group savings

b) Members contributions

c) loan

d) Others

Ksh
Explain (d) or combination of any
.
.
6.

Management: Who will manage the business?

7.

Marketing: How do/will you market your products?

8.

Proposed growth plans: Business and group.

Part C
a) Additional income sources if any:Ksh..
b) Changes expected in the business from loan injection:.

c)

Plan for loan repayment (briefly explain how you expect to service the loan to completion).

C-YES Special Loan Application Form 1009: Not For Sale but can be reproduced

Page 3

SECTION III
A. LOAN AGREEMENT
This Agreement is entered into between Youth Enterprise Development Fund Board (YEDFB) of P.O BOX 48610-00100
Nairobi hereby called the Lender, and(youth group).of
P.O Box .hereby referred to as the Borrower.
Amount
At express request of the Borrower/s, the Lender agrees to advance to the borrower a maximum Kenya
Shilling.. (Kshs...)
Purpose:
The
proposed
facility
will
be
used
for
Terms and conditions: The loan will be repaid in..installment(s) of Kshs..after a
. months grace period until the loan is repaid in full.
Management fees: The Borrower hereby acknowledges and agrees that the loan will be subject to a management fee at a rate
of 5%. The management fee is payable upfront prior the release of the approved loan. It is hereby clarified that the said
management fee will be deducted from the loan approved.
Law: The Kenyan law will be applicable.

B. GUARANTEE
We
the
undersigned
below
hereby
confirm
that
we
are
bona
fide
office
bearers
of
. Group and declare that the information given herein is true to the
best of our knowledge. We further affirm that we have read and fully understood the content of this loan agreement. We
understand that the amount given here is a loan and must be repaid on due date. We hereby guarantee and commit the group to
redeem the loan to the satisfaction of YEDFB.
(a) Chairman..ID/No..Signature.Date.Contact.
(b) Secretary. ID/No..Signature.Date..Contact.
(c) Treasurer. ID/No..Signature.Date..Contact
Witnessed by;
Group Patron/Referee(Name)Community Leadership position
SignatureDate...Contact..
(The patron/referee should be an elder, elected leaders, administrators, religious leaders or reputable mentors)
C. LOCAL CHIEF ENDORSEMENT
I, the undersigned confirm that the applicant and the group mentioned above are known to me and that they operate within the
area covered by my location.
Chiefs Name.. Signature/StampDate..Contact.....

C-YES Special Loan Application Form 1009: Not For Sale but can be reproduced

Page 4

SECTION IV
OFFICIAL USE ONLY
A. Recommendation from Constituency Officer,
Reasons for recommending approval/decline (cite strength & weaknesses).
............................................
.

COs Name..Signature...DateStamp.
A. REGIONAL VETTING COMMITTEE.
Result of Evaluation: Recommended
Recommendation/Conditionalities

Declined

.
..
Member

Designation

Signature

1. _____________________________

_____________________________

_______________

2. _____________________________

_____________________________

_______________

3. _____________________________

_____________________________

_______________

4. _____________________________

_____________________________

_______________

5. _____________________________

_____________________________

_______________

B. YEDF HEAD OFFICE APRAISING OFFICER

Result of Evaluation/Comments:
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_________________________________________________________________________________________________
Officer NameSignature..Date.

C. LENDING & INVESTMENT MANAGER:

COMMENTS
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
____________________________________________________________________________________________________
Name.Signature.Date

C-YES Special Loan Application Form 1009: Not For Sale but can be reproduced

Page 5

GROUP MEMBERSHIP LIST

No

NAME

YEAR

OF ID. NO

TEL. NO.

BIRTH

DESIGNATION

SIGN

(position held)

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

a) List MUST be certified as a confirmation of the genuine membership

b) If more than 20, attach a separate sheet

C-YES Special Loan Application Form 1009: Not For Sale but can be reproduced

Page 6