YOUTH EMPOWERMENT FUND

LOAN APPLICATION FORM

SECTION ONE: BORROWERS DETAILS

Name of Borrower Account Number Company Reg. Number or I.D. Number Date of birth of key director/ Owner Academic /Professional qualification of key director/ Owner Business Address Postal Address Telephone Number(s) work Cell Gender Marital Status Name of spouse & Address (if married) Period at current Residence (Years) Project/business Location i) Province, ii) District/Growth point, iii) Village DETAILS OF GROUP MEMBERS OR COMPANY DIRECTORS

Name

ID No.

Physical Address

Date

Signature

SECTION TWO: LOAN REQUEST INFORMATION Purpose of Loan Working capital Capital Expenditure Total Amount Amount Required ($)

SECTION THREE: PROPOSED USE OF FUNDS Expenditure details: Expenditure Item Value

Total $ Please attach a separate schedule should more space be required SECTION FOUR: BUSINESS INFORMATION Type of business Ownership of business (owner operated, family, partnership, company etc) Business Sector (e.g. manufacturing) Business Sub sector (e.g. food processing) Project (e.g. bakery) Specify main products/services Number of Years in current business Initial capital Source of capital Number of employees Full time Part time Non paid (family members) Who are your main customers (please tick)

i) Individuals ii) Other businesses iii) Other (specify) 2

SECTION FIVE: BORROWERS PAST PERFORMANCE RECORD Trading performance: 2008 Total revenue / income Cost of sales Gross margin Operating expenses Taxation Profit after tax Total current assets Total current liabilities Net current assets / liabilities Total assets Total liabilities Net worth of business Number of employees Actual 2009 to date Projections 2010

SECTION SIX: CURRENT BORROWINGS (Including Hire Purchase)

Bank/Company Loan amount ($) Purpose Last repayment date

Please attach a separate schedule should more space be required

SECTION SEVEN: CLIENT SCHEDULE OF BUSINESS AND FAMILY ASSESTS PLEDGED

Business Assets Item Make Serial Number Year of purchase Estimated Market value

1 2 3 4 5 6
Family/Household Assets

1 2 3 4 5 6 7 Total Value of Assets

Please attach a separate schedule should more space be required

SECTION EIGHT: CHARACTER REFEREES

Name Physical address Postal address Contact numbers (including cellphones)

SECTION NINE: BANKING DETAILS Bank Name Type of account Account Number

Expected benefits from accessing the loan

Current Capacity utilization Income Generation Employment creation DECLARATION BY THE BORROWERS By signing below, we the borrowers / representative parties of the borrower certify the above information is true and correct and that funds will not be used to finance non eligible expenditure. We also confirm our commitment to the viability of this project and that we will not declare or pay any dividends during the tenure of this facility. We have not defaulted on any previous concessional facilities extended by the Reserve Bank and any other finance scheme. Should any of the above information be found to be incorrect, we accept that the whole loan become immediately due and payable to CBZ Bank Limited at the penalty interest rate equivalent to the prevailing 91 day TB Rate for the period the loan was outstanding Full Names Authorized Signatory Authorized Signatory Authorized Signatory RECOMMENDATIONS FROM SUBMITTING OFFICE ( Ministry of Youth Official) Comments. .. Signature . Date . Designation 5 Signature Date 3 months 6 months 12 months 24 months

(For office use only) RECOMMENDATIONS FROM SUBMITTING OFFICE ( CBZ Bank Limited Branch) Amount Grace period Facility tenure Proposed securities if any

Signature . Date.

APPROVING AUTHORITY Decision: Approved / Declined Date.

Comments. Signature . Date . FACILITY SUPPORTING DOCUMENTATION SUBMITTED Customer letter of application for proposed facilities & repayment arrangements signed in terms of customer mandates. Customer cash flow projections covering period of borrowings Pro - forma invoices for assets to be bought where capital expenditure is applied for. Proposed security documents where these are available or duly completed asset pledge form. Project proposal Passport size photo CR14 or CR6 Ministrys Checklist form Ministrys recommendation form Ministrys site visit report