to download the SACCO Fund application form in pdf ... - FSD Kenya

1. DETAILS OF BIDDER
Name of SACCO
Address of Head Office
(physical and postal)
Areas of operation Back office services Front office services
List all locations `
Products offered
Nature of common bond
2. KEY FIGURES (financials for the last 3 years should be attached)
Number of members
Total assets
Total loans to members
Non-performing loans
Total shares
Total savings deposits
Total borrowing
Total capital
Gross income
Operating expenses
Net profit/loss
SACCO FUND
Application form
FY 2004 FY 2005 FY 2006
page 1 of 5

3. TECHNICAL SUPPORT REQUIREMENTS
Period for support
Accounting and control
systems
Financial management
Policies and procedures
Development of lending
practices
Improvements to governance
Personnel administration
SACCO FUND
page 2 of 5

Product development and
expansion
Strategic planning
Training
Auditing
Other
SACCO FUND
page 3 of 5

4. OUTLINE PROJECT BUDGET
Area of requirement
Total
SACCO FUND
Total estimated
cost
page 4 of 5
SACCO’s own
contribution
(min 25%)
Requirement from
SACCO Fund
(max (75%)

SACCO FUND
5. SOURCES OF FINANCE AND PARTICIPATION IN OTHER PROJECTS
Are you receiving finance or applying for finance from a bank or other source? YES / NO
If ‘ yes’ then please specify lending institution:
Is this finance is to be arranged under the Ministry of Finance/AFD Micro-finance
Sector Support Credit? (please indicate ‘no’ if you don’t know)
List any other support
projects or programmes in
which you are participating:
6. CONTACTS
Name
Position
Contact phone number
E-mail address
7. ATTACHMENTS
Project director Project manager
Financial statements for three most recent years (required –tick to confirm)
Current business plan/strategic plan (optional - where available – tick to confirm)
8. WARRANTY
I, the undersigned, duly authorised, hereby warrant that:
page 5 of 5
YES / NO
(i) all information supplied in this application and supporting
documents is accurate and complete at the date of
signature;
(ii) my SACCO is willing and able to meet the terms of the
SACCO Fund as set out in the ‘Terms and Application
guidance’ respect of this application;
Name:
Title:
Signed:
Date: