PRE-HARVEST FINANCE (CUSTOMER)

PRE-HARVEST FINANCE (CUSTOMER)

LOAN ASSESSMENT FORM
Name of Farmer*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Nationality*
Kenyan ID Number*
KRA PIN Number
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Are you a new or existing customer ?

ExistingNew
What is your primary financial institution?
Provide DTB Bank account number
Select the nearest DTB branch ?
If other, please indicate your financial institution
Please type your financial institution
Please attach latest 6 month statement for your financial institution

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PRE-HARVEST FINANCE (CUSTOMER)

LOAN ASSESSMENT FORM
Farm Details
Farm Ownership Type*
Title/ LR No.*
Acreage*
Size of the farm
Type of Crop*
Copy of Title Deed/ Letter of Ownership from Area chief/ Lease Agreement of the Farmer’s parcel of land *

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Please selector an aggregator*
Input provider Name
Input Provider Bank Name
Input Provider Bank Account Number
Aggregator email address
example@example.com
Crop Details
Month/Year planted

DayMonthYear
Date
Expected harvest date.
Crop Age (Months)
Do not fill in. This section automatically calculates itself
County*
Today's Date

DayMonthYear
Date
Constituency*
Ward*
Village/Area*
Do you have a multi-peril crop insurance to guard against weather related losses, uncontrollable pests and diseases, fire and related perils? If yes, please attach.
If No, DTB will provide
Crop Insurance Policy

Crop Insurance (Credit protection)
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PRE-HARVEST FINANCE (CUSTOMER)

LOAN ASSESSMENT FORM
Loan Request Details
Do you have any outstanding loans?*

YesNo
If Yes, please indicate how much is outstanding
Requested Loan Amount*
Kenyan Shillings
Requested Tenor (months)
Bank interest rates are subject to change
Purpose of the Loan*
Loan Request Details (Filled by aggregator)
Loan Amount*
Kenyan Shillings
Loan Tenor (Months)*
Loan repayment terms
a)Over No of months* months by way of No. of installments*equal monthly instalments; or

b) Upon payment by the Aggregator on delivery of the Crop
Aggregator details
Estimated harvest month*
Estimated value of crop*
Crop condition*
Name of person reviewing
Designation
Aggregator signoff

ApproveReject
Approved Amount

PRE-HARVEST FINANCE (CUSTOMER)

LOAN ASSESSMENT FORM
Documents required
ID/passport Document*

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Two guarantor farmers (who supply the crop to/ are contracted by the Aggregator) and or one Society/ out-grower institution as a guarantor*

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Commitment letter from the Farmer’s Cooperative Society/ out-grower institution

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Farmer`s and guarantors’ copy of national identity card/ registration certificate, and Pin Certificate

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Kindly take a clear photo of your signature (on a white background) to confirm your application*

Please take a clear photo of the signature.
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Should be Empty:

Farm Details