POST-HARVEST FINANCE(CUSTOMER)

POST-HARVEST FINANCE(CUSTOMER)

LOAN ASSESSMENT FORM
Name of Farmer*

First NameMiddle NameLast Name
Date of Birth*

DayMonthYear
Date
Nationality*
Kenyan ID Number*
Please input the national ID number
KRA PIN Number
Input your KRA PIN
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?*
Commercial banks/SACCO/ MFI
Provide DTB account number.*
Type in your bank A/c No.
Select the nearest DTB branch?*
If other, please indicate your financial institution.*
Please type in the financial institution
Please upload the latest 6-month statements for your primary institution

Bank/SACCO/MFI/MPESA statements
Cancelof

POST-HARVEST FINANCE(CUSTOMER)

LOAN ASSESSMENT FORM
Farm Details
Farm Ownership Type*
Title/ LR No.*
Acreage*
Type of crop*
Upload copy of title deed/ Lease agreement

Cancelof
Please select an aggregator*
Aggregator Email Address*
example@example.com
Crop Details
Month/Year Planted

DayMonthYear
if unsure please input date as 01 and secelct month
Crop age in months
todays date*

DayMonthYear
Date
County*
Constituency
Ward
Village/Area
Aggregator details
Estimated Tons of harvest (in kgs)*
Date of delivery*

DayMonthYear
Amount due*
Existing Debt*
Net Amount Payable*
Name of person reviewing
Designation
Payment Settlement Date*

DayMonthYear
Date
Aggregator signoff

ApproveReject

POST-HARVEST FINANCE(CUSTOMER)

LOAN ASSESSMENT FORM
Loan Request Details( Filled by customer)
Do you have any outstanding loans?*

YesNo
If Yes, please indicate how much is outstanding
Requested Loan Amount*
Kenyan Shillings
Requested Tenor (Months)
Purpose of the loan*
Disbursement Details
Approved amount*
Customer documents required
ID/passport Document*

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

Cancelof
Should be Empty:

Farm Details